Efficacy of plasmapheresis in neutropenic patients suffering from cytokine storm because of severe COVID-19 infection

Background@#With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication.However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer. @*Methods@#This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes. @*Results@#CRP (P ＜0.001), D-dimer (P ＜0.001), ferritin (P =0.039), and hemoglobin (P =0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P ＜0.001). However, plasmapheresis did not affect the length of hospital stay (P =0.076), which could have significantly increased survival rates (P ＜0.001). @*Conclusion@#Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses.

Changes in the pharyngeal airway after different orthognathic procedures for correction of class III dysplasia / 대한악안면성형재건외과학회지

Objective@#This study was conducted to compare changes in pharyngeal airway after different orthognathic procedures in subjects with class III deformity. @*Methods@#The study included CBCT scans of 48 skeletal class III patients (29 females and 19 males, mean age 23.50 years) who underwent orthognathic surgery in conjunction with orthodontic treatment. The participants were divided into three groups of 16, as follows: Group 1, mandibular setback surgery; group 2, combined mandibular setback and maxillary advancement surgery; and group 3, maxillary advancement surgery. CBCT images were taken 1 day before surgery (T0), 1 day (T1), and 6 months (T2) later. The dimensions of the velopharynx, oropharynx, and hypopharynx were measured in CBCT images. @*Results@#In all groups, there was a significant decrease in airway variables immediately after surgery, with a significant reversal 6 months later (P < 0.05). In subjects who underwent maxillary advancement, the airway dimensions were significantly greater at T2 than the T0 time point (P < 0.05), whereas in the mandibular setback and bimaxillary surgery groups, the T2 values were lower than the baseline examination (P < 0.05). The alterations in airway variables were significantly different between the study groups (P < 0.05). @*Conclusions@#The mandibular setback procedure caused the greatest reduction in the pharyngeal airway, followed by the bimaxillary surgery and maxillary advancement groups, with the latter exhibiting an actual increase in the pharyngeal airway dimensions. It is recommended to prefer a two-jaw operation instead of a mandibular setback alone for correction of the prognathic mandible in subjects with predisposing factors to the development of sleep-disordered breathing.

Objective Monitoring of Brace Wearing Time in Adolescents with Scheuermann’s Kyphosis

STUDY DESIGN: This was a prospective cohort study.PURPOSE: This study aimed to evaluate the potential differences between the objective and subjective bracing compliances of adolescents with Scheuermann’s kyphosis.OVERVIEW OF LITERATURE: Bracing is a well-documented intervention for managing adolescents with progressive thoracic Scheuermann’s kyphosis, and the brace should be worn 23 hours every day. Most research studies that have investigated the efficacy of bracing have assumed that the patients wore the braces as advised or that the bracing time was measured subjectively. This may be one of the reasons for the conflicting reports regarding the efficacy of bracing.METHODS: Nineteen volunteers (11 girls and 7 boys, 12.89±1.77 years) who were prescribed Milwaukee braces for Scheuermann’s kyphosis were enrolled. Each brace was equipped with a miniature temperature logger to record the actual brace wearing time over a period of 3 weeks. The patients and their families were unaware of the mounted sensor. Each participants and/or parent was provided with a questionnaire to record the number of hours for which the brace was worn each day. In addition, the therapist asked each patient and/or his/her parent about the average number of hours that the brace was worn.RESULTS: The compliance rates measured using the temperature logger (16.00±4.90 hours daily) were significantly lower than those reported in the questionnaires (19.52±6.04 hours daily, p<0.001) and the verbal responses (20.21±6.05 hours daily, p<0.001). Moreover, there was no correlation of age, sex, and body mass index with brace compliance.CONCLUSIONS: The braces were worn less often than reported by the patients and/or their parents. Therefore, objective compliance assessments of adolescents with Scheuermann’s kyphosis in a brace are recommended for future studies.

