Imported Malaria in Egypt

Background: With the dramatic increase in international travel among Egyptian people, the risk of malaria importation from malaria-endemic regions threatens the achievement of the malaria elimination goal of Egypt

Patients and methods: Blood samples from 700 patients were collected from different medical laboratories in Egypt from travelers to African endemic areas either Egyptians or foreigners coming to Egypt within previous 8 weeks; during period from January to December 2016. All samples were done by direct microscopic examination of the Giemsa-stained thick and thin blood smears ["gold standard"], as well as the rapid diagnostic test [RDT] [Accurate MAL-w23, Polymed] for feverish cases as a confirmatory test

Results: A total of 25;3.57% [out of 700] imported malaria cases were recorded.P. falciparum [15 cases,60%] and P. vivax [14 cases, 56%] were the two predominant species as well as one case [4%] P ovale. From them 4 cases had mixed P.falciparum and P.vivax and one case had P. falciparum and ovale, The cases were coming from 11 African countries and their distribution was, Sudan,11; Nigeria, 5; Ghana,3; Cameroon,1; Angola,1; Congo,1; Chad,1; Guinea,1; Togo,1; South Africa,1; and Eritrea,1case.RDT was performed for feverish [300] patients and positive results were obtained among 27 cases. Twenty five of them had parasitemia while the other two had history of past infection

Conclusions: Imported malaria infections pose an increasing challenge to the malaria elimination in Egypt. The risk of potential re-introduction of malaria into inland malaria free areas of Egypt should be urgently addressed, also the rapid diagnostic tests [RDTs], offer a useful tool for rapid diagnosis in suspected cases

Early versus late tracheostomy for patients with high and low cervical spinal cord injuries

Objectives: This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries [CSCIs]

Methods: This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit [ICU] stay among patients with high [C1-C2 vertebrae] and low [C3-C7 vertebrae] CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined

Results: Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy [9.3 +/- 7.2 days versus 13.7 +/- 3.2 days; P = 0.041]. Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy [12.1 +/- 10.4 days versus 25.2 +/- 17.7 days; P = 0.035]. Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy [P = 0.015]. However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure

Conclusion: An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury

rare late complication of Meckel's diverticulum: diverticulitis induced parietal abscess presenting with multiple abdominal wall fecal fistulae. a case report and review of the literature

This paper presents a case report of 5 years old boy who presented with abdominal pain and fever to the pediatric reception room since four weeks. He was examined and investigated and the possibility of appendiciditis was excluded and a diagnosis of acute non specific mesenteric adenitis was coined. Follow-up medical treatment with antibiotics and conservative measures yielded a parietal abscess in the right iliac region. Simple incision drainage revealed pus and intestinal fecal content. A fecal fistula of appendicular origin was thought for and conservative management continued. However, investigation revealed a communication to the small intestines, and the multi-orifices draining fistulae caused a severe water and electrolyte imbalance with acidosis and emaciation. A decision at exploration revealed a complicated Meckel's diverticulitis, stuck to the abdominal wall and penetrating the muscular wall to end in an arborisation of fistulae in the right iliac fossa and right lumbar region. Resection anastomosis ensured a sound healing of the condition. The peritoneal cavity was exempted from any leak or peritonitis

Cyclic fatigue of profile rotary instruments in relation to their size and diameter

The purpose of this in vitro study was to invent a testing device similar to curved canals to investigate the cyclic fatigue of 0.04 and 0.06 Profile system by recording the time lapsed from the beginning of rotation until separation occurred. Revolution number and length of separated pieces were also determined. A metal device was designed and 120 Profile were tested after dividing them randomly into 2 equal groups from size 15-40 of the same taper either 0.04 or 0.06. The result demonstrated that the smaller size significantly resist fracture and take longer time and more revolution to separate when compared to larger sizes. The mean length of separated pieces was significantly longer [P<0.001] and near the end of the cutting section for the Profiles 0.04 when compared to those of 0.06. This may indicate that smaller diameter Profiles considered safer and stronger in clinical practice

Apical accuracy of root canal fillings performed using the root ZX as the sole method of working length determination

