Effects of treatment with sitagliptin on hepatotoxicity induced by acetaminophen in mice

Up to date, the management of hepatotoxicity induced by a suicidal or unintentional overdose of acetaminophen (APAP) remains a therapeutic challenge. The present study aimed to elucidate the potential effect of sitagliptin, a DPP-4 inhibitor, to ameliorate the acute injurious effects of acetaminophen on the liver. APAP toxicity was induced in mice by an intraperitoneal injection of APAP (400 mg/kg). The effect of treatment with sitagliptin, initiated 5 days prior to APAP injection, was evaluated. Serum indices of hepatotoxicity, oxidative stress markers in liver tissues, serum IL-1ß, and TNF-α in addition to hepatic- NF-E2-related factor-2 (Nrf2) were determined. Our results showed that APAP induced marked hepatic injury as evidenced by an increase in serum levels of ALT and AST, in addition to the deterioration of histological grading. Oxidative stress markers, serum TNF-α, and IL-1ß were also elevated. Sitagliptin successfully ameliorated the histological changes induced by APAP, improving liver function tests and liver oxidant status accompanied with a marked increase in Nrf2 level in hepatic tissues. Thus, the hepatoprotective effects of sitagliptin in this animal model seem to involve Nrf2 modulation, coincidental with its anti-inflammatory and antioxidant effects

Phenotypic and genotypic methods for detection of metallobeta-lactamase [MbetaL] producing pseudomonas aeruginosa

The occurrence of a MbetaL-positive isolate in a hospital setting represents a therapeutic problem, as well as a serious concern for infection control management. The accurate identification and reporting of MbetaL-producing P. aeruginosa will aid infection control practitioners in preventing the spread of these multidrug-resistant isolates. This study aimed to detect and characterize MbetaL producing P. aeruginosa in Benha and to evaluate IMP- EDTA CDT as phenotypic screening method for MbetaL detection. This study was conducted on 100 P.aeruginosa strains isolated from 220 different clinical specimens collected from patients admitted to Benha University Hospital and Benha Teaching Hospital. The isolated P. aeruginosa strains were subjected to antibiotic susceptibility testing by disc diffusion test and MbetaL detection both phenotypically by IMP- EDTA CDT and genotypically by multiplex PCR. Out of 100 P.aeruginosa isolates, 25 strains [25%] were imipenem resistant and 15 strains of them [60%] were carrying genes responsible for MbetaL production [15% of the total number of P.aeruginosa]. Thirteen strains [13%] were carrying VIM gene while two strains [2%] were carrying both VIM and SPM genes together. IMP, GIM-1, SIM-1 genes were not detected. None of the imipenem sensitive strains were carrying genes of MbetaL production. Nearly all MbetaL producers were resistant to most antibiotics used while all strains were sensitive to colistin and polymyxinB. There is very good strength of agreement between IMP-EDTA CDT and PCR. The sensitivity and specificity of the IMPEDTA CDT in relation to PCR was 93.3% and 100% respectively. MbetaL producers is a serious problem as they are highly resistant to most antibiotics used making treatment options very limited, VIM gene is the most prevelant one in comparison with other genes of MbetaL production and IMP-EDTA CDT is a good and sensitive test in detecting MbetaL production

Human bocavirus among viral causes of infantile gastroenteritis

Human bocavirus [HBoV] infection possibly plays a role in gastroenteritis because of the frequent manifestation of gastrointestinal symptoms. Detect human bocavirus [HBoV] and assess its prevelance among gastroenteritis associated viral agents in infants with gastroenteritis in Benha University Hospital. The study was carried out on 100 stool samples collected from 100 infants with acute gastroenteritis for detection of Rotavirus [RV], Norovirus [NoV] and Astrovirus [AstV] by multiplex reverse transciptase polymerase chain reaction and detection of Adenovirus[AdV] and HBoV by multiplex polymerase chain reaction. Viral agents were detected in 57 [57%] samples; 51 [51%] samples show mono-infection while 6 [6%] samples show co-infection. Rotavirus, Norovirus, Adenovirus and astrovirus were detected in 37%, 14%, 7.0%, and 3% of the study population, respectively; HBoV was detected in 2%. This percentage of HBoV suggests that it might play a minor role in gastroenteritis

effect of betadine versus chamomile on pain relief and healing process of episiotomy among primiparea