Predicting vitamin E and C consumption intentions and behaviors among factory workers based on protection motivation theory

BACKGROUND@#Study of antioxidant vitamin consumption behavior, especially in high-risk groups with high exposure to toxic metals to reduce metal toxicity, is emphasized. This study aims to examine the structural relationships between knowledge, protection motivation theory constructs, and vitamin E and C consumption behavior among cement factory workers.@*METHODS@#Protection motivation theory and food frequency questionnaires were completed by 420 factory workers. Data were subjected to structural equation modeling to examine associations between knowledge, protection motivation theory constructs, and vitamin E and C consumption behavior. Efficacy of current recommended models was also explored.@*RESULTS@#Structural equation modeling showed high explained variance within the constructs of protection motivation theory for vitamin E and C consumption behavior and intention (56-76%). The overall fit of the structural models was acceptable for both vitamin E and C behavior. Knowledge, self-efficacy, response efficacy, and perceived vulnerability predicted intention, which in turn predicted vitamin consumption behavior. Significant relationships between knowledge and self-efficacy, response efficacy, perceived vulnerability, and perceived severity were also found, while self-efficacy and response efficacy showed significant relationships with vitamin E and C consumption behavior.@*CONCLUSIONS@#Considering that response efficacy, self-efficacy, and intention showed as strong predictors of vitamin E and C consumption behavior, specific attention should be paid to coping appraisals and intention when designing intervention plans. Additionally, establishing the predicting role of knowledge for protection motivation theory constructs and protective behaviors should be integrated into intervention programs.

Measurement of Milwaukee Brace Pad Pressure in Adolescent Round Back Deformity Treatment

STUDY DESIGN: In this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment. PURPOSE: We evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace. OVERVIEW OF LITERATURE: A fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction. METHODS: Interface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation. RESULTS: The mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (p=0.001).There were no statistically significant differences between right and left shoulder pad pressures (p>0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (p<0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (p=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction. CONCLUSIONS: In the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.

[Effect of group exercising and adjusting the brace at shorter intervals on cobb angle and quality of life of patients with idiopathic scoliosis]

Objective: Bracing along with exercising is the most effective protocol in patients with idiopathic scoliosis which have Cobb angles of 25 to 45 degrees. However, since the psychological aspects of scoliosis treatment may affect the quality of life, and the exact time for adjusting the pads of Milwaukee brace is unknown; Therefore the aim of this study was evaluating the effect of exercising in a group, with adjusting the brace in shorter intervals, in compare to routine protocol, in the treatment of idiopathic scoliosis

Materials and Methods: Thirty-four patients with idiopathic scoliosis which had Cobb angles of 50 to 15 degrees were included in this study and were divided into experimental and control groups. The patients of two groups participated in an eleven-week treatment program, differ between the two groups. Quality of life scores of both groups were evaluated before and after intervention using SRS-22 questionnaire, as well as scoliosis angles before and after the intervention according to the primary and secondary radiographic X-rays

Results: Statistical analysis was performed using Paired T-Test in each group, and Independent T-Test between the two groups before and after treatment. The severity of scoliosis curvature and satisfaction domain of the experimental group was reduced significantly in compared with the control group, after intervention [P=0.04]. Moreover in the case of the quality of life in patients with Cobb angles less than 30 degrees, compared with patients with Cobb angles greater than 31 degrees, in the domains of selfimage, satisfaction, and total score, the difference was significant [P<0.05]

Conclusion: Adjusting the brace at shorter intervals along with exercising as a group, during the eleven weeks of treatment, has increased satisfaction and reduced the scoliosis Cobb angles of patients

Screening and antibacterial efficacy of selected Indian medicinal plants

Objective: To evaluate the antibacterial efficacy of five Indian medicinal plants such as Acalypha indica L. (A. indica), Aerva lanata (L.) Juss. ex Schult. (A. lanata), Clerodendrum inerme (L.) Gaertn., Pergularia daemia (Forsk.) Chiov. and Solanum surattense Burm. f. against opportunistic bacterial pathogens isolated from HIV infected patients for the potential phytoconstituents in plant extracts. Methods: The opportunistic bacterial pathogens such as Escherichia coli (E. coli), Pseudomonas aeruginosa, Salmonella typhi and Serratia marcescens from Gram-negative group and Staphylococcus aureus from Gram-positive group were isolated from HIV infected patients. The antibacterial efficacy of ethanolic extracts of selected medicinal plants was carried out by disc diffusion method. The potential phytoconstituents of medicinal plant extracts were identified by gas chromatography and mass spectrometry (GC-MS) analysis. Results: Among the five medicinal plants tested, A. indica and A. lanata showed the significant antibacterial activity. A. indica showed potential activity against Staphylococcus aureus and E. coli. A. lanata significantly exhibited antibacterial activity against E. coli, Salmonella typhi and Pseudomonas aeruginosa. A total of 19 phytoconstituents were identified in the ethanolic extract of A. indica and A. lanata by GC-MS analysis respectively. Conclusions: The results of the present investigation revealed that A. indica and A. lanata, possessed significant antibacterial activity when compared with the other plant extracts tested. The presence of 3-O-methyl- d-glucose by GC-MS analysis in both A. indica and A. lanata extracts has not been reported elsewhere in the literature and the findings in this study could be the first one to report.

