Serum Fetuin A, hs-CRP and Homocysteine as Biochemical Markers of Cardiovascular Complications in Chronic Dialysis Patients.

Introduction: Chronic kidney disease (CKD) patients are considered a high risk group of cardiovascular disease in which vascular calcifi cation plays central role. A pivotal role in the inhibition of calcifi cation is played by fetuin-A. Th e measurement of infl ammatory markers such as high sensitivity C-reactive protein (hs-CRP) and homocysteine which promotes atherosclerosis is helpful in predicting cardiovascular disease in ESRD patients on regular dialysis. Material and Method: Th e study included 40 adult CKD patients divided into 30 ESRD patients on conventional hemodialysis, 15 with CVD and 15 without CVD, as well as 10 CKD patients on conservative treatment. Ten healthy subjects served as a control group. Enzyme-linked immunosorbent assays were used for fetuin-A, hs-CRP and homocysteine. Results: ESRD patients showed a signifi cant increase in serum hs-CRP, homocysteine and decrease in fetuin-A compared to control group. In addition, ESRD patients with CVD and without CVD showed a signifi cant increase in hs-CRP, homocysteine and only those with CVD had signifi cantly decreased fetuin-A in relation to CKD patients. Th e study revealed increased levels of hs-CRP and decrease in fetuin-A in ESRD patients with CVD compared to ESRD patients without CVD. Fetuin-A showed a negative correlation with hs-CRP and homocysteine in ESRD patients with and without CVD. Conclusion: Th e combined use of hs-CRP at a cutoff of (10 mg/dL) with either fetuin-A at a cutoff value of (0.26 g/L) or alternatively with homocysteine at a cutoff value of (48.23 μmol/L) proved to be eff ective for discrimination of CVD patients from other ESRD or CKD patients.

Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff

[-vitro anti-bacterial activity of chloroform, ethyl acetate and hydroalcoholic extracts of Scilla persica Hausskn]

The generated genetic diversity in the microbial pathogens and drug resistant led to a growing interest to use herbal medicine. This study was carried out to determine the in vitro anti-bacterial activity of chloroform, ethyl acetate and hydroalcoholic extracts of Scilla persica Hausskn. In this laboratory study, chloroform, ethyl acetate and hydroalcoholic extracts were obtained from bulb of Scilla persica. The anti-microbial activity, the minimum inhibitory concentration [MIC] and the minimum bactericidal concentration [MBC] of the extracts were evaluated on Staphylococcus aureus, Bacillus cereus and Escherichia coli using the disk diffusion [growth inhibition zone] and macro-dilution methods. Dimethyl sulfoxide [DMSO] was used as a negative control while nalidixic acid and ampicillin were used as positive control. The maximum inhibition zone for ethyl acetate extract was 26.3 +/- 0.1 milimetre, 23.7 +/- 0.3 milimetre and 19.5 +/- 0.4 milimetre for Staphylococcus, Escherichia coli and Bacillus, respectively. The maximum inhibition zone of chloroform extract was found to be 16.4 +/- 0.2 milimetre and 14.9 +/- 0.3 milimetre for Staphylococcus and Bacillus, respectively. Antimicrobial activity of the chloroform and ethyl acetate extracts of bulb of Scilla persica on Escherichia coli, Staphylococcus aureus and Bacillus cereus are more effective compared to nalidixic acid and it is similar to ampicillin in in-vitro condition

Predictors of work-related stress among nurses working in primary and secondary health care levels in Dammam, Eastern Saudi Arabia

Work-related stress [WRS] is an insidious and persistent part of everyday life related to the response of people to work environment. Nursing is a strenuous job and WRS is prevalent among nurses. The aim of this study was to estimate the prevalence of WRS among nurses working in primary and secondary health care levels in Dammam, Eastern Saudi Arabia. A cross-sectional epidemiological study was conducted in 17 primary health care centers [PHCCs] representing the primary level of health care and Medical Tower Complex [MTC] representing the secondary health care level in Dammam city. The total number of nurses included in the study was 637 nurses [144 in PHCCs] and [493 MTC]. Data were collected using a self-administered questionnaire, which was developed based on the pertinent literature. It included two main parts: Sociodemographic and job characteristics of nurses and 31 WRS questions. The overall prevalence of WRS among all studied nurses was 45.5%; 43.1% and 46.2% in primary and secondary levels, respectively. In the primary level, there was a statistical significant association between WRS and being married [85.5%], and having living three children and more [53.2%]. Moreover, younger age group 20-<30 years [79.4%], Saudi nationality [86.8%], being married [74.6%], having nonbachelor degree [83.3%], work shifts [89.5%], and working in surgical department [46.5%] were the significant associating factors with the occurrence of WRS among nurses in secondary levels. Young age was the only predicting factor for WRS in primary care level. While being female, Saudi, married, with work shifts, and working in surgical department were found to predict WRS in the secondary level. Appropriate strategy in health care organization to investigate stress in health care settings is recommended. Moreover, interventional programs to identify, and relieve sources and effects of stress should be developed

