Genotyping of occult hepatitis B virus infection in Egyptian hemodialysis patients without hepatitis C virus infection

Background: occult hepatitis B viral infection is the presence of hepatitis B viral nucleic acids in the serum and/or liver in the absence of hepatitis B surface antigen

Aim: the study aimed to determine the prevalence of occult hepatitis B virus infection among hepatitis C virus-negative hemodialysis patients and to identify their genotypes

Methods: of 144 patients on maintenance hemodialysis, 50 hepatitis B surface antigen and hepatitis C virus nucleic acid-negative patients were selected according to strict inclusion criteria to avoid the effect of confounding variables. The following investigations were done: serum AST and ALT; HBsAg; HBcAb; HCV-Ab; HCV-RNA; and HBV-DNA

Results: positive hepatitis B viral nucleic acid was confirmed in 12/144 [8.3%] hemodialysis patients and 12/50 [24%] in our study group [occult infection]. Mean hemodialysis periods for negative patients and occult hepatitis B virus patients were 27.3 +/- 18.8 and 38.4 +/- 8.14 months, respectively, and this difference was significant [p-value = 0.02]. Mean alanine transaminase levels were 20.27 +/- 5.5 IU/L and 25.3 +/- 9.6 in negative patients and occult infection patients, respectively. This difference was non-significant. Aspartate transaminase levels were 21.4 +/- 10.2 IU/L and 27.3 +/- 4.6 IU/L, respectively, in negative patients and infected patients; this difference was significant [p-value = 0.03]. Half [6/12] of the positive samples belonged to genotype 'B', 33.3% [4/12] to 'C', and 16.6% [2/12] to genotype 'D'

Conclusion: OBI is likely among hemodialysis patients even without HCV coinfection [24%]. Genotype D cannot be the only genotype distributed in Upper Egypt, as the current study reported relatively new results that 50% of the patients with occult B carry genotype B, 33.3% carry genotype C and only 16.6% carry genotype D

Enhancement of the anti-schistosomal activity of praziquantel by propolis and/or royal jelly

Due to the emergence of resistance to anti-schistosomal drugs, the present study aimed to explore the antischistosomal activity of the natural products Propolis [PP] and Royal Jelly [RJ] to be used alone or in combination with traditional antibilharzial drug such as Praziquantel [PZQ]. Mice received PP at 8 and 16 mg /mouse/day, RJ at 0.3 and 0.6 mg/mouse/day or PZQ at 0.4 mg/mouse/day in addition to their combinations [PP + RJ] or [PP+RJ+PZQ] using the same low and high dose levels before and after cercarial infection. Antischistosomal activity was evaluated by measuring different parameters including either biochemical [SGOT, SGPT, GGT, albumin and bilirubin total and direct], parasitological [Oogram, liver egg load, worm distribution and burden with hatchability study], antischistosomal antibody titre [ASA titer] and histopathological examination of liver tissue. Inspite of their low antischistosomal activity, PP and RJ in a dose dependent manner induced significant liver protection [p < 0.01] as indicated by reversal of the above parameters tested. Similar effects were obtained using combined doses of PP, RJ and PZQ with reduction rate of 67% and 74% of liver enzymes and worm burden; respectively, compared to the reduction rates of the standard drug PZQ alone 48% and 65%, respectively. Thus the anti-schistosomal activity of PZQ could be augmented by the natural products Propolis and /or Royal Jelly

Role of radiological evidences and vascular endothelial growth factor estimation in dating of fractures in children