Molecular characterization of Cysticercus tenuicollis of slaughtered livestock in Upper Egypt governorates

Objective To present the molecular characterization of Cysticercus tenuicollis (C. tenuicollis) of Taenia hydatigena (T. hydatigena) from livestock isolates in Egypt, and to introduce a detailed image of C. tenuicollis infection in ruminant animals in Upper Egypt. Methods The prevalence rates of C. tenuicollis infections among the slaughtered animals from different organs were determined using the amplification of sequencing of the MT-CO1 gene. Results In the present study the infection rates of C. tenuicollis were found to be 16% and 19% in sheep and goat samples respectively. Firstly we report one larval stage of T. hydatigena detected in the camel liver in Egypt. C. tenuicollis infection manifested a higher prevalence in females than in males. Those above two years of age manifested a higher infection rate than younger animals. The preferred site for the infection was the omentum: a 70% preference in sheep and a 68% preference in goats. The molecular characterization using the MT-CO1 gene of isolates from sheep, goats and camels corresponded to T. hydatigena. For this study, molecular characterizations of T. hydatigena were done for the first time in Egypt. Molecular tools are of great assistance in characterizing the C. tenuicollis parasite especially when the morphological character cannot be detected, because the metacestodes are frequently confused with infection by the hydatid cyst, especially when these occur in the visceral organs. In the present study, C. tenuicollis manifested high identity in the goat and sheep samples, while differences were found more frequently in the camel samples (10 base pair). Conclusions Clearly molecular diagnosis for C. tenuicollis infection significantly helps to differentiate it from such other metacestodes as hydatidosis, which manifests a completely different pathogenicity and requires different control programs.

Medical students' perception of the proposal for theme-based integrated multi-disciplinary objective structured practical examination in Saudi Arabia / 보건의료교육평가

This study aimed to find the opinion of preclinical medical students concerning a new suggested approach for practical assessment. Fifty-three female students agreed to participate in this study, out of 87 registered students in years 2 and 3 of the basic science phase of the College of Medicine, Qassim University, Kingdom of Saudi Arabia. Full explanation was made to the students of theme-based integrated objective structured practical examination (TBI-OSPE), followed by distribution of a questionnaire to collect the students' opinions. The study was conducted in January 2015. Results showed that 78% of respondents were accepting of this new approach, and that only 5.7% rejected it. This difference was statistically significant (P<0.05). This study suggested a new model for assessment of preclinical students' competencies using the proposed tool (TBI-OSPE) rather than standard classical OSPE, particularly in curricula involving high levels of integration and theme-based problems. This form of assessment would more positively enhance learning.

Review on Application of Nucleic Acid Amplification Techniques in Pharmaceutical Products Analysis.

The aim of this study was to describe application of molecular diagnostic tests based on nucleic acid amplification technologies (NAATs) in pharmaceutical product analysis. NAAT have become widely established in clinical microbiology laboratories in recent years, as well as in quality control (QC) laboratories for food testing, and lately introduced to the pharmaceutical QC laboratories. The number of available nucleic acid and gene amplification-based rapid microbiological methods has increased over the last few years, and for good reason. When compare to standard culture based methods, NAAT provide a rapid, an accurate and reliable means for detecting specific microorganisms of interest, especially in pharmaceutical dosage forms that are required to be free of objectionable or specified pharmacopeial organisms. This article discussed about the different types of nucleic acid amplification techniques and methods available to pharmaceutical microbiologists working on quality control of pharmaceutical products and develop some awareness among other pharmaceutical scientists. This review also highlights limitations of these methods applied in industrial setup.

