Gene mutations in Wilson disease in Egyptian children: report on two novel mutations

Wilson disease [WD] is an autosomal recessive disorder, caused by defects in copper-transporting P-type adenosine triphosphatase [ATPase] encoded by the ATP7B gene, resulting in the deposition of copper in the liver and brain with significant disability or death if left untreated. An available regimen of treatment gives hope to those predisposed to the disease if diagnosed early. The objective of this study was to determine the frequency of the most common European mutation [p.H1069Q] in Egyptian children with WD, in addition to screening for previously reported mutations in the Egyptian patients in our selected group. Direct DNA sequencing was applied to exons [13, 14, 18, and 19] of the ATP7B gene for 19 patients previously diagnosed with WD. Then DNA sequencing and pedigree analysis were performed in the families of the patients showing variations in their results for the purpose of family screening and carrier detection. Six out of 19 patients were studied with their families [three families]. We identified five variants of which two were novel among the studied patients. One of the novel variants was synonymous substitution [p.A1074A] in 16% of patients and the other was predicted to be missense disease-causing mutations [p.T1076I] in 16% of patients, and three previously published mutations p.H1069Q were detected in 5% of patients, p.P1273Q in 10% of patients, and a silent variant p.A1003A in 26% of patients. Screening for the two exons 14 and 18 of the ATP7B gene is important in Egyptian patients especially in suspected patients without hepatic manifestations

In vitro comparison of the antimicrobial activity of five herbal extracts, and selected mouthwashes marketed in Egypt against cariogenic streptococcus mutans

Dental caries is a multifactorial human disease that has widely affected many populations all over the world. Streptococcus mutans plays a major role in dental caries development. Few of mouthwashes, however, have undergone rigorous testing and lack the quality of an ideal agent as evidenced by the limited amount of information on their safety and efficacy in the literature. Thus presently the antibacterial activity of herbal agents is being extensively studied. The present study aims to compare the antimicrobial effects of 70% aqueous ethanol extract obtained from traditional Egyptian plants with the most common Egyptian mouthwashes brands against S.mutans. S.mutans isolated on Mitis Salivarius Agar [MSA] and confirmed by API 20 Strep C. 70% aqueous ethanol extracts of Achillea fragrantissima Sch.Bip [No 5], Euphorbia hirta L. [No 2], Nymphaea alba L. [No 1], Thymus vulgaris L.[No 4] and Plectranthus amboinicus L [No 3] were prepared.The susceptibility pattern of 25 S. mutans bacterial isolates obtained from 82 dental plaque samples of patients having dental caries to the selected mouthwashes and plant extracts was determined using the agar well diffusion method. The zones of inhibition produced by the mouthwashes and herbal extracts against the bacterial isolates were measured compared with chlorhexidine positive control. Chlorhexidine formulations listermix and jase were the most effective mouthwash preparations, while chlorhexidine free formulation betadine was the least effective preparation against S.mutans. Extracts No 1 and 2 exhibited the highest antimicrobial effect, while extract No 4 showed the least one. Chlorhexidine formulations Jase and listermix are considered to be the most effective mouthwash anticaris. N. alba, E. hirta plant extracts have the greatest antibacterial activity against S.mutans. If similar results are confirmed in clinical trials, these plant extracts can be used alone or in combination to produce new, useful and economic antimicrobial mouthwashes alternative to commonly known mouthwashes with less side effects

association of metabolic syndrome, insulin resistance and non-alcoholic fatty liver disease in overweight/obese children

To study the prevalence of metabolic syndrome [MS], insulin resistance [IR] and non-alcoholic fatty liver disease [NAFLD] in overweight/obese children with clinical hepatomegaly and/or raised alanine aminotransferase [ALT]. Thirty-three overweight and obese children, aged 2-13 years, presenting with hepatomegaly and/or raised ALT, were studied for the prevalence of MS, IR and NAFLD. Laboratory analysis included fasting blood glucose, serum insulin, serum triglycerides [TG], total cholesterol, high-density lipoprotein cholesterol [HDL-c], low-density lipoprotein cholesterol [LDL-c] and liver biochemical profile, in addition to liver ultrasound and liver biopsy. Twenty patients [60.6%] were labeled with MS. IR was present in 16 [48.4%]. Fifteen [44%] patients had biopsy-proven NAFLD. Patients with MS were more likely to have NAFLD by biopsy [P=0.001]. Children with NAFLD had significantly higher body mass index, waist circumference, ALT, total cholesterol, LDL-c, TG, fasting insulin, and lower HDL-c compared to patients with normal liver histology [P<0.05] and fitted more with the criteria of MS [80% vs. 44%]. IR was significantly more common among NAFLD patients [73% vs. 28%]. There is a close association between obesity, MS, IR and NAFLD. Obese children with clinical or biochemical hepatic abnormalities are prone to suffer from MS, IR and NAFLD