The aim of this study is to examine the effect of betadine versus chamomile on pain relief and healing process of episiotomy among primiparae. A sample of [90] postpartum women were selected from the post partum unit of Elshatby Maternity University Hospital in Alexandria. They were equally divided into two study groups. Each group was instructed to apply one of the intervention modalities: betadine or chamomile for ten days. Three tools were used for data collection. The first was a structured interview schedule to elicit the socio-demographic characteristics of the subjects. The 2nd tool was the healing and pain assessment scale which comprised 2 parts: the Reeda scale [RS] to evaluate the condition of the perineum before and after intervention; and the visual analoge scale [VAS] to assess the pain intensity before and after intervention. The 3rd tool was an observation follow up check list to assess the healing process of episiotomy among the two groups. The results revealed that women using chamomile significantly achieved complete or maximum recovery earlier and faster than women using betadine

Autoimmune hepatitis and hepatitis C infection: diagnostic dieemma

The evidence for an association between autoimmune forms of chronic hepatitis and hepatitis C virus [HCV] infection is controversial. Although anti-liver kidney microsomal antibody-positive autoimmune chronic hepatitis appears to be associated with HCV infection, evidence of such an association is less convincing with other subtypes of autoimmune chronic hepatitis. Autoantibodies are frequently found in patients with chronic hepatitis C, although usually in low titers which suggests that HCV elicits an immune response in the host. In a small subset of patient with chronic hepatitis C, autoantibodies are seen in high titers along with hypergammaglobulinemia, which further clouds the distinction between autoimmune chronic hepatitis and chronic hepatitis C.This has important therapeutic implications because inappropriate treatment of autoimmune chronic hepatitis with interferon-based therapy may exacerbate liver disease. Conversely, corticosteroid therapy for chronic hepatitis C may enhance HCV replication, which could worsen underlying liver disease. Few data are available to show how patients with features of both autoimmune hepatitis and chronic hepatitis C should be treated

Diagnostic value of antisoluble liver antigen/ liver pancreas antigen [SLA/LP] and other autoantibodies in the diagnosis of patients with autoimmune liver disease

This study aimed to evaluate the role of auto antibody profile in the diagnosis of patients with suspected autoimmune liver disease and their ability to define the putative type 3 autoimmune hepatitis [AIH]. Forty adult patients with abnormal liver function, elevated serum IgG and negative hepatitis markers were chosen from those attending the Hepatology Clinic and Internal Medicine Clinic of Alexandria Main University Hospital and Armed Forces Hospital. According to the results of liver biopsy, 36 patients were diagnosed as AIH, one patient as primary biliary cirrhosis [PBC] and the other 3 patients were still undiagnosed. Also, 10 patients with documented diagnosis of non-immune hepatitis B virus in addition to 10 age and sex matched healthy controls were enrolled in this study. Autoantibody profile of ANA, ASMA, AMA, LKM and p-ANCA was measured by indirect immunofluorescent technique [IF] and anti SLA/LP, LKM-1, LC-1 and AMA-M2 autoantibodies were detected by western blot assay. The sensitivity of ANA, ASMA, AMA, LKM, p-ANCA, SLA/LP and LC-1 were 48.6%, 51.4%, 2.7%, 8.1, 56.8%, 18.9% and 10.8% respectively with high specificity [100% for all auto-antibodies except that for ANA 95.7% and ASMA 87%]. However, the overall sensitivity of the complete profile was increased to 100% and specificity was 91.3% from this study we conclude that a complete profile of autoantibodies can be used as a useful tool for the diagnosis of patients with suspected autoimmune liver disease. Anti SLA/LP is an additional specific and diagnostic marker for the diagnosis of AIH type 1 and it remains to be seen whether the seropositivity of SLA/LP may characterize the patients who are more likely to relapse after corticosteroid therapy

