Weekly intravesical bacillus Calmette-Guerin [BCG] alternating with epirubicin in Ta and T1 urothelial bladder cancer: an approach to decrease BCG toxicity

Bacillus Calmette-Guerin [BCG] therapy is the standard treatment for nonmuscle-invasive bladder cancer [NMIBC]. However, its toxicity is a major concern. If we reduce the number of BCG doses by half and replace the second half with epirubicin, we may have a lower toxicity while maintaining the same efficacy of BCG. To test this hypothesis, we conducted this study as an update of our previous report. The study included 607 patients with Ta and T1 NMIBC between January 1994 and December 2008. After transurethral resection of bladder tumor [TURBT], the patients received weekly doses of 120 mg BCG alternating with 50 mg epirubicin for six weeks [three weekly doses of each]. Maintenance was given. Recurrence, progression rates, and toxicity were assessed. End points were progression, recurrence, and cancer-specific survival. A total of 532 patients were eligible for evaluation [mean age: 58 years; median follow-up: 45 months]. Of these, 291 [55%] were free, 157 [29.5%] showed recurrence, and 84 [15.8%] showed muscle-invasive progression. Toxicity developed in 221 patients. These were mild in the majority [167], whereas 10 developed hematuria, 30 severe cystitis, and five systemic complications. The rate of permanent therapy discontinuation was 3.8%. SPSS package version 16 and Kaplan-Meier curves were used to evaluate survival. Reducing the frequency of BCG instillations by half and replacing the second half with epirubicin results in a similar efficacy and a lower toxicity compared with historical cases receiving BCG alone. However, further trials are required to support these results

Interactions of spodoptera littoralis haemocytes following injection with the entomopathogenic fungi: Beauveria Bassiana and Nomuraea Rileyi

This study compared the cellular interactions of Spodopteralittoralis haemocytes with two virulence-different entomopathogenic fungi: Beauveriabassiana and Nomuraearileyi. Using light and transmission microscopy, five types of haemocytes namely, prohaemocytes [PRs], plasmatocytes [PLs], granulocytes [GRs], spherule cells [SPs] and oenocytoids [OEs] were identified in the 6[th] instar larvae. PRs and PLs were found in the haemopoietic tissue.Intra-haemocoelic injection of blastospores induced ultrastructural alterations in the cytoplasm and nucleiof circulating haemocytes of treated larvae. Different responses were observed in the populations of haemocyte types following injection with the tested fungi. The most important changes were the decrease of the numbers of GRs aiccompanied with increase inSPs at 12-48h following injection with B. bassiana, whereas,a decrease of PLs with a commitment increase inSPs and OEs were observed at most time intervals after injection with N. rileyi. Both fungi provoked a decrease of the total number of haemocytes at 48h followed by an increase at 72h post-injection. In vivo assay showed that the GRs and PLs actively phagocytised fungal blastospores. There was a time-dependent decrease and increase in the phagocytosis activity after injection of B. bassiana and N. Rileyi, respectively .In B. bassiana-injected insects, the numbers nodules increased significantly at 6-48h in comparison with the controls post-injection. In N. rileyi-injected insects, nodules increased significantly only at 72h post-injection.No cellular encapsulation was observed in any of the examined insects

novel report on european foulbrood as the most recent disease in honeybee [apis mellifera L.] colonies in Egypt; instigating a control approach

This work considered the widespread of European foulbrood [EFB] infections among honeybee colonies in Egypt. Apiaries in some Egyptian-Delta governorates were inspected for the occurrence of foulbrood during the period extended from February 2007 to June 2008. Field diagnosis illustrated the abundance of EFB-symptoms among the inspected apiaries in spring and early summer as well as in winter. Investigation of foulbrood-associated-microflora revealed the dominance of Gram-positive non spore-forming cocci-shaped bacteria followed by Gram-positive aerobic spore-forming bacilli. Isolation and identification of Melissococcus pluton from scales verified the preliminary field diagnosis of foulbrood type. According to some of their morphological, cultural and biochemical characteristics 97 of cocci-shaped isolates were belonged to M. pluton, the primary aetiological EFB agent, and 91 strains were related to the secondary EFB invading bacterium Streptococcus faecalis. Characterization of spore-forming bacilli isolated from EFB affected larvae indicated the absence of Paenibacillus larvae, the American foulbrood causing agent, and the dominance of Paenibacillus alvae, the second EFB indicator. This conclusively confirmed the field diagnosis of EFB clinical symptoms as well as the preliminary detection of EFB causing bacterium in the laboratory. Essential oils from Eucalyptus globules, Coriandrum sativum, Citrus nobilis, Citrus limonum and Thymus vulgaris exhibited in vitro various antibacterial activities against M. pluton. Eucalyptus globules oil was the most effective antibacterial substance against the pathogen; growth inhibition due to this phytochemical was a concentration dependent trait