Hypertrophic cardiomyopathy: prevalence, hypertrophy patterns, and their clinical and ECG findings in a hospital at Qatar

Hypertrophic cardiomyopathy [HCM] is a genetic disease associated with risk of morbidity and sudden cardiac death. The prevalence, hypertrophy patterns, mode of presentations, and different ECG findings vary in different regions of the world. To date, no data is present regarding these variables in Qatar. A retrospective, cross sectional, descriptive analysis of all patients referred for echocardiography study at Hamad General Hospital, Qatar. The study period was from January 2008 till December 2010. Aims: To study 1] the prevalence of HCM, 2] the different patterns of hypertrophy, and 3] the clinical and ECG presentations in this population. Out of the 29,286 cases evaluated, 38 patients were found to have HCM [0.13%]. Their clinical, ECG, and echocardiography findings were analyzed. Mean age was 47 y, 35 males [92%] and 3 females [8%]. Four patterns of hypertrophy were described; 17 [44.7%] had septal hypertrophy alone, 6 [15.8%] had septal and other segments hypertrophy but sparing the apex, 10 [26.3%] had apical segments along with any other segment hypertrophy, and 5 [13.2%] had apical hypertrophy alone. No obstruction was found in 19 [50%], left ventricular outflow [LVO] tract obstruction was found in 13 [34%], and mid cavity obstruction [MCO] in 6 [16%]. Twenty one [55.3%] patients were referred because of chest pain, 15 [39.5%] with palpitations, 15 [39.5%] with shortness of breath, and 5 [13.2%] with syncope. Nine patients [23.7%] were asymptomatic and were referred because of cardiac murmur during routine examination. ECG evidence of LV hypertrophy was found in 29 [76.3%]. The prevalence of HCM in our population group is 0.13% with a male predominance [12:1]. There was a diversity of clinical presentation, ECG abnormalities and patterns of LV hypertrophy among HCM patients

Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients

To compare two different supraglottic airway devices, the laryngeal mask airway [LMA] and the I-gel, regarding easiness of insertion of the device, leak pressure, gastric insufflation, end tidal CO[2], oxygen saturation, hemodynamic and postoperative complications in anesthetized, spontaneously ventilated adult patients performing different non-emergency surgical procedures. The study was carried out as a prospective, randomized, clinical trial among 80 patients who underwent different surgical procedures under general anesthesia with spontaneous ventilation in supine position. They were equally randomized into two groups: I-gel and LMA groups. Both the devices were compared with regard to heart rate, arterial BP, SPO[2], end-tidal CO[2], number and duration of insertion attempts, incidence of gastric insufflation, leak pressure and airway assessment after removal of the device. No statistically significant difference was reported between both the groups, regarding heart rate, arterial BP, SPO[2] and end-tidal CO[2]. The mean duration of insertion attempts was 15.6 +/- 4.9 seconds in the I-gel group, while it was 26.2 +/- 17.7 seconds in the LMA group. The difference between both the groups regarding duration of insertion attempts was statistically significant [P=0.0023*], while the number of insertion attempts was statistically insignificant between both the study groups [P>0.05]. Leak pressure was [25.6 +/- 4.9 vs. 21.2 +/- 7.7 cm H 2 O] significantly higher among studied patients of the I-gel group [P=0.016*] and the incidence of gastric insufflation was significantly more with LMA group 9 [22.5%] vs. I-gel group [5%] [P=0.016]. Both LMA and I-gel do not cause any significant alteration in the hemodynamic status of the patients, end tidal CO[2], and SPO[2]. The postoperative complications were not significantly different except nusea and vomiting was statistically significant higher in LMA group [P=0.032]. among both LMA and I-gel patients. Insertion of I-gel was significantly easier and more rapid than insertion of LMA. Leak pressure was significantly higher with I-gel than LMA and thus incidence of gastric insufflation was significantly lower with I-gel

Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery

Cisatracurium in clinical practice is devoid of histamine-induced cardiovascular effects. On the other hand, 2 ED[95] doses of cisatracurium [100 microg/kg] do not create satisfactory intubating conditions such as those seen with equipotent doses of atracurium. The recommended intubating dose of cisatracurium is 3 ED[95]. To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium. The study designed as randomized controlled clinical trial to compare between atracurium [2?ED[95]] and different doses of cisatracurium [2?ED[95], 4?ED[95], 6?ED[95]] regarding onset time, duration of action, condition of intubation, hemodynamic effects, and sings of histamine release clinically. Sixty four patients were randomly assigned to one of four groups, the first group [group 1] received 2?ED[95] dose of atracurium, group 2 received 2?ED[95] dose of cisatracurium, group 3 received 4?ED[95] dose of cisatracurium, while group 4 received 6?ED[95] dose of cisatracurium. The Datex relaxograph [Type NMT-100-23-01, S/N: 37541] for neuromuscular monitoring was used. HR, MABP was statistically significant increased post-intubation with administration of 2?ED[95] dose of atracurium in group 1 and the same dose of cisatracurium in group 2 but 5-20 min later was not statistically significant with administration of 4?ED[95] and 6?ED[95] doses of cisatracurium in groups 3 and 4, respectively. Onset time was found to be significantly lower with 2?ED[95] dose of atracurium than with the same dose of cisatracurium. At the same time, higher doses of cisatracurium [4?ED[95] and 6?ED[95]] showed onset time and longer duration of action that was significantly lower than with atracurium and with lower dose of cisatracurium [2?ED[95]]. Only 6?ED[95] dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent condition of intubation. 4?ED[95] and 6?ED[95] doses of cisatracurium were significantly better than 2?ED[95] dose of cisatracurium. 2?ED[95] dose of atracurium and 2?ED[95] dose of cisatracurium were similar, while 4?ED[95] and 6?ED[95] doses of cisatracurium were significantly better than atracurium and 2?ED[95] dose of cisatracurium. The same dose [2?ED[95] dose] atracurium is more effective neuromuscular blocking agent than cisatracurium, while higher doses of cisatracurium 4?ED[95] and 6?ED[95] provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, and no associated signs of histamine release clinically

Abdominal ultrasonic changes in pediatric patients with acute viral hepatitis

Acute hepatitis causes not only pathological ultrasound changes in the liver, but also affects other abdominal organs. This study was carried out to detect ultrasonic changes in the abdominal organs and hepatic vessels in cases of acute hepatitis in children and determine the chronology of these changes. 143 pediatric patients with clinical picture and laboratory findings of acute hepatitis were prospectively examined by gray scale and Duplex Doppler ultrasound early at the start of the disease and every 6 weeks for 6 months. Eighty seven age and sex matched normal children were also examined as a control group. Enlarged lymph nodes in hepatic hilum was the most common finding, it affected 97.9% of cases in the first examination and did not disappear for 12 weeks; 30% of cases showed its presence at 6 months but with decreasing size. Hepatomegaly was found in 84.6% of cases in the first examination, but returned to normal size by 12 weeks. Increase in liver echogenicity was found in 50.4% of the cases in the first examination, in 39% after 6 weeks and disappeared by 18 weeks. Hypoechoic liver was found in 20.3% at the start of the disease and disappeared by 6 weeks. Splenomegaly was detected in 33% of cases at the start of the disease, in 3.6% at 6 week visit and disappeared by 3 months. Thickened gallbladder wall was present in 25.2%, hepatic veins biphasic waveform in 19.3% and ascites in 2.1% of cases at the start of the disease, all were very transient and not detected by 6 weeks. Lymph node enlargement in porta hepatis was the most prevalent and persistent finding in children with acute viral hepatitis. Other organ affection detected by abdominal ultrasonography [gray scale and duplex Doppler] in those children disappeared by 6 to 24 weeks

Dyeing of cotton fabrics using some natural dyes part II: some studies on dyeing properties of cotton fabrics using chelidonium majus [Roots]