Hepatits A induced diabetes mellitus, acute renal failure and liver failure

A 12-year-old otherwise healthy boy presented with hyperacute hepatic failure [encephalopathy, occurred within seven days of disease onset; total and direct bilirubin of 94 umol/l and 73 umol/I respectively; aspartate aminotransferase [AST] of 8,367 u/l; alanine aminotransferase [ALT] of 11,164 u/I; prolonged prothrombin time 29.1 sec [INR 3.03] and activated partial thromboplastin time of 48.2 sec [ratiol.6]], non-oliguric acute renal failure [creatinine of 591 umol/L and blood urea nitrogen of 21.0 mmol/L], transient leukopenia, transient thrombocytopenia, with new onset diabetes mellitus [on admission the patient had blood glucose of 23.9 mmol/L]. On admission, this patient had reactive 1gM antibody for acute hepatitis A with non-reactive results for hepatitis B surface antigen, hepatitis B core antibodies, and hepatitis C antibodies, The acute renal failure and hepatitis resolved in 17 days and 30 days from admission, respectively; but the patient continues to have diabetes mellitus 6 months [time of follow up] after the hepatitis A infection while the leukopenia and thrombocytopenia resolved in 3 and 6 days from admission respectively. This case illustrates unusual presentation of acute hepatitis A infection induced with acute liver failure, non-oliguric acute renal failure, and, diabetes mellitus as sequele of this infection

Helicobacter pylori infection: relation to protein losing enteropathy in malnutrition

This work was carried out to study the prevalence of Helicobacter pylon [H-P] infection in malnourished children and to prove the association -if any- between H-P infection and protein losing enteropathy [PLE] in these children. Stool samples of 100 children ranging in age from 3 to 24 months were studied. Those children included 40 under weight children, 40 marasmic children and 20 age and sex matched well nourished children as a control group. Stools from malnourished and control children were tested for H-P antigen and focal concentration of alpha 1- antitrypsin [FA-AT] using ELISA technique. Measurement of both parameters was repeated in H-P positive children 2 weeks after eradication therapy of H-P infection. The results proved that the prevalence of H-P infection amounted to 53% of malnourished children compared to 20% of control group. The mean values of FA-AT were significantly higher in malnourished children with positive H-P infection than those with negative infection [P <0.0001]. Following the eradication therapy of H-P infection, the mean values of FA-AT showed a significant decrease [P < 0.0001]. However, these values were still higher than those of the control group [P <0.0001]. H-P infection is an important co-factor in the etiology of some aspects of protein energy malnutrition [PEM]. H-P infection plays also a leading role in the pathogenesis of PLE and its therapeutic eradication can reverse some of these findings

Safety and efficacy of proseal laryngeal mask airway versus classic laryngeal mask airway and endo tracheal tube during elective surgery

The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway [PLMA], classic Laryngeal mask airway [LMA] and cuffed Endo Tracheal Tube [ETT] as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA[groupI],classic LMA [groupII]and ETT [group III] . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation – Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2 patients and grade 1 in no patient In conclusion :- PLMA and classic LMA could be better choices as ventilatory device in hypertensive and coronary artery disease patients

Evaluation of plasma elastase, D-dimer and fibrin degradation products in comparison to doppler ultrasonography in the diagnosis of patients with deep vein thrombosis

The present work aimed at evaluating the usefulness of plasma elastase, D-dimer and fibrin [ogen] degradation products [FDPs] in comparison with doppler ultrasonography for the diagnosis of deep vein thrombosis [DVT] among 20 adult patients who were admitted to the emergency unit of Alexandria main University hospital with symptoms and signs suggestive of DVT. 10 healthy age and sex matched controls were also enrolled in this study. Plasma elastase, D-dimer were estimated by ELISA technique while FDPs by semiquantitative latex agglutination. They were done at presentation and 10 days after heparin therapy while they performed once in control group. It was found that the mean values of plasma D-dimer elastase and FDPs were significantly higher than those in control group both before [P[1]< 0.0001] and after therapy [P[2]< 0.0001] respectively. Post heparin therapy, the mean values of same parameters were significantly decreased when compared with pretreatment mean values using paired t-test [p= 0.000] for D dimer, elastase and FDPs respectively. As regards the extent of thrombus diagnosed by doppler ultrasonography, there was a significant increase in the mean values of D-dimer in proximal and all DVT than those in distal DVT while there was no significant difference between plasma elastase and FDPs and the extent of thrombus. A significant positive correlation was found between plasma D-dimer and elastase both before [r=0.845, p=/< 0.0001] and after heparin therapy [r= 0.764, p= 0.000]. No significant correlation was found between FDPs and the previous two parameters neither before nor after treatment. Doppler ultrasonography is a definitive test for diagnosis and localization of thrombus in DVT. Plasma D-dimer, elastase and FDPs can be used for initial evaluation of DVT suggestive patients in the emergency unit and further studies are needed to clarify their role in predicting the recurrence of DVT