Selection of microencapsulation method to improve antimicrobial agents production by some lactobacillus species and propionibacterium thoenii in dairy products

The aim of this research is to select the agreeable encapsulation method to improve antimicrobial production from Lactobacillus acidophilus, Lactobacillus reuteri, Lactobacillus rhamnosus and Propionibacterium thoenii. The effect of different organic acid concentrations [1 and 2 w/v], different pH values [3, 4, 5, 6. 7 and 8], different temperature degrees [0, 7, 25, 37 and 45°C] and storage temperature on viability of encapsulated bacteria were investigated. Also, the efficiency of microencapsulated methods [alginate + NaCI, alginate + oil and K-carrageenan] on enhancement of antimicrobial production were studied. Microencapsulation with alginate + NaCI offered greater production in extreme conditions [low pH, low temperature and in the presence of organic acids]. In addition, this method was more effective against pathogenic bacteria by enhancement of antimicrobial production, thus it may be effectively used to increase the safety and the shelf- life of dairy products

Could the MMR vaccine replace the measles vaccine at one year of age in Egypt?

This cross-sectional study evaluated the immune status of non-vaccinated healthy infants to determine if it is possible to replace both measles vaccine [at 9 months] and measles, mumps and rubella [MMR] vaccine [at 18 months] with a single dose of MMR at 12 months. Serum samples from 566 children in Alexandria, Egypt showed a significant decrease in the seropositive rate to the 3 viral diseases with increasing age, but a significant increase in the seropositive rate among infants who were ranked 1st or 2nd in their family, full-term or born to mothers with no history of hypertension during pregnancy. We recommend administration of the first dose of MMR vaccine between 9 and 12 months of age, and a booster dose of MMR vaccine at 4 years of age

Effect of drying methods on the chemical and technological properties of the instant talbina powders

Talbina, cooked barley syrup, is made by cooking barley flour in water. It was subjected to different drying methods, freeze-drying, spray drying and under vacuum drying to produce instant Talbina powders [A], [B] and [C], respectively. Chemical composition, scanning electron microscope [SEM]; X-ray diffraction, differential scanning colorimeter [DSC] and color attributes of the barley flour and the produced instant Talbina powders were studied to see the effect of the drying methods. Reconstitution capacity of the instant Talbina powders was studied. Adding milk improved the organoleptic properties of the reconstituted instant Talbina powders, while adding vanilla deteriorated these organoleptic properties. Reconstitution capacity of the instant Talbina powder [B] recorded the highest score in aroma, taste and overall acceptability compared with reconstituted instant Talbina powder [A] and [C], respectively. Instant Talbina powder can be produced by spray drying of cooked solution of Talbina with big quantity, economic costs, high reconstitution capacity and good quality in color, aroma, taste and overall acceptability

Detection of enteroviral RNA in cerebrospinal fluid [CSF] specimens of children presenting with aseptic meningitis using reverse transcription- polymerase chain reaction [RT-PCR]: correlation with CSF cell counts and elevated protein levels