Medical treatment of nasal polyps: a review

Nasal polyp is macroscopic edematous mass and it is a most common nasal complaint of the patients. The exact etiology is still unknown and controversial, but the main causes are assumed to be the inflammatory conditions and allergy. Their clinical presentations are obstruction, rhinorrhea, postnasal drip. Nasal polyp is more common in allergic patients with asthma. Treatment of this complication is associated with both medical treatment and surgery. Corticosteroids [systemic and topical] are shown to be beneficial in reducing the size of nasal polyp. Corticosteroids are also used as a primary treatment and postoperative management for avoiding recurrence. The rate of leukotrienes is increased in polyps. It is reported that leukotriene receptor antagonists [antileukotriene] have a beneficial effect on nasal polyp treatment. Montelukast is an antileukotriene. It can be used to modify the symptoms of nasal polyp. There is no significant difference between corticosteroids and montelukast clinical efficacy

Understanding of school related factors associated with emotional health and bullying behavior among Jordanian adolescents

Students emotional health and bullying behavior are receiving greater attention worldwide due to their long-term effects on students' health. The purpose of this study was to examine the relationships between perceived school climate, peer support, teacher support, school pressure and emotional health and bullying among adolescent school students in Jordan. A cross-sectional descriptive design was used to recruit a sample of 1166 in-school adolescents in Amman between November 2013 and January 2014. A multi-stage cluster sampling technique was used to select respondents and Health Behavior in School Aged Children questionnaire was used to collect the data. Data were analyzed using Pearson Correlation to detect relationships among study variables. Significant correlations [P value was

Primary vaginal hydrocele; different surgical procedures: a comparative study

A hydrocele is a fluid - filled sac surrounding a testis that results in the swelling of scrotum. They can develop due to inflammation or injury within the scrotum. This study aimed to evaluate the efficacy and adaptation of different surgical procedures in the repair of hydrocele.Comparative, Retrospective study .The study was conducted at Fauji Foundation Hospital Karachi, Al-Tibri Medical College, Karachi and Civil Hospital Karachi from January, 2000 to December, 2013. Patients with primary vaginal hydrocele registered during the period of thirteen years in the out patient department of surgery were selected. A total of 300 patients were assessed clinically, diagnostically and radiologically about the status of hydrocele before the surgical procedures and anesthetic opinion. The different surgical technique were carried out in different group of patients asJaboulay's technique in 70 patients, Lord's procedure in 70 patients, Aspiration and Sclerotherapy in 05 patients, Window operation technique in 05 patients and the Hydrocelectomy by supra pubic procedure were carried out in 150 patients out of total 300 registered patients. The data collected and analyzed statistically in SPSS version 19.00. The different procedures have been adopted surgically in patients with primary vaginal hydrocele. The results showed that among the different operative techniques adopted, the best procedure regarding hydrocelectomy is the supra pubic approach line of treatment. It showed better result and recovery with very minimum complications and side effects as compared to other surgical procedure. The data thus concluded that hydrocelectomy done via supra pubic approach in number of patients proved to be the best procedure because of having very little complications

Effects of season (summer & winter) on electrical characteristics of skeletal muscle membranes of the spiny-tailed lizard, uromastix hardwickii.

This study deals with the observation of changes with temperature variations of the seasons in the muscular electrical excitability in the reptile Uromastix hardwickii. Freshly captured adult animals of both the sexes were used in all the experiments, and the gastrocnemius (skeletal) muscles were dissected out. The muscle samples were digested with digestive fluid (pepsin & Hcl), stirred, settled and supernatant was removed, till whitish fluid having clear cells obtained for patch clamp recording of ionic currents and potentials. Resting membrane potentials and action potentials of reptilian cell membranes were measured in whole cell current mode. The glass microelectrodes, with a tip diameter 2–3 μm and tip resistance 5–6 MW (when filled with intracellular solution) were used in these experiments. The present study was carried out to investigate the electrical characteristics of the skeletal muscles of this species of Uromastix, which are not studied earlier. The average mean values of resting membrane potential, action potential and its durations showed no significant changes with the change in the season, but other components of action potential including threshold potential, after-potential and its duration were found to be increased significantly (P<0.05) in summer as compared to winter. Temperature dependency of these parameters with seasonal variation, are studied for the first time in the gastrocnemius (skeletal) muscles of Uromastix hardwickii. Hence seasonal changes in the components of action potential are invariably associated with changes in environmental temperature, and may be responsible for changes in the activities and homeostasis of these animals; and possibly indicating underlying mechanism of hibernation.