Diagnostic value of PRO C global test in patients with deep vein thrombosis

This study was carried out to evaluate pro C Global [PCG] test in clinical routine with special regard to its sensitivity and specificity for factor V [FV] leiden as well as the deficiency of protein C [PC] and protein S [PS]. 70 adult patients with documented diagnosis of deep vein thrombosis [DVT] by Doppler ultrasonography were chosen from those were attending the emergency unit of Alexandria main university hospital and Alexandria armed forces hospital in addition to 30 age and sex matched healthy controls were evaluated for PCG test in relation to gold standard tests i.e. PC activity, PS activity and activated protein C resistance [APCR]. Also determination of lupus anticoagulants [LA] was done for all subjects under study. The sensitivity and specificity of PCG test were [100% and 100%] for FV leiden, [87.5% and 82.3%] for PC and [80% and 78.5%] for PS. The negative predictive value was [100%, 98.1% and 98.1%] for FV leiden, PC and PS respectively. The positive predictive value was [100%, 38.9% and 22.2%] for FV leiden, PC and PS respectively. Also, the diagnostic accuracy was [100%, 82.9% and 78.6%] for FV leiden, PC and PS respectively. The results of LA were negative in all patients and controls. However, the normalized ratio [NR] of PCG test was decreased in [14.8%] of patients group without any detectable defect in PC system and their results were significantly lower than control group [P=0.000]. On the other side, the results were considerably higher than those for the patients with a proven defect in PC system. Pro C Global test is sensitive, specific, less time consuming and can be performed on a routine base. Because of the high negative predictive value, we recommend the use of Pro C Global test in the screening of thrombophilic patients and further determination of F V leiden, PC activity and PS activity is only indicated in case of abnormal Pro C Global results

Use of Mitomycin C in treatment of adult epiphora with blocked nasolacrimal duct

Evaluation and comparison of the safety and efficacy of low dose of mitomycin C [0:2 mg/ml] with lacrimal probing and silicone intubation in adult epiphora, were performed in 46 eyes of 36 adult patients suffering from epiphora due to nasolacrimal duct obstruction. They were divided into 2 groups:-Group I: included 25 eyes treated by probing of NLD with adjunctive washing the duct with MMC. Group II: included 21 eyes treated by silicone intubation after lubricating the tube within MMC. All patients were followed up for at least 6 months. In group I, NLD remained open in 18 eyes [72%] 6 months after the procedure, repeated procedure was successful for 3 eyes [12%] of the remaining 7 eyes with recurrent obstruction during follow up time, an overall patency rate 84% with no complications during follow up. In group II, NLD remained open with surgical success rate in 20 eyes [95.2%] and over drainage of tears from nose was observed in one case. Patient satisfaction was assessed at the end of follow up period in two groups and proved that, watering was disappeared completely in 15 eyes [group I] and 14 eyes [group II], mild improvement in 6 eyes in each group and no improvement in 4 eyes [group I] and one eye [group-II]. Probing of NLD with low dose of MMC in adult epiphora is a simple, effective and minimally invasive technique. Use of low dose of MMC together with NLD intubation is advantageous and carries less risk in adults

Effect of a developed educational booklet about menstruation on nursing students ' knowledge attitude and practices

This study aimed to identify the effect of using an educational booklet on nuringe students' knowledge, practices and attitude regarding menstruation and menstrual hygiene. The study was implemented at the Faulty of Nursing, University of Alexandria. From the previous setting a convenient sample of ZOO students were selected. Two tools were used for data collection. Questionnaire sheet used to assess knowledge and practices of the study subjects about menstruation and menstrual hygiene. While, an attitudinal scale was used to assess students' attitudes towards menstruation. Based on the analysis of data collected during pre-test, the educational booklet was developed. It was distributed to students to read it. The evaluation of the effectiveness of educational booklet's content was measured after 3 months by reassessing the students' knowledge, practices and attitude regarding menstruation and menstrual hygiene. The results revealed that, the educational booklet had an obvious effect in improving students' knowledge, practices and attitude regarding menstruation and menstrual hygiene