The pre-treated cotton fabric with tannic acid [60g/l] was dyed in a bath containing natural colouring matter extracted from vegetable plants Chelidonium majus [roots]. Factors affecting dyeing properties such as concentration of colouring matter as well as pH values, time and temperature of dyeing bath were studied. It was found that the most suitable dyeing properties are obtained when colouring matter is obtained from 18 g Chelidonium majus [roots]/100 ml water using 5g/l sodium chloride, L.R 1:50, pH 6, dyeing was continued for 30 min at 70°C. Environmentally friendly mordants such as copper sulphate, ferrous sulphate, stannous chloride and alum were added using three mordanting methods: [pre-simultaneous - post] mordanting methods and overall fastness properties of dyed mordanted fabrics were assessed. In the recent years, growing interest in the revival of natural dyes has been manifested. This interest is the result of a worldwide movement to protect the environment for indiscriminate exploitation and pollution by industries. Natural dyes are considered to be complementary and not conflictive with the use of manufactured dyes in the textile industry as a whole. Chelidonium majus is an erect plant from 2-4 feet and is native to temperate Europe and Asia. Leaves are deeply pinnatifid, crenate or lobed, flowers are yellow medium sized, in a small peduncled umbel, sepals 2, petals 4; stamens many ovary of 2 carpels, fruit is a cylindrical capsule 1-2 inch long. It belongs to papaveraceae family[1]. The present work was carried out to optimize the conditions for dyeing cotton with natural colouring matter derived from Chelidonium majus [roots]. The evaluation of [K/S, L, a, b, delta E] for different dyed mordanted and/or dyed washed fabrics. Estimation of metal ions [ppm] of the dyed mordanted cotton samples [pre-treated with 60 g/l tannic acid] was carried out[9-2]

Effect of exogenous adminstration of anti-oxidants on Blastocystis hominis in vivo

The effect of exogenous administration of antioxidant [Anttox] on the course of B. hominis in experimentally infected mice was studied. B. hominis isolates were obtained from 10 gastrointestinal symptomatic adult patients. Three groups of 30 infected mice [3/isolate] were used. GI was untreated infected, GII was treated by antox for 4 weeks after infection diagnosis [treatment strategy], and GIII antox treated by antox for 4 weeks before infection [prophylactic strategy]. Mild pathological changes were detected on 13.4%, 19.9% and 86.8% of mice in Gs I, II and III, respectively. Moderate pathological changes were found in 29.9%, 26.6% and 6.6% of mice in Gs I, II and III, respectively. While, the majority of severe pathological changes were in Gs I and II [56.7% and 53.5%] as compared to GIII [6.6%]. Meanwhile, 86.8% of mice in GIII had B. hominis forms >10/high power field compared to 3.3% in Gs I and II, respectively. Although 19.8% of mice in GII were positive for B. hominis by direct smear, no growth resulted in vitro and all the forms were non-viable by using neutral red stain. All the differences were statistically significant. So, antioxidant exacerbated B. hominis intensity but it decreased the pathological changes

Comparison between trichmonas vaginalis symptomatic and asymptomatic isolates effects in intravaginally infected rats

In this study, histopathological and immunohistochemical changes of the posterior vaginal fornix's and upper portion of the vagina were compared on rats infected with symptomatic and asymptomatic human isolates. Eighteen symptomatic and asymptomatic female isolates were used [nine/ each]. Two groups of infected female rats were included in this study [3 rats /isolate]. The results showed that there were no differences between symptomatic and asymptomatic isolates in histopathological changes; T. vaginalis of both isolates adhered to PAS epithelial cells at the surface and traversed under these cells. Both isolates were PAS and cathepsn D positive. By scanning electron microscopy many of T. vaginalis of the isolates adhered to microvilli of the epithelium cells in the same manner. Transmission electron microscopy proved that both isolates used the pseudopodia to adhere to the vagina upper part cells. The experimental infections did not differentiate between symptomatic and asymptomatic human isolates regarding histopathological and immunohistochemical changes

Myocardial viability, which definition should we depend upon role of radionuclide imaging