Fractures of varying ages in young children are highly suggestive of child abuse. When suspicious circumstances are expected, one of the many factors involved in diagnosis of child abuse is the dating of fractures. The aim of this study is to determine the timing of bone fracture In children based on the evidences of radiological changes and estimated blood level of vascular endothelial growth factor [VEGF] in the context of child protection. Forty child patients with forearm fracture were obtained from outpatient clinic of orthopedic surgery department, Zagazig university hospitals during the period from 1-1-2008 to 31-12-2000. The approval from Ethical Committee of Faculty of medicine, Zagazig University and the consent from the legal responsible person of each child were obtained. The images were done initially and every two weeks till the end of the study at 12 weeks. A blood sample was taken for estimation of vascular endothelial growth factor initially [zero day] and at 2,4,6,8 10 and 12 weeks after injury. Blood sample was also taken from another forty healthy children to serve as control of VEGF level. This study showed blunting of fracture margins in all radiographs obtained two weeks after injury and thereafter. There was significant increase in periosteal reaction percentage increase at 6 weeks. Although, bone remodeling had significant increase at 8 weeks, the periosteal incorporation, increased callus density and fracture gap decrease showed significant increase at 12 weeks. The estimated level of VEGF had the maximum significant elevation at 2 weeks then showed significant decrease at 4 and 6 weeks when compared with the initial concentration. An approximate significant increase was noted at 8 and 10 weeks. At 12 weeks the level of VEGF had significant difference with that of zero day. In addition, all these VEGF levels including the initial one had significant increase when compared with control level of healthy children. Radiological data could help in estimation of the minimum and maximum time of fracture steps repair and thus provide assistance in dating. Also, estimation of vascular endothelial growth factor has an important role in timing of fracture especially during the healing phase in which the case is present and limit the observation of radiological features

Ultra structural and biochemical studies on the effects of natural and synthetic anti-fibrotic drugs on liver of schistosoma mansoni infected mice when given with anti-schistosomal treatment

Schistosoma mansoni is one of the most prevalent causes of liver fibrosis in Egypt. Liver fibrosis is the result of an imbalance between synthesis and degradation of extracellular matrix proteins of the liver. This progressive process is mainly characterized by activation of hepatic stellate cells [HSCs]. Colchicine is a well known drug used for treating liver fibrosis, however higher doses cannot be used due to its toxicity. Silymarin is a natural acknowledged hepatoprotector used in humans to treat liver diseases. The aim of this work was to evaluate the antifibrotic effects of colchicine [when given alone or combined with Silymarin] on liver of schistosomal infected mice model, treated with antibilharzial drug [Mirazid]. Ninety mice were divided into 6 groups [15/group], the first served as non-infected control and the second as infected control. The infected mice of the 3[rd], 4[th], 5[th] and 6[th] groups were given mirazid, mirazid and colchicine, mirazid and Silymarin and mirazid, colchicine and Silymarin respectively. Histological [Light and Electron microscopical analysis] and biochemical tools were used. The current work showed that best results were achieved in group of animals treated with mirazid and administered combined colchicine and Silymarin. Electron microscope examination showed HSCs returned to approximately resting phase. Hepatocytes revealed normal appearing picture with normally seen microvilli surface. This was confirmed by light microscopic examination. Biochemical analysis of some liver functions [Total proteins, albumin, GGT, ALP and LDH], was in parallel with the histological results. We concluded that activation of HSCs may play a key role in the progress of Schistosoma induced hepatic fibrosis, and the use of Silymarin, colchicine combined with antibilharzial drug reduces this activation

Early detection of Egyptian colorectal cancer patients using stool-based DNA markers

About 50% of the patients with colorectal cancer who are diagnosed on the basis of clinical symptom could be cured by surgery. It may be assumed that diagnosis and surgery at an earlier asymptomatic stage would allow more patients to be cured. Therefore, screening appears to be the simplest way to decrease mortality due to colorectal cancer. The emergence of molecular stool testing promises accurate and user friendly alternative to conventional methods of colorectal cancer screening. The aim of this work is to evaluate the stool-based DNA test for three genetic markers on Egyptian patients. DNA was extracted from stool and/or tissue samples collected from 45 Egyptian patients [17 colorectal cancer, 28 non-cancerous lesions and normal] the lesions include ulcerative colitis, polyps, and schistosomiasis. Mutations were detected in k-ras oncogene at codon 12 using RFLP technique, p53 gene [exons 5, 6, and 7] using SSCP technique and finally microsatellite instability [MSI] for BAT-26 locus as a marker for mismatch repair gene. The overall molecular changes using the three markers showed that 25 patients out of 45 [55.56%] exhibited mutations in one or more of the markers used. Mutations were detected in 76.46% colorectal cancer patients. In non-cancerous cases, 42.86% exhibited mutations using the same gene panel. P53 mutation recorded the highest percentage of markers used [58.8%] in cancerous cases whereas it was 42.86% in non-cancerous cases. K-ras mutations recorded about 29.4% in cancerous cases and non in non-cancerous cases. Finally, MSI at BAT-26 was only 5.9% in cancerous cases and no MSI in non-cancerous group. In conclusion, p53 may represent a golden marker for Egyptian patients with colorectal cancer and pre-malignant diseases. Using multi-target genetic panel is successfully for early detection of colorectal cancer. Finally, stool-based DNA test is a real golden method which reflect the genetic changes in the tumors