This is an in vivo investigation that was undertaken to evaluate the apical accuracy of root canal fillings performed using the Root ZX apex locator as the sole method to determine the root canal length during root canal treatment and to compare them with conventional radiographic method. Twenty-eight root canals from ten orthodontic patients scheduled for bilateral extractions of their premolars were used in this study. One premolar received root canal therapy using the Root ZX to determine the working length without using active root canal treatment radiographs. The contra-lateral premolar was treated following routine root canal treatment procedures using multiple radiographs [pre-operative, working length, master apical file, master cone and final radiographs]. The teeth were then extracted, decalcified, cleared and the accuracy of the root filling length was evaluated. The results demonstrated that the apical accuracy of root canal fillings performed using the Root ZX only were satisfactory in 86% of the cases compared with 57% using the conventional method, however, the difference was not statistically significantly [P = 0.135]. It was concluded that both techniques produced root canal fillings with similar apical accuracy

Uncontrolled hypertension: the impact of complex drug-regimens and patient non-compliance

To determine the prevalence of uncontrolled hypertensive patients on antihypertensive therapies, and to investigate the causes, accordingly. To achieve desired blood pressure goal, recommendations were projected, as well. A survey was conducted in a community pharmacy during a three- month period on all walking-in patients already identified as hypertensive on pharmacological therapies. Studied parameters mainly focused on patients demographic status, habits, medical history, drug intake, compliance/ non compliance and reasons of non-compliance. Microsoft Excel was used. Data was analyzed and interpreted to find out the reasons of unrestrained hypertension and its occurrence. A total of 46% of hypertensive patients on blood pressure lowering agents were identified as uncontrolled. Two main reasons were recognized: non- adherence to treatments, and concurrent drug intake. Complex drug regimens, medication cost, and drug adverse reactions, accounted for 37%, 35%, and 13% respectively with respect to pharmacological treatment patients' non-compliance. Besides, 67% of patients did not comply with non-pharmacological treatments; of these 33% were current smokers and around 20% were obese not following a special diet to reduce their weight. Patients taking other drugs known to cause or exacerbate blood pressure accounted for 31%. Non-steroidal anti-inflammatory drugs [NSAIDs] made out the major proportion [31%]. To achieve controlled blood pressure mainly depends on the role of health care professionals. They should tailor appropriate antihypertensive therapies based on individual basis, and educate their patients about the importance of treatment regimen adherence

New trends in the use of biological response modifiers for treatment of malignant neoplasm

Biological response modifiers are critical controllers of cell division and hence tissue, growth, migration, development and differentiation. The family of biological response modifiers includes, interferons, tumor necrosis factor, interleukins, colony stimulating factors and hematopoietic growth factors as well as tumor vaccines and monoclonal antibodies. Biological response modifiers have important roles in cancer development and progression, control of cell replication and, apoptosis, and modulation of immune reactions such as sensitization. This article reviews the biology, pharmacology and clinical application of biological response modifiers in oncology. The antitumor activity of biological response modifiers may be mediated by augmented immune responses including activation of natural killer lymphocyles and enhanced expression of cell surface antigens [MHC I and II]. Combination of biological therapy with chemotherapy improves the response of those tumors refractory to conventional therapies. Colony stimulating factors are used for manipulating the immune system to fight against cancer and to prevent chemotherapy-induced Neutropenia. Recent advances in tumor immunology, most notably the identification of genes encoding for cancer regression antigens, have paved the way for the development of a variety of novel and specific vaccines and monoclonal antibody approaches. These approaches are discussed from a therapeutic perspective

Use of a chemically activated resin-modified glass ionomer as a retrograde filling material: an in-vitro study

A comparison was made between the apical microleakage of retrograde fillings with amalgam and with a chemically activated resin-modified glass ionomer cement using a dye penetration technique. Forty instrumented and obturated human teeth were divided into four groups of 10 teeth each. Each root was apically resected. Nail polish was applied to the tooth surfaces of the first 3 groups, and then standardized apical cavity preparations were performed. The retropreparations were filled either with zinc free amalgam [group I], chemically activated resin-glass ionomer [group II], or only covered with nail polish [group III]. In group IV, no retrofillings were made and no nail polish was applied. The specimens were suspended in 2% methylene blue dye for 7 days. The teeth were sectioned longitudinally and the depth of linear dye penetration was measured. The results demonstrated that group II significantly had the least microleakage of all [P < 0.05]. It was concluded that chemically activated resin-glass ionomer should be considered as an alternative retrofilling material

Pulpal response to composite restorative materials: a clinical and radiographic study