Organophosphorus chemistry, 36[1]reactions of furobenzopyran-6-carboxaldehydes with alkyl phosphites and ylidenetriphenylphosphoranes [Witting reagents]

Dialkyl phosphites [4] and trialkyl phosphites [5] attack the aldehydic carbonyl carbon of 4-methoxy-5-oxo-5H-furo[3,2-g] benzopyran-6-carboxaldehyde [3a] and 4,9-dimethoxy-5-oxo-5H-furo [3,2-g] benzopyran-6- carboxaldehyde [3b] yielding the corresponding alpha-hydroxyphosphonates [7]. Compounds 7 regenerate the starting gamma-pyrone derivatives [3a or 3b] and the appropriate dialkyl phosphites [4] upon thermolysis under reduced pressure. On the other hand, the reaction of 3 with ylidenetriphenylphosphoranes [6] proceeds according to the Wittig mechanism to give the respective ethylenes [E 17]. The reaction of 3b with diethyl cyanomethylphosphonate [18] under Homer-Wittig conditions yields 6-[[alpha-cyano-alpha diethoxyphosphoryl] ethyliden-yl]-4,9-dimethoxy-5-oxo-5H-furo [3,2-g] benzopyran [20]. Structures of the isolated new products were elucidated by compatible, analytical, chemical and spectroscopic measurements

Comparison between fetal fibronectin and cervical index in early detection of preterm labor

The present study will compare between two methods of diagnosis of preterm labor, which are, Transvaginal Ultrasonography [for cervical index] and fetal fibronectin in cervicovaginal secretions and to evaluate their rules in early detection of preterm labor. This is a prospective study carried out at Obstetrics and Gynecology Department, Suez Canal University Hospital, Ismailia Governor ate [2001-2002]. The study was carried out on Patients attending the department of Obstetric and Gynecology who were pregnant >/= 24 - < 37 weeks of gestation and at risk of preterm labor. The material of the study included 50 cases divided into two groups according to strict inclusion criteria. Each case was subjected to thorough questionnaire obstetric examination, determination of fibronectin level in cervico-vaginal secretions and estimation of the cervical index. The results of the study showed the superiority of the fibronectin estimation for the earlier detection of cases subjected to impending preterm delivery compared to cervical index. The conclusion of the study is that the combined use of cervical index and fibronectin assay give better anticipation to cases with impending preterm delivery

Pharmacognostical and antibacterial studies of chorisia speciosa st. Hil. flower [Bomhacaceae]

The ethyl acetate soluble fraction of the aqueous alcoholic extract of Chorisia speciosa St. Hil. flowers yielded three flavonoids; quercetin, kaempferol-3-0-beta-D-[6"-P-coumaroyl]-glucoside [tribuloside] and apigenin-7-0-neohesperidoside [rhoifolin]. Their chemical structures were established using UV, MS,1H-,13C-and 2D-NMR spectral data as well as by direct comparison with authentic reference samples. The mucilage content [1.12%] was studied both qualitatively and quantitatively. The antibacterial study of the different extracts revealed significant activities. Tribuloside exhibited substantial antibacterial effect with MIC 1.96 mug/ml against Bacillus subtilis. Moreover, detailed macro- and micromorphological characters of the flower parts have been studied in order to find out the diagnostic features which can help in the identification of the plant flower in both entire and powdered forms

Congenital toxoplasmosis: a significant cause of congenital hydrocephalus in Egypt

This study was performed on 100 hydrocephalic children aging from one month to 8 years. The patients were examined physically and radiologically to exclude any hydrocephalic case associated with any other intracranial lesion. Serum and CSF samples were taken during ventriculoperitoneal shunt operation for all patients and serum samples from all mothers were collected and examined to detect anti- toxoplasma IgG using indirect ELISA. Serum samples of 40 normal children and their mothers sera were examined for IgG as controls. Positive anti-toxoplasma IgG was detected in 23% of the hydrocephalic children and their mothers denoting that their infection may be congenital from their mothers. The mean optical density [OD] of anti- toxoplasma IgG antibodies in the cerebrospinal fluid of hydrocephalic cases was significantly higher than their level in the serum of the same patients