Rest-redistribution thallium [RD T1] imaging has high negative predictive value [NPV] but low positive predictive value [PPV] for the prediction of recovery of regional myocardial dysfunction after revascularization [R]. Combining perfusion [MP] and functional data with nitrate-enhanced gazed SPECT MIBI [GSM] at rest appears to be a promising approach for viability detection. Differentiate between the role of resting TL and resting GSM for detection of viability. 66 pts with coronary artery disease [CAD] underwent T1 imaging [R-RD protocol], 2 sets of resting GSM using 2 MIBI injections, and echocardiography, both at rest and after low dose dobutamine [LDD]. One hour Before GSM2, 60 mg. of oral trimetazidine [TMZ] and nitrates had been given. All pts had their echos repeated after [R]. Perfusion and wall motion [WM] were scored from 0 to 4 [absent to normal] using 17 segment model. 385/1122 segments were found to have abnormal resting WM on echo. 165/217 of the hypokinetic segments, 48/102 of the akinetic segments and 6/66 of the dyskinetic segments showed contractile response for LDD echo. The MP images showed normal uptake, complete, partial reversibility and poor uptake in TI, GSM1 and GSM2 images as following: [54, 31, 45], [36, 22, 35], [198, 119, 190] and [32, 148, 50] of segments respectively. Following table showed degree of matching. Sensitivity and specificity of T1, GSM1 and GSM2 and LDD echo had been found respectively to be [94.9%, 75.5%], [60%, 93.6%], [94.2%, 90%] and [79.6%, 100%]. Post-revascularization Resting Echocardiography: -, -, Viable, Non-Viable, -, Viable, Non-Viable, -, Viable, Non-Viable, -, Viable, Non-Viable. Pre-revascularization: Viable- Non-Viable, Rest-Redistribution Thallium, 261- 14, 27- 83, Non-TMZ gated SPECT, 165- 110, 7- 103, TMZ gated SPECT, 259- 16, 11- 99, LDD Echocardiography, 219- 56, 0- 110. Total: -, -, 275, 110, -, 275, 110, -, 275, 110, -, 275, 110. Clinical definition of viability is better looked for in GSM2

Simvastatin reverses cyclosporin A-induced endothelial damage in rats: lipid-lowering-dependent and -independent effects

Cydosporin A [CyA] is the immunosuppressant most frequently used in transplant surgery and in the management of autoimmune diseases. CyA-induced oxidative stress together with dyslipidemia have been implicated in the pathogenesis of vascular dysfunction associating CyA therapy. The present study investigated the possible protective effect of simvastatin, a lipid-lowering drug with potent antioxidant properties, against CyA-induced endothelial damage in male rats. Eighteen male Wistar rats were used. They were divided into 3 groups: control, CyA and CyA + simvastatin. In the control group, rats were administered the vehicle, olive oil; in the CyA group, rats were administered CyA [20 mg/kg/day, s.c. for 14 days] and in the CyA+simvastatin group, rats were co-administered simvastatin [2.5 mg/kg/day, s.c. for 14 days] and CyA. Administration of CyA [20 mg/kg/day, s.c. for 14 days] in male rats resulted in a significant increase in the lipid peroxidation product, malondialdehyde [MDA], and a significant decrease in superoxide dismutase [SOD] activity in plasma. CyA treatment was also associated with a significant increase in plasma nitrite level as well as an elevation in plasma cholesterol, triglycerides [TGs], low density lipoproteins [LDL] and a reduction in high density lipoproteins [HDL] levels. CyA-induced vascular dysfunction was further confirmed by the attenuation of endothelium-dependent relaxations produced by carbachol in rat isolated aortic rings. Co-administration of simvastatin [2.5 mg/kg/day, s.c. for 14 days] with CyA significantly reversed the deleterious biochemical and functional vascular effects that accompanied CyA treatment. The present study provides good evidence that both oxidative stress and dyslipidemia underlie the CyA-induced vascular damage, an effect that could be reversed by simvastatin co-administration

Aldehyde dehydrogenase 2 polymorphism: possibly a predisposing factor to hepatocellular carcinoma in hepatitis C cirrhotics?