Assessment of the outcome after popliteal distal bypass for limb salvage

Twenty four patients with limb threatening ischaemia due to occlusion of the popliteal artery were included in this prospective study. The patients were considered potential for surgery due to presence of ischaemic ulcer or gangrene in 15 patients and ischaemic rest pain alone in 9 patients. The inclusion criteria for popliteal distal bypass was short segment occlusive diseases of the popliteal artery and its trifurcation. Patients with diffuse disease of the superficial femoral artery were excluded from this study. Popliteal artery bypasses were performed electively in all patients. Autogenous vein as a conduit was utilized in all of them. Translocated saphenous vein was the most frequent conduit used in 12 patients [50%]. In situ saphenous vein was utilized in 9 patients [37.5%] where as reversed saphenous vein was used in 3 patients [12.5%]. The inflow vessels were below knee popliteal artery in 14 patients [58.3%] and above knee popliteal artery in 10 patients [41.7%]. The outflow were posterior tibial artery in 12 patients [50%], peroneal artery in 4 patients [16.6%] anterior tibial artery in 6 patients [25%] and dorsalis pedis artery in 2 patients [8.4%]. In the early and late postoperative periods, the survival rates were 95.83% and 87.50%, the primary patency rates were 91.30% and 80.95%, the secondary patency rates were 91.30% and 85.7% and limb salvage rates were 91.97% and 87.50% respectively which compare favorably with other reports of popliteal distal bypass. The same is true regarding reports for femorodistal bypass. At the end of the follow up period 16 [66.6%] out of 24 patients had a functioning limb used for ambulation and transfer. In conclusion, popliteal distal bypass is a safe and efficient procedure with favorable outcome. However, the results are poor in patients with renal impairment

Ovarina mass assessment with transvaginal ultrasound, color doppler and the histopathological findings

To compare transvaginal sonography and color Doppler imaging accuracy in diagnosing benign ovarian masses from malignant masses by the histopathological finding. The study was performed as a prospective study at Ain Shams University, departments of Obstetrics and Gynecology and Radiodiagnosis over the period from November-2002 to September-2004. A total of 80 cases with ovarian masses on which transvaginal sonography was performed before surgical exploration were included in the study. An ovarian mass was first studied using transvaginal sonography, then color Doppler evaluation of the solid portions of the tumor were done. A mass was graded malignant if flow was shown within the solid areas or papillary projection and benign if there was no flow and the actual histological type was detected after surgical exploration. The overall agreement between the test result and the actual outcome was calculated by K-statistics. Color Doppler evaluation was more accurate in the diagnosis of ovarian malignancies in comparison with transvaginal sonography [K = 0.836 and 0.62, respectively] because of significant higher specificity [0.95 versus 0.84; P <.05] and higher Positive predicative value [PPV] [0.81 for color Doppler versus 0.56 for transvaginal sonography] with same negative predictive value [NPV] [0.984 for color Doppler versus 0.982 for transvaginal sonography]

Factors affecting the outcome of axillosubclavian arterial injuries

Twenty cases of subclavian artery injury and 14 cases of proximal artery injury were included in this study. Penetrating trauma was responsible for 26 cases of axillosubclavian arterial injuries, whereas blunt trauma accounted for only 8 patients. Thirty patients were presented with absent distal upper extremity pulses, while only four patients with subclavian artery injury suffered from a supraclavicular swelling with palpable distal pulses. Angiography was done in 17 patients who were vitally stable. Patients with soft signs that were suspicious of vascular injury underwent duplex study prior to angiography to confirm the diagnosis and angiography was followed to locate the site of the injury and to plan the operation. Four patients died before surgery and another four patients died intraoperatively from massive blood loss. Twenty patients needed saphenous interposition graft, four patients required venous patch, while the remaining two patients underwent a repair with synthetic graft [ringed PTFE, 8 mm] when suitably sized vein was not available and in the absence of contamination. The factors that influenced the mortality rate were the hemodynamic status of the patient, the presence of other associated injuries and the site of arterial injury. Preoperative ischemia time, the site of arterial injury and the presence of other associated injuries had a major impact as regards the postoperative morbidity. Associated brachial plexus injury is considered the most important item regarding postoperative morbidity, leaving the patient with very poor recovery of upper extremity function