Socioenvironmental predictors of abortion and stillbirths in an industrial community in Egypt

Air pollution is considered to be one of the overgrowing problems of cosmopolitan distribution, due to marked progress in industrialization. The applied epidemiological and environmental studies related to reproductive health in the community are considered as the main principles for comprehensive health development in industrial cities. The present study focused on the role of air pollution on the occurrence of abortion and stillbirths among married fertile women during the childbearing age [15-50 years] in two industrial areas, namely Helwan in Cairo Governorate and Tenth of Ramadan City in Sharqyia Governorate. A cross-sectional epidemiological study based on community background was implemented in the two studied areas. The unit of observation was the family including married fertile women based on specific inclusion criteria. Cluster sampling procedure was used in which the unit of sampling was the household, selected within a radius of not less than five Kilometers around the factories. Using Epi-info program, the total sample size in the two studied areas was 1934 women. The interview questionnaire was the tool adopted for data collection, which includes gynecological and obstetric data related to reproductive health. The socio-economic status of studied women was determined using scoring system that includes the education and occupation of both couples. The environmental study was carried-out in the two areas in order to assess the levels of air pollutants and their chemical nature. Data management using Logistic regression analysis was done to determine the effect of independent variables, such as socio-economic factor, exposure to air pollutants on the occurrence of abortion and stillbirths as examples of reproductive health problems. The mean age of the studied women was 33.8 +/- 8.8 years in Helwan and 28.1 +/- 6.5 years in Tenth of Ramadan. Also the study showed significant differences in both the socio-economic status, smoking inside houses and parity between the studied women in Helwan and Tenth of Ramadan City. The overall prevalence of abortion and stillbirths among women in the studied areas were 29.2% and 4.5%, respectively. However, the prevalence of such reproductive health hazards among women in Helwan was significantly higher than in Tenth of Ramadan City. Also the results of environmental study indicated that Helwan has higher mean values of total dust count, suspended and respirable dust concentrations as well as lead concentration in the ambient air than in Tenth of Ramadan City. The Logistic regression analysis showed that the respirable dust concentration in the air and smoking inside houses are the significant independent factors for the occurrence of abortion. Moreover, Lead concentration in the air and women education is the main predictors of both abortion and stillbirths. Accordingly, the Egyptian authorities should attempt to improve air quality in urban industrial communities to promote reproductive health and prevent woman's health hazards

Laparoscopic intracorporeally-constructed Ileal conduit after porcine cystoprostatectomy

Introduction and Objectives: ileal conduit urinary diversion following cystoprostatectomy has not been reported by the laparoscopic intrracorporeal technique to date. Herein, we present our technique of laparoscopic ileal conduit following cystoprostatectomy in the porcine model performed in a completely intracorporeal manner. After developing the technique in 5 acute animals, laparoscopic cystoprostatectomy with intracoporeally performed ileal conduit urinary diversion was performed in 10 male survival pigs. A 5-port transperiloneal technique was used. All steps of the technique as applied during open surgery were duplicated intracorporeally, Specifically, cystectomy, isolation of an ileal conduit, restoration of bowel continuity, and mucosa to mucosa, stented bilateral ileoureteral anastomosis were performed with exclusively intracorporeal laparoscopic techniques. Surgery was successful in all 10 study animals without intraoperative or immediate postoperative complications. Blood loss was minimal and operating time 'averaged 290 minutes. An end ileal stoma was formed at the right lower quadrant port site. At euthanasia, renal function was normal in all surviving animals. No ileoureteral anastomotic strictures were noted on pre-euthanasia loopgrams or on post-mortem examination of the anastomotic sites. Laparoscopic ileal conduit urinary diversion .following cystoprostatectomy can be performed completely intracorporeally in the porcine model. Clinical application of this technique is imminent

Congenital toxoplasmosis: a significant cause of congenital hydrocephalus in Egypt

This study was made on [100] hydrocephalic children aging from one month to eight years. These patients attended Neurosurgery Department of AI-Azhar University Hospitals and Neurosurgery Department of Nasser Institute Hospital, in the period from. November 1997 to November 1999. They were examined physically and radiologically, to exclude any hydrocephalic case associated with any other intracranial lesion. Serum and CSF samples were taken during ventriclo-peritoneal shunt operation for all patients and serum samples from all their mothers were collected and examined to detect anti-Toxoplasma IgG using indirect ELISA. Forty normal children serum samples and their mothers sera were examined for IgG as control. Positive anti-Toxoplasma IgG was detected in 23% which was significantly higher than control [P<0.01] with O.D. values significantly higher [P<0.01] of hydrocephalic children and their mothers denoting that their infection may be congenital from their mothers. The mean optical density [O.D.] of anti-Toxoplasma IgG antibodies in the cerebrospinal fluid of hydrocephalic cases was significantly higher than their level in the serum of the same patients [P<0.001]. This means that there may be local antibody production in the CNS. Congenital infection with T. gondii might be a cause of congenital hydrocephalus in Egypt