Hepatocellular carcinoma [HCC] is considered as a long term multistage disease with multiple genetic alteration. Aldehyde dehydrogenase 2 [ALDH2] polymorphism may modify the risk of HCC. The aim of the present work was to evaluate the role of ALDH2 polymorphism as a predisposing factor for HCC in chronic hepatitis C virus [HCV] infected patients with cirrhosis for early detection. This study included fifty five subjects divided into three groups; twenty chronic hepatitis C patients with cirrhosis [group A], twenty chronic hepatitis C patients with cirrhosis and HCC [group B] and fifteen control subjects [group C]. The included patients were subjected to history taking, clinical examination, abdominal ultrasonography and liver biopsy [whenever possible]. All the subjects enrolled in this study were analysed for ALDH2 gene polymorphism. Genomic DNA prepared from leucocytes were used for polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] technique. In addition, mitöchondrial ALDH activity was estimated in leucocytes. Of all fifty five subjects included in this study, six were heterozygous for ALDH2 gene mutation [ALDH2*1/*2] representing 10.9%, and the others were homozygous for the normal allele [ALDH2*11*1]. Non was detected to have homozygous mutant allele. The distribution among the patients groups was the same; three patients out of twenty in each group were heterozogous for the mutant gene [15%]. All the control subjects had normal homnozygous gene [ALDH2*1/*1]. The two patients' groups showed significantly higher percent of heterozygous mutant; ALDH2*1/*2 [X[2]=11.92,P=0.0027] and lower mitochondrial ALDH activity towards acetaldehyde [F=24.32, P=0.0002] in comparison to control group. However, non significant changes in both parameters were observed between the two patients' groups [P>0.05]. ALDH2 gene mutation could not be considered as a possible predictor for HCC in non alcoholic HCV-cirrhotic patients. However, these data did not exclude completely the relation to HCV infection and/or cirrhosis. Follow-up large scale studies are needed to investigate the exact link between ALDH2 mutation and cancer

Surgical versus chemical [Botulinum toxin] sphincterotomy for chronic anal fissure

This is a prospective randomized trial aiming to compare the effect of open lateral internal sphincterotomy versus Botulinum toxin injection in the treatment of chronic anal fissure. Thirty patients diagnosed as suffering from chronic anal fissure were randomly allocated into two groups. In the surgical sphincterotomy group [n =15] lateral internal sphincterotomy was done. In the Botulinum toxin group [n = 15] 20 U of type A botulinum toxin was injected into the internal anal sphincter. The injection was repeated two months later of complete healing was not accomplished. The patients were re-examined by inspection and re-evaluated for symptoms at 2, 6 and 12 months. Two months after treatment, the healing rate was 60% [9/15] in the BT group, and 93.5% [14/15] in the LIS group [p=0.031]. In the BT group 6 patients were offered a second injection at the second month. Six months after treatment one patient of the LIS group developed recurrences. Therefore, at six months the healing rate was 73.3% [11/15] in the BT group, compared to 86.7% [13/15] in the LIS group [p=0.36]. By 12 months post treatment, the healing rate remained stable in the LIS group 86.7% [13/15], while three patients in the BT group developed recurrence, resulting in an overall success rate of 53.3% [8/15] [P=0.046]. The return to daily activity was significantly longer in the LIS group [12.8 +/- 4.6 days] vs. [1 day] in the BT group [p<0.0001]. The incidence of complications in the sphincterotomy [4 cases of transient partial incontinence] group was significant as compared with none in the BT group [p=0.32]. In comparing the results of the two treatment modalities, BT injection was found to be inferior to LIS regarding the healing rates. On the other hand the BT therapy is easy to perform, can be done as an outpatient procedure, and associated with less complication. Considering these factors BT therapy might be valuable in selected patients with high surgical risks, or high incidence of future incontinence

Evaluation of different phenotypic methods for detection of methicillin [oxacillin] resistance in coagulase-negative staphylococci

Coagulase-negative staphylococci [CNS] are one of the major causes of nosocomial infections. Methicillin [oxacillin] resistant strains are particularly important because they narrow therapeutic options. Detecting methicillin resistance among CNS has been a challenge for years. The objective of this study was to evaluate the ability and accuracy of four phenotypic methods, disk diffusion [DD]; agar screening plate with 6 micro g of oxacillin per ml [OXA]; E-test and the MRSA-Screen latex agglutination test [Denka-Seiken, Tokyo, Japan], to determine the susceptibility of CNS to oxacillin. The methods were evaluated by using the presence of the mecA gene, as detected by PCR, as the "gold standard". One hundred and ninety seven strains of CNS of 7 species were analysed. 49.2% were mecA positive. For the different methods evaluated, the sensitivities and specificities were as follows: for disk diffusion, 93.8 and 93%, respectively; for the agar screen test 95.9 and 98%, respectively; for E-test, 100 and 95%, respectively; and for the slide latex agglutination test, 96.9 and 100%, respectively. The latex agglutination test sensitivity was increased to 100% when retested after induction. In conclusion, all of the phenotypic methods evaluated in the present study appeared to perform very well for the detection of oxacillin resistance in CNS. The MRSA-Screen latex agglutination test was not only the most sensitive, specific and accurate method but also rapid and technically simple method to be applied in routine laboratories for the detection of oxacillin resistance which is mediated by the mecA gene