Enteroviruses are known to be involved in at least 85% of cases of aseptic meningitis [AM] for which an aetiology can be determined, particularly among children and infants. The diagnosis of enteroviral meningitis presents a challenge for the clinician and is frequently a diagnosis of exclusion as clinical criteria alone are not enough to distinguish between enteroviral AM and other, more serious, central nervous system [CNS] infections caused by other neurotropic viruses and some bacteria. This has raised concerns regarding accuracy of diagnosis and its impact on patient management. The aim of this study was to determine whether cerebrospinal fluid [CSF] parameters mainly pleocytosis and elevated protein level can be used to establish viral aetiology of meningitis and to indicate if Enteroviral Reverse Transcription- Polymerase Chain Reaction [EV RT-PCR] should be performed. The material of this study consisted of 50 CSF specimens obtained by lumbar puncture from children presenting with clinical features of meningitis, and with no Gram stain or culture evidence of bacterial or fungal infection who were admitted to El Shatby University Paediatrics Hospital in Alexandria, throughout a period of approximately 6 months starting from April 2005. CSF samples were used to perform laboratory analysis including cell count, differential leucocyte count, protein level, and for detection of enteroviral RNA by EV RTPCR using general primers selected in the highly conserved 5' non-coding region. Twenty four percent of samples tested positive for EV RNA by EV RT-PCR. Pleocytosis was detected in 54% of the studied samples with lymphocyte predominance in 63% of them. Lack of CSF pleocytosis in CSF samples that were positive for EV RNA was limited to one case below 2 months of age. For all ages, the sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV] of presence of pleocytosis in relation to the results of RT-PCR were: 92%, 58%, 41% and 96% respectively. They dropped to 67%, 50%, 33% and 80% respectively in the age group 2 months and were 100%, 60%, 43% and 100% respectively in the >2 months age group. Elevated CSF protein level was found in 58.3% of EV RT-PCR positive cases and 58% of EV RT-PCR negative cases. For all ages, the sensitivity, specificity, PPV, and NPV of elevated protein levels in relation to the results of RT-PCR were 58%, 42%, 24%, and 76%, respectively. When we examined a combination of CSF parameters: the presence of both pleocytosis and elevated protein level, in relation to EV RT-PCR results, the sensitivity, specificity, PPV, and NPV were 58%, 74%, 41%, and 85% respectively. We conclude that CSF parameters namely pleocytosis and elevated protein level are not satisfactory to establish viral aetiology of meningitis even when used in combination. We recommend the introduction of EV RT-PCR as a simple, rapid and reliable routine test to establish enteroviral diagnosis in the early course of meningitis to eliminate unnecessary treatment with parenteral antibiotics until a bacterial cause can be disproved, and shorten hospitalization periods

Synthesis and hypoglycemic activity of some new 4[3H]- quinazolinone analogues

The synthesis and biological evaluation of many 3-[4-[[[[cyckohexylamino] carbonyl]amino]sulfonyl]phenyl-4[3H]-quainzolinones [IVa-t] as oral hypoglycemics are described. Derivates [IVf], [IVg], [IVh], [IVj], [IVk], [IVm], [IVq] and [IVr] showed appreciable glucose lowering effects in alloxanized diabetic rats at a dose of 5 mg/kg. They decreased the blood glucose level by 40.7, 36.4, 37.2, 35.4, 43.7, 38.8, 35.3, 42.9 and 45.9 respectively. The hypoglycemic action of the synthesized compounds is comparable to, and in few cases is higher than that exhibited by the well known antidiabetic drug "glyburide" which showed 35.1 percent decrease of the blood glucose level

Spectrophotometric determination of Glucosamine and Mannitol With 4-Amino-5-Hydrazino-4h[1,2,4]-Triazole-3-Thiol in Pharmaceutical Formulations

S-Triazoles have been utilized to produce reagents that can react with drugs containing carbonyl group and drugs that are susceptible to oxidation with periodic acid to produce carbonyl function such as diols and amino alcohols. In this study, glucosamine and mannitol were analyzed through oxidation with periodic acid to give formaldehyde which was allowed to condense with 4-Amino5-hydrazino-4H[1,2,4]-triazole-3-thiol [AHTT] [1]. The condensation product was further oxidized to yield a purple colored compound [II] with maximum absorption at 550 nm. Beer's law was obeyed in the range of 12.5-125 lig for glucosamine and 25-150 mg ml for mannitol. Both drugs were also successfully determined in their pharmaceutical formulations with mean percentage recoveries +/- RSD ranged between 100.69-101.51% +/- 1.57-0.44 for glucosamine and 100.06% +/- 1.08 for mannitol