Comparative results of transurethral resection [TURP], transurethral vaporization [TVP] and vaporesection in benign prostatic hyperplasia. A prospective randomized study

To compare the efficacy and safety of TURP, TVP and combined TURP and TVP method termed Vaporesection using new storz-designed electrode in complete tissue removal in cases of Benign Prostatic Hyperplasia.From January 1998 to July 1999, in a prospective triple blind study, 120 patients with moderate to severe lower urinary tract symptoms and diagnostic evidence of obstruction [Clinical, urodynamic and TRUS] were randomized to undergo either TURP [using standard cutting wire loop], TVP [using roller bar electrode, vapotrode] or Vaporesection using roller cutting electrode. The prostate volume was measured before and after procedure using transrectal ultrasound to evaluate the completeness of tissue resection by either method. The parameters evaluated included the operative time, postoperative catheterization, American Urological Association [AUA] symptom score, Peak urine flow and post-void residual urine.A total of 111 patients were evaluable for follow up at 1 year. None required retreatment. Patients of the 3 groups were balanced for the different baseline variables. The mean operative duration of the TVP was 46.7 +/- 17.6 min., significantly longer than that of TURP at 35.9 +/- l2.2 min and vaporesection at 36.l +/- 11.2 min [p<0.01]. One hour after TURP, patients had significantly lower levels of serum sodium and hematocrite than TVP and vaporesection. The mean duration of catheterization after TURP was 67.4 +/- 13.6 hours, significantly more than after TVP 30.2 +/- 4.6 hours and vaporesection 28.6 +/- 5.3 hours. Compared with baseline values, the IPSS, Qmax and PVR improved significantly in the 3 groups at all intervals of follow up and there were no significant differences between the groups during the follow up. None of the patients of the 3 groups complained of impotence during the follow up.TURF and TVP have equal efficacy in completeness of tissue removal with less blood loss in TVP than TURF but TURP consumes less time than TVP. Vaporesection of the prostate is a safe, effective alternative to standard TURF and TVP. It has the advantages of minimal blood loss, excellent operative visibility, less postoperative irritative symptoms and good tissue removal for histopathology

Fibromyalgia syndrome in pediatric and adolescent populations

The objectives of this study were to describe the characteristic features of FS in children and adolescents, to note similarities and differences of FS in adults and to determine the outcome after treatment. Twenty-three children and adolescents with FS and a similar number of adult patients with FS were selected for this study. The characteristic features of FS were used for the evaluation of these patients at the initial visit and two successive visits with three-month interval. The patients were subjected to full clinical examination, routine urine and stool analysis, ESR, ASOT, CRP and RF. The mean cumulative number of tender points of all visits was 8.3 +/- 2.6. The sites of tender points were trapezius, knee, occiput, lateral epicondyle, upper gluteal area, greater trochanter, supraspinatus, lower cervical area and second costochondral junction

Ultrasonographic analysis of local steroid injection in plantar fasciitis

The aim of this study was to investigate the value of ultrasonographic examination in the diagnosis of plantar fasciitis and the demonstration of the changes in the plantar fascia following local steroid injection. Twenty patients with clinical diagnosis of plantar fasciitis and 20 normal subjects were studied prospectively. Ultrasound examination was performed using ATL apogee 800 [USA] with 11 MHz linear array transducer. The ultrasonographic examination of plantar fascia was easy and quick to perform. It was suggested that ultrasound should be the screening procedure of choice in heel pain. Local steroid injection proved to be clinically safe and effective in the treatment of plantar fasciitis