Slime forming staphylococcus epidermidis isolated from orthopedic prosthesis infections and its sensitivity to antibiotics

Staphylococcus epidermidis [S.epidermidis] is a frequent cause of infections of indwelling medical devices especially those with orthopedic implants. S.epidermidis grows on medical devices as an adherent biofilm consisting of cells enmeshed in a sticky, extracelluar slime that is firmly attached to the underlying surface. The slim matrix makes S.epidermidis biofilm highly resistant to antibiotics and host defenses and nearly impossible to eradicate. The aim of the study is to determine importance of slime formation in S. epidermidis orthopedic prosthesis infections and to investigate if slime formation has an effect on its antibiotics sensitivity. 80 coagulase negative staphylococcus strains [CoNS] were isolated from 200 tissue specimens of patients with orthopedic prothesis infections. Out of these 80 CoNS, 52 [65%] strains were S.epidermidis. Isolated S. epidermidis were plated on Congo red agar and subjected to PCR to detect icaA and icaD genes to identify and confirm slime producing strains respectively. All biofilm producing strains were subjected to MIC and MBEC using Calgary Biofilm Device[CBD]. 36 [69%] S. epidermidis strains were slime [biofilm] producers and 16 [31%]strains were non slime [non biofilm] producers by CRA, while by PCR 39[75%] strains of S. epidermidis were biofilm producers and 13 [25%] strains were non biofilm producers. The results also revealed that the minimal biofilm eradication concentrations [MBECs] were higher than the corresponding conventionally determined MICs for all antibiotics tested. MIC 50 and MBEC 50 for vancomycin, were 2 micro g/ml versus 8 micro g/ml, gentamycin, 1 micro g/ml versus 32 micro g/ml, oxacillin, 4 micro g/ml versus 16 micro g/ml, erythromycin, 8 micro g/ml versus 64 micro g/ml, ciprofloxacin, 0.5 micro g/ml versus 2 micro g/ml and cephalothin 4 micro g/ml versus 16 micro g/ml. MIC90 and MBEC90 for vancomycin were 4 micro g/ml versus16 micro g/ml, gentamycin, 16 micro g/ml versus 128 micro g/ml, oxacillin, 8 micro g/ml versus 128 micro g/ml, erythromycin, 16 micro g/ml versus 128 micro g/ml, ciprofloxacin, 4 micro g/ml versus 8 micro g/ml and cephalothin 32 micro g/ml and 128 micro g/ml. The results of the present study confirm that ica genes can be considered a virulence marker in the pathogenesis of implant associated orthopedic infection by S. epidermidis. This study also demonstrates marked differences between the results of susceptibility testing performed according to standard NCCLS guidelines and testing based on biofilm susceptibility testing

Association of CagA and VacA genotypes of helicobacter pylori with gastroduodenal diseases

Helicobacter pylori [H. pylori] infects the majority of the population in developing countries. However, the rate of gastrointestinal complications has no parallel with the infection. In the present study our aim was to detect and type the cagA [cytotoxin associated gene] status and the vacA [vacuolating cytotoxin] genotypes directly from biopsy DNA, and to further define the relationship between H. pylori genotypes and gastroduodenal pathology. Antral gastric biopsies were obtained for molecular analysis and histopathological diagnosis from 105 patients with dyspeptic symptoms undergoing upper gastrointestinal endoscopy. H. pylori DNA, cagA status and vacA s and m types were detected by polymerase chain reaction [PCR]. H. pylori DNA was detected in 100 [95.2%] of gastric biopsy specimens, of those, 43 [43%] were cagA positive and all [100%] were vacA positive. The vacA s2/m2 genotype was the most prevalent [54%] followed by s1/m2 [27%], then s1/m1 [16%] and 3% showed multiple genotypes. We found 90.5% and 75% of cases with peptic ulcer disease [PUD] and gastric adenocarcinoma respectively to be cagA positive in contrast to only 28% of gastritis cases. The vacA s1 allele was the commonest in PUD and gastric adenocarcinoma cases [85.7% and 75% respectively], while the vacA s2 allele was the commonest in gastritis cases [70.7%]. In conclusion, we suggest the possibility of a genotype-phenotype association of H. pylori disease. Determination of cagA status and vacA genotypes may contribute to the potential clinical identification of patients at different levels of risk. We recommend further studies involving other virulence genes