effects of altered ultrasound parameters on the recovery of sciatic nerve injury

Initial studies have shown that low-energy ultrasound stimulates living tissue cells to reduce regeneration or speed up their recovery. The purpose of this study was to examine the effects of various ultrasound parameters on the speed of recovery in injured sciatic nerves. NMRI mice [n = 200] with injured left paw, caused by crushing their sciatic nerves, were randomly selected. The animals were exposed to ultrasound radiation with various frequencies, intensities, and exposure time. They were allocated into 20 groups [19 treatment and 1 control groups]. Sciatic functional index [SFI] test was used to evaluate the difference between the groups with respect to functional efficiency of the sciatic nerve and its recovery. The results of SFI test obtained from the 14th day showed a significant difference among the groups [P<0.05]. On the 14th day after treatment, one of the groups [US11] recovered up to 90%. Altered ultrasound exposure parameters had more favorable outcomes compared with our previous work

Application of molecular methods of genetic counseling in inherited forms of renal tubular acidosis for preventive strategy

Renal tubular acidosis [RTA] results from failure of the kidney to acidify the urine resulting in a state of hyperchloraemic metabolic acidosis with a normal anion gap. Three main clinical types of RTA are now recognized [proximal, distal and hyperkalemic] but the number of possible causes is large. Inherited forms of distal RTA have three variants: autosomal dominant and autosomal recessive with or without deafness, while the inherited forms of proximal RTA include many variants as autosomal recessive proximal RTAt cystinosis, Fanconi-Bickel syndrome [FBS] and Wilson's disease. Thus, we conducted a prospective study to screen all the documented cases of inherited RTA in pediatric nephrology outpatient clinic in MUCH for relevant gene mutation. This study was carried out in the period from November 2009 to February 2012. The study comprised 17 Egyptian families having documented cases of inherited RTA. We found three families compatible with the clinical diagnosis of FBS, two families compatible with the clinical diagnosis of cystinosis and 12 families of dRTA. All patients were subjected to a thorough history, full clinical examination and laboratory investigations. Pedigree construction was done for each family. Radiological investigations were done for some cases including plain x-ray for racketic findings, abdominal ultrasound and echocardiography done for those with clinical findings coping with congenital or acquired heart diseases. Liver biopsy was done for those with hepatomegaly. Molecular workup was done in the form of DNA extraction, agarose gel electrophoresis, polymerase chain reaction of the extracted DNA and sequencing for the specific gene according to each disease. We found two new mutations in GLUT2 gene and an old missense mutation [re-enumerated] in three families of FBS. We found a novel truncating mutation in CTNS gene associated with a severe clinical course and double heterozygosity for two known mutations in the other family. Two novel mutations were detected in two out of 12 families of dRTA in ATP6VOA4 gene. We concluded that although these diseases are not rare in the Egyptian population, evolving new mutations could add some allelic variants. Moreover, studying phenotype-genotype pattern of different mutations is crucial for linkage analysis

Results of milwaukee and boston braces with or without metal marker around pads in patients with idiopathic scoliosis

Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis [AIS] and careful application of pads on apical segment of curve is very important for correction. Control of pads' appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases [182 female, 33 male] of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2 +/- 1.8 years [9-16] and mean duration of follow-up was, 16.1 +/- 16.4 months [0-114] that treated by 4 type of brace; 89 with type 1[Milwaukee with metal pads], 87 with type 2 [Milwaukee with simple pads], 17 with type 3 [Boston with metal pads] and 22 with type 4[Boston with simple pads]. Cobb angle recorded at 5 stages [initial, best, wean, stop and final follow-up]. Mean initial Cobb was 36.2°, at stop stage, 35.2° and reached 38° at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients [27.4%] underwent spinal fusion that for brace type 1 to 4, was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50°, at follow-up, 12 were >/= 50° or had spinal fusion. Correction of lumbar [P=0.008] and main thoracic curves [P=0.002] was better by Boston than Milwaukee, however, in general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites well, so, we recommend to use

Gene polymorphism analysis in the epidemiological typing of hospital acquired methicillin-resistant staphylococcus aureus isolates

Background and objectives: typing of Meticillin-resistant Staphylococcus aureus [MRSA] is of great importance for detection of the relatedness of isolate. Both phenotypic and genotypic markers can be employed to type MRSA strains. The spa gene encoding protein A and the CoA gene encoding coagulase enzyme contain highly polymorphic repeat units. These repeats allowed for differentiation between MRSA isolates that are heterogeneous in respect to these regions using polymerase chain reaction - restriction fragment length polymorphism [PCR - RFLP] assay. This study aimed to address the competence of various typing methods [antibi typing, coa gene typing and spa gene typing] in discriminating MRSA isolates and to assess the concordance between the used typing methods

