Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados para o isolamento completo do Mycobacterium tuberculosis.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients / Comparação de diferentes modalidades de diagnóstico para isolamento de Mycobacterium tuberculosis entre pacientes com suspeita de linfadenite tuberculosa

Abstract Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Resumo A tuberculose é uma doença transmissível com altas taxas de morbimortalidade nos países em desenvolvimento. O objetivo principal do estudo é comparar métodos convencionais, como cultura de bacilo álcool-ácido resistente (BAAR) e microscopia, com métodos de diagnóstico rápido. O objetivo secundário é comparar os achados histopatológicos e microbiológicos em pacientes com suspeita de linfadenite tubercular. Um total de 111 amostras (agosto de 2018 a setembro de 2019) de gânglios linfáticos foi processado ​​para microscopia de AFB, culturas de AFB, teste de susceptibilidade a drogas (DST), histopatologia e Xpert Mycobacterium tuberculosis (MTB)/ensaios de resistência à rifampicina (RIF). Das 111 amostras de linfonodos, 6 (5,4%) foram positivas para baciloscopia de AFB, 84 (75,6%) foram positivas para cultura de AFB, 80 (70,7%) foram positivas para o GeneXpert e 102 (91,8%) foram indicativas de tuberculose para estudos histopatológicos. A positividade da cultura do tubo indicador de crescimento de micobactérias (MGIT) foi 84 (75,6%), maior que a cultura sólida de Lowenstein-Jensen (LJ), 74 (66,6%). As culturas positivas foram submetidas a DST fenotípico. Dois casos eram multirresistentes (MDR) ao DST, enquanto três casos eram resistentes à rifampicina no GeneXpert. A sensibilidade do GeneXpert foi 62% contra o método convencional de cultura AFB. O fraco desempenho dos métodos convencionais de diagnóstico de linfadenite requer metodologia de diagnóstico precoce e precisa. O teste Xpert MTB/RIF pode ajudar no tratamento de casos de tuberculose multirresistente. No entanto, métodos rápidos e convencionais devem ser usados ​​para o isolamento completo do Mycobacterium tuberculosis.

Evaluation of bioherbicidal potential of Carica papaya leaves / Avaliação do potencial de bioherbicida dase folhas de Carica papaya

Abstract Due to increased number of herbicide resistant weeds, it is needed to explore the allelopathic potential of plants as an alternative. The research was conducted to investigate allelopathic effects of Carica papaya L. leaf powder and aqueous extract on seeds as well as pre-germinated seeds of Avena fatua L., Helianthus annuus L., Rumex dentatus L., Zea mays L. and Triticum aestivum L. on filter paper and soil in Weed Management Program Laboratory, Department of Plant and Environmental Protection at PARC Institute of Advanced Studies in Agriculture, National Agriculture Research Centre, Islamabad, Pakistan. Germination percentage (%), radicle length (cm) and plumule length (cm) were parameters observed for 'Plant leaf powder bioassay' and 'Aqueous extract method'. Most significant growth inhibition was observed in A. fatua seedlings in filter paper method. A. fatua radicle length was reduced by C. papaya aqueous extract (80%) and leaf powder (89%) bioassays. Plumule length was reduced under the influence of aqueous extract (57-73%) and powdered material (59-77%). The inhibitory effects on other test species were in sequence of H. annuus followed by Z. mays and R. dentatus. The aqueous extract showed non-significant effect on wheat seed germination, radicle and plumule growth. It is suggested that C. papaya aqueous extract can be used as source of weed management in wheat crop.

Resumo Devido ao aumento do número de ervas daninhas resistentes aos herbicidas, é necessário explorar o potencial alelopático das plantas como uma alternativa. A pesquisa foi conduzida com o objetivo de investigar os efeitos alelopáticos do pó foliar de Carica papaya e do extrato aquoso das sementes, bem como das sementes pré-germinadas de Avena fatua, Helianthus annuus, Rumex dentatus, Zea mays e Triticum aestivum em papel de filtro e solo no Laboratório do Programa de Manejo de Ervas Daninhas, Departamento de Plantas e Proteção Ambiental do Instituto PARC de Estudos Avançados em Agricultura, Centro Nacional de Pesquisa Agrícola, Islamabad, Paquistão. A porcentagem de germinação (%), o comprimento radicular e o comprimento da plúmula (cm) foram os parâmetros observados para o 'Bioensaio de Pó de Folha de Planta' e o 'Método de Extração Aquoso'. A maior inibição do crescimento foi observada em mudas de A. fatua no método de papel de filtro. O comprimento radicular de A. fatua foi reduzido com os extratos aquosos de C. papaya (80%) e pó de folhas (89%). O comprimento das plúmulas foi reduzido sob a influência do extrato aquoso (57-73%) e material em pó (59-77%). Os efeitos inibitórios em outras espécies-teste foram na sequência de H. annuus seguido por Z. mays e R. dentatus. O extrato aquoso apresentou efeito não significativo na germinação das sementes de trigo, nos crescimentos radiculares e das plúmulas. Sugere-se que o extrato aquoso de C. papaya pode ser utilizado como fonte de manejo de plantas daninhas na cultura do trigo.