Spectral studies of some azodyes in different solvents

The spectral behaviour of some azadyes was investigated in different organic solvents of varying polarities at room temperature. The ionization constants of studied dyes were determined in aqueous buffer solutions and in different organic solvents as well as in ethanol-water mixtures. The spectra in the mixed solvent proved the formation of molecular complexes between the solute and ethanol, for which the stability constant and heat of formation are determined. The variation of absorbance with pH is utilized for the determination of pK a

Predictors of hospital readmission among children with bronchial asthma

This study was undertaken to reveal he rate and predictors of asthma related readmissions at Alexandria University Children's Hospital. Children attending the emergency department with an acute episode of asthma between October the 1[st], 2004 and March the 31[st], 2005 were enrolled in this study. They were subjected to a detailed medical history and clinical evaluation to obtain relevant information. Data were subjected to a detailed medical history and clinical evaluation to obtain relevant information. Data were analyzed using the univariate and multivariate and multivariate logistic regressions analyses. The study included 304 asthmatic children between 2 and 12 years of age. In 80% of them, the diagnosis was made before the age of 2 years. Parents of 51.0% of the children perceived the child's asthma as severe, 38.2% viewed that the child's activity is variably affected and 23.6% expressed that the control of asthma is either unsatisfactory or bad. Children who felt in the band of moderate to severe asthma accounted for 54.3% of the sample; in the preceding four weeks, 32.6% experienced asthma symptoms more than twice weekly and 36.8% had night symptoms more than twice per month. Only 18.1% were receiving prophylactic therapy and 55.3% attended for periodic follow up. In a life time, 60% were hospitalized and 36.8% were readmitted within a year of a previous admission. Readmission because of bronchial asthma was independently predicted by the frequency of asthma symptoms and night symptoms, disease severity score and unsatisfactory or bad control of asthma. it is also predicted by life time hospitalization, lack of periodic follow up and non-use of prophylactic therapy. This is in addition to presence of a smoker in the household, bad ventilation and high sleeping index. These children constitute a group of asthmatic with moderate to severe disease and high rates of readmission but still readmission could be prevented. Parents and children should avoid the identified precipitating factors of an attack, ensure appropriate ventilation and strictly prohibit smoking in the household. Physicians and parents should work together to develop a better understanding of the child's condition and to set an asthma management plan including crisis intervention. Adherence to preventive therapy and periodic follow up should be the rule. Educational sessions should be considered for parents to develop skills and competencies in controlling their children's asthma. Further research is needed to evaluate the quality of care provided to asthmatic children at the emergency department and inpatient

Evaluation of erythropoiesis in protein energy malnutrition

This study evaluated erythropoiesis in 50 infants hospitalized with protein energy malnutrition and in 50 control infants. The red cell count, mean corpuscular haemoglobin and reticulocyte index were significantly lower, while the white blood cell count, median corpuscular fragility and red cell distribution width were significantly higher on admission than in controls. Total serum protein, albumin, fasting blood glucose, and serum folate were significantly lower on admission than in controls. Serum ferritin was significantly higher and total iron-binding capacity was significantly lower on discharge compared to controls. The serum erythropoietin was significantly higher on admission and discharge than in controls. The anaemia of protein energy malnutrition is due to mixed deficiencies resulting in ineffective erythropoiesis despite an increased level of erythropoietin

Bacterial nosocomial infections among children admitted to wards at El-Shatby university children's hospital