Material and Methods: this study included, 61 nosocomial MRSA isolates collected from different clinical wards of Mansoura University Hospitals between December 2009 and September 2010. They were analyzed by antibiotic resistance profile and PCR - RFLP of both CoA and spa genes after Alu- I and Rsa -I restriction enzymes digestion respectively. The discrimination index [D] and concordance were calculated

Results: the power of discrimination among MRSA isolates as estimated by the discrimination index increased orderly from antibi typing [D = 0.69], spa gene typing [D = 0.74] to CoA gene typing [D = 0.82] yielding 8, 5 and 6 types respectively. Combination of the 3 typing methods offered the highest D of 0.98. Coa gene typing was more concordant with spa gene typing, while the concordance between antibi typing and each of Coa and spa typing was the same

Conclusion: we concluded that, CoA typing demonstrated the most effective discrimination of MRSA isolates, while grouping of isolates based on combining the 3 typing methods provided the highest discrimination. So, CoA and spa genetic typing methods could be used in routine epidemiological surveillance in association with antibi typing as daily screening test which is very beneficial to develop efficient infection control measures in hospitals

role of QuantiFERON TB and adenosine deaminase tests in the early management of tuberculous peritonitis

Background: Peritoneal tuberculosis [PTB] is an unusual cause of ascites in developed countries but it is a considerable problem in developing countries. The advance and validation of new diagnostic strategies are precedence for tuberculosis control programs

Objective: To probe the effectiveness of adenosine deaminase [ADA] activity and QuantiFERON TB Gold In-tube [IT] for diagnosis of PTB

Materials and Methods: Forty one patients were enrolled from Feb. 2007 to Jan. 2010 with a presumptive diagnosis of tuberculous peritonitis with ascites at Mansoura University Hospitals. The ascitic fluid was examined biochemically [protein content], cytologically [WBCs count] and microbiologically [ZN stain and TB culture on Lowenestien-Jensen media]. The level of ADA was determined in ascetic fluid samples. Interferon [IFN] - gamma of whole blood was assayed by QuantiFERON TB Gold [IT] ELISA test

Results: Fourteen [34.14%] patients were diagnosed as TB peritonitis according to pre-determined definition criteria. Three [21.4%] cases were positive for acid-fast bacilli [AFB] smear with 21.4% detection sensitivity and 100% specificity. Mycobacterium tuberculosis [MTB] cultures were positive in 8 patients with a detection sensitivity of 57.1% and 100% specificity. Using Receiver operating characteristics [ROC] curve, a cut-off level of 35 IU/L for the diagnosis of TB peritonitis by ADA was found to have the best results with corresponding sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of 100%, 92.6%, 87.5% and 100% respectively. Thirteen [92.85%] out of 14 TB peritonitis patients were positive for QuantiFERON-TB Gold [IT] assay. The only negative case was TB culture positive and AFB-smear negative. The sensitivity and specificity of PPV and NPV assay were 92.9%, 100%, 100% and 96.4% respectively

In conclusion: the use of these rapid tests with enough discriminatory power gives a chance for initiation of treatment while waiting for the results of MTB culture

Endothelin-1 and leptin as markers of intrauterine growth restriction.

Objective. To explore the role of endothelin-1 (ET-1) and leptin in intrauterine growth restriction (IUGR) among preeclamptic and non-pre-eclamptic women. Methods. Forty three patients with a pregnancy complicated by IUGR, 23 cases with severe pre-eclampsia and 20 cases of non-pre-eclamptic were enrolled. Control group comprised 15 cases with uncomplicated pregnancy. Blood samples from umbilical artery and maternal venous blood were collected at the time of delivery for analysis of ET-1 and leptin levels. Mode of delivery, birth weight and Apgar score were also recorded. Results. The mean maternal and fetal ET-1 level was significantly higher in pregnancies complicated by IUGR than in control group. The mean maternal leptin level was significantly higher in pre-eclamptic patients when compared to nonpreeclamptic and control groups. Mean fetal leptin level was significantly lower in patients compared to control; however, when fetal leptin corrected to fetal weight, it was insignificantly different in the both groups. Conclusion. Maternal plasma ET-1 and leptin correlate with the degree of fetal growth restriction originating from deterioration of placental function. Maternal plasma leptin and ET-1 levels may reflect deterioration in fetal growth.