Evaluation of bioherbicidal potential of Carica papaya leaves

Abstract Due to increased number of herbicide resistant weeds, it is needed to explore the allelopathic potential of plants as an alternative. The research was conducted to investigate allelopathic effects of Carica papaya L. leaf powder and aqueous extract on seeds as well as pre-germinated seeds of Avena fatua L., Helianthus annuus L., Rumex dentatus L., Zea mays L. and Triticum aestivum L. on filter paper and soil in Weed Management Program Laboratory, Department of Plant and Environmental Protection at PARC Institute of Advanced Studies in Agriculture, National Agriculture Research Centre, Islamabad, Pakistan. Germination percentage (%), radicle length (cm) and plumule length (cm) were parameters observed for Plant leaf powder bioassay and Aqueous extract method. Most significant growth inhibition was observed in A. fatua seedlings in filter paper method. A. fatua radicle length was reduced by C. papaya aqueous extract (80%) and leaf powder (89%) bioassays. Plumule length was reduced under the influence of aqueous extract (57-73%) and powdered material (59-77%). The inhibitory effects on other test species were in sequence of H. annuus followed by Z. mays and R. dentatus. The aqueous extract showed non-significant effect on wheat seed germination, radicle and plumule growth. It is suggested that C. papaya aqueous extract can be used as source of weed management in wheat crop.

Resumo Devido ao aumento do número de ervas daninhas resistentes aos herbicidas, é necessário explorar o potencial alelopático das plantas como uma alternativa. A pesquisa foi conduzida com o objetivo de investigar os efeitos alelopáticos do pó foliar de Carica papaya e do extrato aquoso das sementes, bem como das sementes pré-germinadas de Avena fatua, Helianthus annuus, Rumex dentatus, Zea mays e Triticum aestivum em papel de filtro e solo no Laboratório do Programa de Manejo de Ervas Daninhas, Departamento de Plantas e Proteção Ambiental do Instituto PARC de Estudos Avançados em Agricultura, Centro Nacional de Pesquisa Agrícola, Islamabad, Paquistão. A porcentagem de germinação (%), o comprimento radicular e o comprimento da plúmula (cm) foram os parâmetros observados para o 'Bioensaio de Pó de Folha de Planta' e o 'Método de Extração Aquoso'. A maior inibição do crescimento foi observada em mudas de A. fatua no método de papel de filtro. O comprimento radicular de A. fatua foi reduzido com os extratos aquosos de C. papaya (80%) e pó de folhas (89%). O comprimento das plúmulas foi reduzido sob a influência do extrato aquoso (57-73%) e material em pó (59-77%). Os efeitos inibitórios em outras espécies-teste foram na sequência de H. annuus seguido por Z. mays e R. dentatus. O extrato aquoso apresentou efeito não significativo na germinação das sementes de trigo, nos crescimentos radiculares e das plúmulas. Sugere-se que o extrato aquoso de C. papaya pode ser utilizado como fonte de manejo de plantas daninhas na cultura do trigo.

Effects of pure eicosapentaenoic and docosahexaenoic acids on oxidative stress, inflammation and body fat mass in patients with type 2 diabetes