Rocuronium versus cisatracurium: onset of action, intubating conditions, efficacy, and safety

Neuromuscuiar blockers [NMB] are very important adjuvant to general anesthesia. Rocuronium bromide [ammosteroidal NMB] and cisatracunum besylate [benzyl isoquinolme NMB] are recently introduced non-depolarizing muscle relaxants In a prospective randomized study we had compared both drug at a dose 2x [ED95] as regard the onset of action, intubating conditions, clinical duration, hemodynamic changes, and adverse effects 40 female patients ASA l and ll. 20-50 year old underwent elective gynecological ambulatory surgery under general anesthesia [GA] were randomly assigned into 2 equal groups. ROC group, where 0.6mg/kg rocuronium was given and CIS group, where 0 1mg/kg cisatracurium was given. Neuromuscuiar monitoring was done by stimulating uinar nerve and recording the action potential of the first dorsal interosseous muscle using Date x Relaxogram. Standardized GA was given to all patients as follows, fentanyl 1.5mcg/kg. propofol 2mg/kg. 2x [ED95]/kg of the examined NMB. intubation was tried by the same anesthetist who was blind to the given NMB after 60 sec of injection, intubation was done if the intubating condition was acceptable [excellent or good], and it was re-attempted every 30 sec if it was poor or inadequate Anesthesia was maintained by 60% N2O in 02 and isoflurane to a total MAC 1.5. controlled ventilation was adjusted to normocarpia. Mean arterial blood pressure [MAP], heart rate, and intubating conditions were recorded interpretation of relaxogram for the onset of action, clinical duration, recovery index was done Clinically acceptable intubating conditions were achieved after 60 sec more frequently after rocuronium [80%] than after ctsatracurium[O%]. Rocuronium had a significant shorter onset time than cisatracunum [70.6 +/- 18.2 versus 160.4 +/- 14.3sec], Rocuronium had a significant shorter duration of action than cisatracurium [30.3 +/- 5.2 versus 45.7 +/- 7/5min], and the spontaneous recovery index was significantly shorter with rocuronium than cisatracurium [9.2 +/- 1.8 versus 13.6 +/- 2.4min]. There were no evidences of any significant clinical cardiovascular changes in both groups. There were no clinical signs of histamine release in both groups, but there was burning pain at the site of rocuronium injection in more than 50% of patients Conclusion: Rocuronium has a rapid onset of action with good intubating conditions, cisatracurium has an intermediate duration of action, both are potent and safe with excellent cardiovascular stability and without apparent histamine release

Molecular characterization of Egyptian trichomonas vaginalis clinical isolates by HSP70 restriction fragment length polymorphism

Molecular typing of 20 Egyptian Trichomonas vaginalis clinical isolates was performed using the Restriction Fragment Length Polymorphism [RFLP] analysis employing a probe from the heat-inducible cytoplasmic HSP70 gene family hybridized with EcoR I-digested genomic DNA. In each of the isolates tested 5 to 6 distinct DNA fragments ranging from 2.7 Kb to 7.5 Kb in size were detected. Analysis of 13 isolates from symptomatic and 7 isolates from asymptomatic women revealed 6 distinct RFLP pattern subtypes of T. vaginalis. Eleven isolates [55%] showed the same RFLP pattern, teen of them [90.9%] were from symptomatic patients. T. vaginalis virus [TVV] was present in 7 isolates [35%]. Only one isolate was considered resistant to Metronidazole. There were no relations between TVV infection or Metronidazole susceptibility and RFLP subtypes