This prospective study aimed at determination of the incidence, pattern, and the organisms causing nosocomial infections [NIs] among general pediatric wards patients, and to identify the risk factors predictive of NI through a daily concurrent surveillance. All patients admitted for at least 72 hours to both medical and surgical divisions of a large teaching hospital in Alexandria [El Shatby Children's Hospital] from August 1[st], 2001 to April 30[th], 2002 were followed daily. The recorded informations included identifying data, clinical data, duration of admission, type and time of infection and information concerning surgical procedures especially type of operation and wound class. Specimens for culture differed according to site of infection. A total of 51 NIs were found among 801 patients with an overall NI rate of 6.4 per 100 admissions. There was no significant difference of NI rate among medical and surgical services. The most common infections were those of the urinary tract [47.8% of patients], wound site [17.4%], bloodstream [23.9%] and gastrointestinal tract [10.9%]. Lower respiratory tract [LRT] and skin infections were the least encountered infections [2.2% and 4.3% of patients respectively]. Two patients [4.3%] developed specific rashes; one of them was diagnosed as measles, and the other was chickenpox. Diagnosis of both cases was based on clinical criteria only. Eighty per cent of these infections were caused by the common gram-negative bacilli; Klebsiella, E. coli, proteus and pseudomonas aeruginosa in the order of frequency. Hospital-acquired diarrhea was caused exclusively by rotavirus. The isolated gram-negative bacilli showed marked resistance to the studied antibiotics. The main risk factors identified were the presence of underlying malnutrition, malignancy, and antibiotics and immunosuppressive therapy. Long duration of preoperative hospitalization, abdominal operation and dirty wound were identified as risk factors for surgical site infections. The use of catheters whether intravascular or urinary catheters and wound drains were also best predictors of NIs. This first surveillance study provided information on the current status and trends of NIs in a major teaching hospital. The results may contribute to the evaluation of infection control programs and the development of effective strategies in this hospital. Patients with a high risk of infection can be target of special preventive measure

Long- term cardiac sequelae in patients with initial isolated rheumatic arthritis: a study of 100 patients in Alexandria, Egypt

The study was undertaken to assess the risk of development of rheumatic heart disease [RHD] in patients with initial isolated rheumatic arthritis [RA] and to identify the risk factors behind it. Clinical data of 100 patients with initial RA, who met the revised Jones criteria for acute rheumatic fever [ARF], diagnosed at the Alexandria University Children's Hospital, and their diagnoses dated back at least one year were retrospectively reviewed. Age at diagnosis was 7.9 +/- 3.29 years [mean +/- SD, range 3-16 years]. Echocardiographic findings at the initial episode were obtained from the hospital charts. The average duration of follow up of our patients was 7.5 +/- 4.42 years [range 1-21 years], and age at the time of enrollment was 15.4 +/- 5.09 years [mean +/- SD, range 7-31 years]. Complete clinical and echocardiographic examinations were done for all patients to detect the presence and severity of cardiac involvement [if any]. Our results showed that 23 patients had got one or more recurrences during the period of follow-up with a total of 39 episodes of recurrent rheumatic activity. Migratory polyarthritis constituted 66.7% of these episodes, carditis 17.9%, and 15.4% were in the form of chorea. Twelve of the 23 patients had definite valve lesions, although 6 of them did not experience carditis during recurrences. Seventeen patients had no clinical evidence of recurrent rheumatic activity, still developed RHD. So, a total of 29 of our patients [29%] developed RHD at the end of follow- up period. About 60% of them developed RHD within the first 5 years of the acute episode. Mitral regurgitation was the commonest valve lesion. Echo proved to be of great value in detecting cases with abnormal valve regurgitation in the absence of clinically audible murmur [silent murmur]. Patients with initial isolated RA should be carefully monitored, undergone frequent echo examinations for early detection of valve lesion which will influence the prognosis of these patients. Development of RHD in these patients should be considered while deciding the duration of secondary prophylaxis in these patients

Synthesis and Hypolipidemic Activity of Some New Dibenz [c,e] azepine Deravatives

Some new 6-substituted 5H-dibenz[c,e]azepine-5,7[6H]-diones [VII] were synthesized and tested for possible hypolipidemic activity. Thus anthranilic acid [I] was converted to diphenic acid [II] which was cyclodehydrated to give diphenic anhydride [III]. Ammonolysis of [III] afforded diphenamic acid [IV] which was cyclodehydrated to yield diphenimide [V]. Potassium salt of [V] was condensed with chloroacetic acid, ethyl chloroacetate or N-substituted and unsubstituted chloroacetamides to produce the target compounds [VII]. The preliminary evaluation of the hypolipidemic activity of [VII] against Triton WR 1339-induced hyperlipidemia in rats showed that several derivatives have demonstrated significant lowering of serum total cholesterol and triglyceride levels at dose of 150 mg/kg comparing with clofibrate