Cochlear histopathology in experimental induced chronic suppurative otitis media

Seventy-four albino rats [72 comprised the study group and two served as a control group] were used in this study. According to the period after different bacterial strains inoculation, the animals were sacrificed, dissected and stained for a histopathological examination for three conservative weeks. The histopathological changes of the organ of corti varied from edema of stria vascularis lip to degeneration and necrosis of outer, inner hair cells, degeneration of endorgan, endolymphatic hydrops and nerve fiber necrosis

Experience with the management of mesenteric aneurysms

Mesenteric artery aneurysms represent a rare but very interesting clinical entity. Despite their rarity they comprise a challenging vascular problem as regards diagnosis and treatment. We have managed six mesenteric anuerysms, four involving the SMA and the other two involving the IMA. There were five males and one female patient. The presentation included acute abdominal pain in four cases, haematemesis in one case and abdominal mass in the remaining aneurysm. Surgical treatment was carried out in all six including ligation of the two IMA aneurysms, as well as two SMA aneurysms. Reconstruction was performed in the remaining two SMA aneurysms. Surprisingly, no complications [apart from ARDS in one patient] were recorded in all six cases

Water contact activities and schistosomiasis infection in Menoufia, Nile Delta, Egypt

With the aim of developing schistosomiasis health education programmes through primary health care, water contact activities were studied in two large villages in Menoufia Governorate. In 1994, an in-depth epidemiological study performed on a calculated sample of households revealed that certain water contact activities [grain washing, irrigation, ablution] resulted in higher schistosomiasis infection rates than others. The irrigation system used appeared to be significantly related to the infection rate. Health education and community participation in schistosomiasis control via primary health care are recommended

use of cinnarizine diphenhydrinate, co-dergocine and beta - histine dihydrochloride to select the best anti vertginous drug in treatment of vertigo

Sixty adult patients suffering from vestibular vertigo were examined and treated. They were divided into four groups according to the line of treatment. They were treated with cinnarizine 25mg. t.d.s., diphenhydrinate 50mg. t.d.s., co-dergocine 1.0mg. t.d.s. and Beta-histine dihydrochloride 8mg. t.d.s. to the first, Second, third and fourth group respectively for three month duration. They were evaluated pre. and post treatment clinically and audio logically with vestibular assessment. The results of this work revealed that cinnarizine was the drug of choice used in treatment of different causes of vestibular vertigo because of its calcium antagonistic action. followed by diphenhydrinate then Beta-histine dihyrochloride and the least was co-dergocine

Schistosomiasis reinfection and community compliance in a primary health care participatory research project in Menoufia, Egypt

This study aimed to train local primary health care teams on sound scientific techniques for schistosomiasis case-finding, recording, treatment and follow-up in the context of primary health care; involve local community members in designing and conducting epidemiological research on schistosomiasis and follow-up of positive cases in collaboration with primary health care teams; and assess the impact of this methodology on community compliance to laboratory testing and treatment, besides the impact on rates of prevalence, intensity, incidence and reinfection

Thrombolytic therapy versus anticoagulant therapy in the treatment of deep venous thrombosis

Searching for a mode of treatment that preserves the functional anatomy of the deep venous system after deep vein thrombosis, thrombolytic therapy has been tried. There is much argument in the literature as regards the superiority of this treatment over the standard anticoagulant therapy. In this study, thrombolytic treatment was applied and compared to the standard line of treatment. It seems that the end result of both lines of therapy is similar, added to this the high risk of complications of thrombolytic therapy especially hemorrhage and its high cost. So, the routine use of thrombolytic therapy cannot be recommended in early proximal deep vein thrombosis

Effect of cimaterol-induced muscle hypertrophy on calcium-dependent proteinase and calpistatin activities in young lambs

The aim of the present study was to reveal the possible relationships between cimaterol-induced hypertrophy of skeletal muscle and the activity of micromolar -Ca2- dependent proteinase [uM CDP], millimolar - Ca2+ - dependent proteinase [mM CDP], and their specific inhibitor [calpastatin]. 200 mg /kg/day of Cimaterol in milk replacer for 21 days increased mM CDP. The increased activity of calpastatin indicated that Cimaterol-induced muscle hypertrophy may be attained in part by reduction of the proteolytic activity of myofibrillar protein