N 3 Fatty acids reduce the risk of cardiovascular disease. Previous studies have shown that they may reduce inflammation, oxidative stress, and fat mass in patients with type 2 diabetes, but the results are inconclusive, due, in part, to type of omega 3 fatty acids used. The aim of this study was to determine the effects of pure eicosapentaenoic [EPA] and docosahexaenoic acids [DHA], the two major omega 3 fatty acids, on inflammation, oxidative stress, and fat mass in patients with type 2 diabetes. Sixty patients with DM II were randomly allocated to receive daily either tilde1 gr EPA or tilde1 gr DHA, or a canola oil as placebo for 12 weeks in a randomized triple blind, placebo controlled trial. Serum MDA, CRP, body weight, BMI, and fat mass were measured at baseline and after intervention. Forty five patients with a mean [ +/- SD] age of 54.9 +/- 8.2 years with BMI of 27.6 +/- 4.1 kg/m[2] and fasting blood glucose 96.0 +/- 16.2 mg/dl completed the intervention. Neither EPA nor DHA had significant effects on serum FBS, C reactive protein, body weight, BMI, and fat mass after intervention [P > 0.05]. In addition, while MDA increased 18% in the placebo group [P = 0.009], it did not change in the EPA or DHA group [P > 0.05]. Twelve weeks of supplementation with 1gr/d EPA or DHA prevent increasing oxidative stress without changing marker of inflammation. This study is the first report demonstrating that neither EPA nor DHA have effects on body fat mass in type 2 diabetic patients

Recurrence in breast cancer. analysis with frailty model

To determine the value of known prognostic factors for metastasis in breast cancer by accounting for patient-specific effect of patients who received surgical treatment followed by adjuvant treatment using the frailty model. One hundred seventeen women with breast cancer who underwent surgery followed by adjuvant therapy at 3 hospitals in Tehran, Iran between 1995 and 2003 were enrolled in this study. Women with defined breast cancer with no distant metastases at time of diagnosis that have undergone modified radical mastectomy or breast-conserving surgery were enrolled. Tumors were classified according to the Tumor, Node, Metastasis [TNM] system of the American Joint Committee on cancer. Grading was performed according to Scarff-Bloom-Richardson method. Estrogen receptor [ER] was measured by immunohistochemistry method. The patients have been followed regularly by routine clinical laboratory profile, serologic markers [CEA, CA15-3] and para-clinical examinations; furthermore, we have followed missing materials by other access ways such as calling. Median follow up time for patients was 26 months after surgery. During the follow up time 44 [38%] patients developed metastasis and 20 [45%] of these 44 patients experienced the second metastasis. The median disease-free survival for patients in the study was 49.6 month. The median time to experience second metastasis after the first one was 22.5 months. Risk of occurrence of a metastasis in the first year after surgery was 12%. Risk of experience a metastasis up to the second year was 32% and up to fifth years was 69%. Result of fitting a frailty model to data showed that size of tumor, number of positive lymph nodes and histologic grade had a significant effect on the risk of metastasis [p<0.05]. Patients with tumor size larger than 5 cm were in higher risk of metastasis compared with others. Increase in the number of positive lymph nodes to more than 10, increased risk of metastasis. Patients with moderate or undifferentiated histologic grade were in higher risk of metastasis to well differentiated patients. Age, family history, lymph node stage, and ER had no significant effect. It was found that there was heterogeneity between patients after adjusting for other covariates because variance of frailty was 0.315. It means that based on the variance of the distribution of frailty, the relative risk of high-risk patients to low-risk patients was 7.2, wherein high-risk group is defined as a cluster at the 95th percentile and low-risk to a cluster of 5th percentile of the frailty distribution. Known risk factors describe the risk of metastasis partly and other unknown or unmeasured factors, such as genetics or environmental factors are important to describe the risk of metastasis in breast cancer

Clinical signs as a guide for performing HSV-PCR in correct diagnosis of herpes simplex virus encephalitis.

BACKGROUND: Clinical criteria (symptoms) are not reliable enough to differentiate between different causes of encephalitis. The clinical presentation of herpes simplex virus encephalitis (HSVE) is not classically constant and in such a patient, therefore, it is vital to make early diagnosis. AIMS: To investigate satisfactory and crucial clinical signs as guide to perform HSV-PCR in a rapid diagnosis of herpes simplex virus encephalitis. MATERIAL AND METHODS: A total of 156 CSF specimens from 70 patients with clinically suspected HSVE or meningoencephalitis were tested. The criteria for cases suspected of HSVE were fever >380C, altered mental status and other critical manifestations. CSF features, irregularity in brain CT scan and MRI findings were also assessed. All the specimens were collected before and after Acyclovir treatment. Polymerase chain reaction was performed using primers, which amplified DNA sequences for both HSV-1 and HSV-2. STATISTICAL ANALYSIS: To analyze data, two-tailed Fisher's exact test and the X2-test with Yates' correction were used as appropriate. The odds ratio was used to express the strength of association between the clinical factors and the PCR results. RESULTS: HSV-DNA was detected in 18% of the specimens, belonging to 25.7% of the patients. Results indicate that the majority of the clinical symptoms are not specific to definitive clinical diagnosis of HSVE, except alteration in the level of consciousness--odds ratio [0.27 (0.07-0.96) (P=0.033)]; and lateralization sign--odds ratio [4.7 (0.98-22.6) (P=0.023)]. However, laboratory data, including total white blood cell count, especially the number of lymphocytes, and MRI findings could be suggested for HSV-PCR examination. CONCLUSION: At the first admission, a preliminary finding of at least two important clinical features mentioned above along with the pattern of CSF cell and differential counts could be sufficient to perform HSV-PCR which could ultimately result in a rapid and correct diagnosis of herpes simplex encephalitis.