Evaluation of Bell's palsy by electromyography

This study was done in El-Zahraa University hospital. Thirty patients suffering from idiopathic Facial palsy [Bell's palsy] were included in this research. They were subjected to full history thorough clinical examination. The patients were divided into two groups. according to their final outcome, all patients were subjected also to electoromyography for motor unit action potential. The first group [19 patients] and the second group [11 patients], the time for recovery was significantly shorter in the first group [4.6 +/- 1.34] months compared with those for the second group [9.4 +/- 1.36] months. The patients were also divided into those who had more or less than 90% degeneration as determined by the electorneurography. All the patients but two of those whose degeneration less than 90% made a complete recovery while two of those with more than 90% made complete recovery. The final clinical outcome was also graded using the House and Brackman system. Eighty - nine per cent of those recovered completely has been predicted by ENoG within 10 days of onset

Diabetic nephropathy as a cause of end stage renal disease among the Egyptian hemodialysis population

Diabetes mellitus is one of the leading causes of end stage renal disease [ESRD] all over the world. The aim of this work was to find out the prevalence of diabetic patients among the Egyptian hemodialysis [HD] population. This work is a multicenter cross sectional study carried out in multiple HD centers all over Egypt, and involved 1000 uremic patients on regular HD. Patients were subjected to detailed history taking, full clinical examination, fundus examination. ECG, blood chemistry [including renal and liver function tests, serum calcium and phosphorous, FBS and PPBS], and complete blood picture. Patients were clinically classified into three groups. Group A included uremic patients with IDDM. Group B included uremic patients with NIDDM, and group C included uremic non diabetic patients who were taken as a patients control group. The results of this study showed that 98 patients [9.8%] out of the 1000 uremic patients studied had DM as a cause of their ESRD. Diabetic uremics were found to be more frequently hypertensive, hypercholesterolemic and suffered more from coronary heart disease than non diabetic uremics. This study also showed that the relative contribution of IDDM and NIDDM among HD patients was 38.8% and 61.2%, respectively. The, duration of NIDDM was significantly shorter indicating that the progress of renal complications in this type is much faster than in IDDM. The result of C-peptide measurement perfectly matched with the clinical criteria for classification of the type of DM. where the predictive value was 100%. Finally, this study recommends to improve the medical care given to the diabetic patients establishment of education programs for diabetics stressing upon how to avoid diabetic complications and the importance of early intervention for treatment of those complications should they occur

Comparative bioavailability of oral salbutamol formulations

A bioavailability study was conducted to assess the bioequivalence of different oral dosage forms of salbutamol. The study involved six br and s of tablets and syrups, two imported and the remaining were locally produced in Egypt. The in vitro tests on the tablets included assessment of weight variation, content uniformity, disintegration time and dissolution rate. The tablet br and s differed in tablet weight, disintegration time and dissolution rate. The in vivo study was carried out on eight healthy male volunteers. The study design was r and om balanced crossover. Each volunteer received 8 mg of each product twice monthly. Urine samples were collected for 24 hours. Unchanged salbutamol in urine was extracted and determined by HPLC with fluorescence detection.% salbutamol excreted was higher and urinary excretion rates peaked earlier following administration of three syrup br and s compared to the tablets. Relative bioavailability was calculated from mean% salbutamol excreted in 24 hours. The values obtained ranged from 86.95% to 97.64%. The results were analyzed statistically. Confidence intervals were calculated to verify bioequivalence among product pairs. The developed assay method was validated. The method proved suitable for bioavailability testing of salbutamol based on urine collection

Synthesis of some new 4 [3H] -Quinazolines as potential anticonvulsants

Condensation of various 4H-3.1 benzoxazin-4-ones [III] with homoslfanilamide afforded some new derivatives of 3-[p-sulfamoylbenzyl]-4 [3H]-quinzolinone [V]. Some o-amido-N- [p-sulfamoylbenzyl]-benzamides [IV] were isolated as reaction intermediates. Structures of the newly synthesized compounds were confirmed by IR, 1H-NMR, MS and elemental analyses. Several target compounds [V] exhibited good anticonvulsant effects against pentylentetraxol -induced convulsions in frogs. Compound [V-4] was 2.33 times as potent as phenobarbitone