Paradoxial therapy and behavioral therapy in the treatment of obsessive-compulsive disorder

Ninety-two outpatients with obsessive-compulsive disorder [OCD] were randomly assigned to receive either medication with paradoxical or behavioral therapy. The treatment program continued for six months. Evaluation after the first three months showed an improvement of 39 patients from the group treated by paradoxical therapy; after six months, they decreased to 35 patients. They were compared with 29 patients in the group treated by behavioral therapy, who were improved within the first three months and decreased also to 22 patients, who improved after six months. Most of the patients, who were treated by paradoxical therapy, showed a better improvement. The superiority of paradoxical therapy over the behavioral therapy was clearly demonstrated

Prevalence of premenstrual tension syndrome among student nurses and its relationship with environmental factors

In a cross sectional study of the premenstrual tension syndrome, it's prevalence, it's relationship to environmental factors and the relief measures taken by the student nurses in the secondary nursing schools, the High Institute of Nursing and the Health Technical Institute [nursing department] of Port-Said Governorate. 404 student nurses were enrolled in this study using a modified version of Moos [1968] menstrual distress questionnaire. Computed data revealed that premenstrual tension syndrome was complained of in 77% of the student nurses. It was mild in 39.3%, moderate in 24% and severe in 15%. There was a statistically significant positive correlation between premenstrual tension syndrome and the academic qualification, mother's education, student age and the amount of the menstrual flow. Relief measures used by the student nurses in this study were medications in 26.7%; the intake of certain types of domestic drinks 51.2%, exercises 48%, hot baths 89.4%, rest 25% and certain types of food 6%

Longevity life expectancy, mortality rates, and causes of deaths of elderly rural population, Egypt, 1996

It is a descriptive analytical study utilizing death records of aged ones after 60 years and its causes, together with using available data from national vital statistics. The results showed that the age of deaths is increasing from [65-70] years reaching the age groups 85 + years in the last [3-5]years [1989-l 996]. The death causes are statistically different from combined to rural health units, which uncontrolled and not guided by WHO's international classification of diseases and causes of death. It was done on 521 cases and the age of death reached 85+ years mostly due to heart failure

Evaluation of peripheral pulmonary lesions using plain chest radiography, ultrasonography and computed tomography

Thirty patients with peripheral pulmonary lesions had been examined, 24 of them were peripheral parenchymal lesions which included 16 cases with primary bronchial carcinoma, 3 cases with metastatic lesions and 5 with infective lesions. The remaining 6 cases were 2 with pleural masses and 4 with mediastinal lesions with peripheral extension. They were evaluated by plain radiography, chest sonography [US] and computed tomography [CT]. The diagnostic accuracy of plain radiography was 87% for free pleural effusion and solid masses whether neoplastic or non neoplastic, 77% for chest wall involvement and 93% for phrenic nerve palsy. It failed to detect lymph nodal enlargement in one case and peripheral pericardial effusion in another. Ultrasonography was 100% accurate in diagnosis of pleural effusion whether free or encysted, masses whether solid, cystic or vascular and for phrenic nerve palsy and picardial effusion. It was 83% accurate in detection of bone involvement whether primary [multiple myeloma] or secondary [thoracic or extrathoracic] and failed to detect lymph nodal involvement in one case. On the other hand, computed tomography [CT] was 97% accurate in detection of chest wall invasion, 100% in lymph nodal involvement and pleural masses, but failed to detect phrenic nerve palsy. Its accuracy was comparable to that of US in the rest of the lesions

Epinephrine induced arrhythmia during sevoflurane, isoflurane and halothane anaesthesia: an experimental study

The effect of sevoflurane, isoflurane and halothane on cardiac arrhythmias induced by injection of epinephrine into cats was studied. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rate of epinephrine and the corresponding plasma level. The mean values of the arrhythmogenic doses of epinephrine and the corresponding plasma levels were 19.3 mu /kg and 275.7 ng/ml for sevoflurane, 8.7 mu/kg and 149.2 ng/ml for isoflurane and 1.68 mu/kg and 39.1 ng/ml for halothane, respectively. These results indicated that the arrhythmogenic doses of epinephrine during sevoflurane and isoflurane anesthesia were significantly higher than those during halothane anesthesia