Adaptive response to low dose of EMS or MMS in human peripheral blood lymphocytes.

Human peripheral blood lymphocytes stimulated in vitro for 6 hr were exposed to a low (conditioning) dose of ethyl methanesulfonate (EMS; 1.5 x 10(-4) M) or methyl methanesulfonate (MMS; 1.5 x 10(-5) M). After 6 hr, the cells were treated with a high (challenging) concentration of the same agent (1.5 x 10(-3) M EMS or 1.5 x 10(-4) M MMS). The cells that received both conditioning and challenging doses became less sensitive to the induction of sister chromatid exchanges (SCEs) than those which did not receive the pretreatment with EMS or MMS. They responded with lower frequencies of SCEs. This suggests that conditioning dose of EMS or MMS has offered the lymphocytes to have decreased SCEs. This led to the realization that pre-exposure of lymphocytes to low dose can cause the induction of repair activity. This is a clear indication of the existence of adaptive response induced by alkylating agents whether it is ethylating or methylating in human lymphocytes in vitro.

Inducible protective processes in animal systems: adaptive response to a low dose of methyl methanesulfonate in mouse bone marrow cells.

To investigate the induction of adaptive response (inducible protective processes) in mitotic cells of Swiss albino mouse, a monofunctional alkylating agent methyl methanesulfonate (MMS) was employed. When the animals treated with a low dose of 50 mg/kg body weight were challenged with a subsequent high (challenging) dose of 150 mg/kg body weight, after different time lags (2,5,8 or 10 hr), the yield of chromosomal aberrations in bone marrow cells was found to be significantly reduced compared to the additive effects of both conditioning and challenging doses. It seems, therefore, that the low dose of MMS employed has made the cells less sensitive against further clastogenic effect of challenge dose of MMS. The data clearly suggest that the phenomenon of adaptive response to methylating agents can be encountered in in vivo mammalian cells. Furthermore, it is also observed that ethylating agent EMS is a poor inducer of adaptive response than its corresponding methylating agent MMS in the bone marrow cells of mouse.

Acid base status and IgG index in viral meningoencephalitis: diagnostic and prognostic aspects

The current study was carried out on 182 patients with viral encephalitis or meningoencephalitis being selected according to certain clinical as well as C.S.F. criteria in which the viral etiology could be confirmed in 118 cases of them through various virus identification techniques. The aim of the study was to evaluate from the diagnostic as well as prognostic point of view various pH and gases changes in the CSF as well as arterial blood in those patients and in addition to assess the intrathecal IgG production which was reported to increase in those patients. In order to get reliable data, the study included 20 healthy subjects as a control group who were subjected to all lab tests as the patient's group including: CSF and blood pH PO[2] PCo[2] and also a simple equation for determining IgG index as an indicative for intrathecal IgG production. The results showed highly significant reduction in blood PCO2, PO[2] and CSF pH, PO[2], associated with a highly significant elevation in blood pH and CSF PCO[2] in patients compared to control group. Prognostically speaking, the changes in the above mentioned variables, with the exception of blood pH and CSF PO[2] could reflect the clinical severity with an intimate relation to the final outcome. However, no statistical relationship; could be found between these variables and the various etiological viruses. Regarding the IgG index, elevated figures, i.e. > 0.7 were reported in most of the patients [around 84 percent] while all individuals within the control group showed values less than 0.7. However, local IgG production was unreliable test for predicting the outcome, din cal severity and viral etiology where the difference between IgG index values among different outcomes, clinical severity and virals etiology parameters were statistically insignificant

predisposing factors of otitis in children

Our research was done on infants and children with acute or recurrent acute suppurative otitis media to study the significance of the different predisposing factors. The youngest infant subjected to this study was 2 months old, while the oldest child was 12 years old