Comparison of low dose intraoperative mitomycin C, postoperative mitomycin C drops and conjunctival autograft in primary pterygium

Comparison the safety and efficacy of low dose intraoperative MMC [0.02%], postoperative MMC [0.02%] drops and conjunctival autograft transplantation were done on 48 eyes of 39 patients with primary pterygium. Their age ranged from 21 to 68 years, they were 29 males and 10 females. All patients underwent complete ophthalmological examination including visual acuity, slit lamp biomicroscopy of anterior segment. Patients divided into 3 groups after excision of pterygium. Group I: 16 eyes with intraoperative MMC [0.02%]. Group II: 15 eyes with postoperative MMC drops [0.02%]. Group III: 17 eyes with application of conjunctival graft. Follow up period ranged from 8-15 months [mean +/- SD: 10 +/- 3.2 years]. In eyes treated with intraoperatival MMC, 2 eyes [12.5%] had delayed epithelial defects and recurrence occurred in one eye [6.25%]. In eyes treated with postoperative MMC drops, 3 eyes [20%] had punctate keratitis, delayed epithelial defect observed in one eye [6.6%] and recurrence occurred in one eye [6.6%]. In eyes treated with conjunctival autograft transplantation, 4 eyes [23.52%] had graft oedema, 2 eyes [11.76%] had wound dehiscence, granuloma was seen in one eye [5.88%] and recurrence occurred in one eye [5.88%]. Intraoperative low dose of MMC [0.02%], postoperative MMC drops [0.02%], and conjunctival autograft transplantation are equally effective as adjunctive treatment to primary pterygium with no statistical difference in recurrence rates and neither associated with severe complications

Hang-back versus conventional recession of medial rectus muscles

Forty five patients were included in this study. 25 patients with mean age 4.3 years who underwent conventional medial rectus recession [CR], 10 had infantile esotropia and 15 had acquired esotropia. 20 patients with mean age 5.2 years who underwent hang - back medial rectus recession [HBR], 8 had infantile esotropia and 12 had acquired esotropia. No statistical significant difference in success rate [correction within 10 prism diopters] was noted between two groups. The six months success rate was 84% for CR compared to 85% for HER. In infantile esotropia the success rate was 90% for CR and 87.5% for HBR. In acquired esotropia, the success rate was 80% for CR and 83.3% for HBR. Over correction occurred in 2 cases [8%] of CR and in one case [5%] of HER. Undercorrection was noted in 2 cases [8%] of CR and in 2 cases [10%] of HBR. Hang- back recession of medial rectus muscle is safe, easier to perform and is a satisfactory alternative to conventional recession surgery

Management of traumatic cataract in children

Fifteen eyes of 14 patients with an age ranged between 8 and 17 years, suffering from traumatic cataract underwent extra-capsular cataract extraction with posterior chamber intraocular lens implantation,the preoperative visual acuity was ranged between light perception and 3/60. Postoperative visual acuity was 6/18 or better in 11 eyes out of 13 eyes after we excluded 2 eyes with corneal opacities. Uveitis [33.3%] was the main early postoperative complication and opacification of posterior capsule [40%] was the main late postoperative complication

Effect of sodium barbitone on acetylcholinesterase and monoamine oxidase activities in discrete brain regions of albino rat

The effect of i.p. injection of two separate doses of sodium barbitone [10 or 20 mg/100 g body wt.] on the AChE and MAO activities was studied in nine brain regions of albino rat after one, 2, 3, 4, 5 and 6 days of repeated injection. Injection of 10 mg sod. barbitone/100 g body wt. provoked a general increase in AChE activity in most of the brain parts, however 20 mg sod. barbitone/100 g body wt induced a decrease rather than an increase in the AChE activity of the different brain areas during the whole experimental period. Administration of either of the two doses of sodium barbitone provoked a general increase of MAO activity in the different brain regions and the amount of increase was not the same at the different time intervals investigated. It is possible to conclude that the changes in the activity of the catabolic enzymes [AChE and MAO] in the different brain regions of rat following drug treatment may be associated with the rapid reactions in a general regulatory system against chemical stress