OBJECTIVE: To analyze and evaluate clinically and radiographically, the reasons for endodontic therapy in 172 anterior teeth [116 were maxillary and 56. were mandibular] that had been previously restored with composite resin. MATERIALS AID METHODS: A survey was conducted on the basis of data collected and the reason for endodontic treatment, as stated by treating personnel. The results showed that irreversible pulpitis [46 teeth- 26.7%] and necrotic pulp [126 teeth 73.3%], were the reasons for endodontic treatment. The teeth had been filled with composite from 9 to 16 months for irreversible pulpitis and 14 months to 3:5 years before the patients required endodontic treatment. This study suggests that that leakage of composite resin restorations may lead to pulpal disease within a short period of tune and clinicians must take precautions to avoid this

Effect of treatment schedule on the toxicity andpharmacokinetics of cisplatin-doxorubicin combination in Rabbits

The effects of treatment schedule on the interaction between cisplatin [CDDP] and doxorubicin [DOX] were studied in male New Zealand rabbits. Rabbits were divided into three groups., five animals each. Group I received the two drugs simultaneously while group II animals were treated sequentially with DOX one hour post CDDP administration. A third control group was injected with normal saline. Both drugs were injected as an IV. bolus of equal doses, 4 mg/kg each, and their concentrations were determined by spectrofluorometry and flameless atomic absorption spectrometry, respectively. Toxicity was assessed biochemically by estimating indices of nephrotoxicity and tissue peroxidative alterations in terms of malondialdehyde MDA production levels and non-protein sulfhydryl group contents as well as histopathological examination of kidney, heart and liver tissues. Both treatment schedules showed significant increases in serum creatinine and urea levels [p<0.01]. Also, both treatment schedules showed significant increase in MDA production levels and depletion of non-protein sulthydryl group contents in the kidney, heart and liver tissues [p<0.001]. All previous changes were aggravated with sequential administration of CDDP-DOX combination in comparison with the simultaneous one. Furthermore, histopathological examination revealed that sequential CDDP-DOX combination produced significant pathological changes in the rabbits kidney, heart and liver tissues in comparison with those animals treated simultaneously. These results were confirmed by studying the phaimacokinetics of both drugs. The plasma concentration time data for both drugs were fitted into an open two compartment model. DOX pharmacokinetics was significantly altered in the sequentially treated group [p<0.001]. The distribution and elimination half lives for the simultaneously and sequentially treated groups were 0.06 +/- 0.0095 h vs 0.104 +/- 0.0287 hand 3.48 +/- 0.5 11 h vs 18.96 +/- 3.7 h, respectively. The total body clearance in the two groups were 17.64 +/- 1.28 mI/min and 3.31 +/- 0.68 mI/min, respectively. The mean resident time [MRT] and total area under the curve [AUC] were 4.77 +/- 0.689 h and 3.8 +/- 0.26 pg/mI x h vs 26.82 +/- 5.34 h and 20.92 +/- 4.76 pg/mI x h, respectively. The volume of distribution at steady state [V] was 5.02 +/- 0.58 L vs 5.15 +/- 0.291 L, respectively. The pharmacokinetics of CDDP was not affected by changing the treatment schedule [p>0.05]. The only significant change observed was in the distribution half-life, where it appeared to be 0.09 1 +/- 0.054 h and 0.33 1 +/- 0.047 h for simultaneously and sequentially treated animals, respectively. In conclusion, sequential administration of CDDP at one hour prior DOX injection was associated with dramatic changes in the pharmacokinetics of DOX. This might contribute to aggravation of DOX-induced cardiotoxicity as well as hepatorenal toxicity of both drugs

Effect of taxol on the expression of transforming growth factor beta-1 in ehrlich ascites carcinoma cells

Ehrlich ascites carcinoma cells [EAC] were found relatively sensitive to taxol and exhibited a significant apoptotic response following treatment in vitro. The effect of taxol treatment on the expression of transforming growth factor beta one TGF- [Beta1] in vitro was examined. EAC cell line [6 x 10[6] cell] were exposed to different concentrations of taxol for different intervals of time, and the amount of intracellular TGF-[Beta1] was measured using ELISA technique and western blotting. Results revealed that 50 nM of taxol is the optimum concentration at which TGF-[Beta1]. was expressed. Also TGF-[Beta1] 1 expression was maximum after 24 hours of exposure to taxol rather than the other exposure times [2,4,6 h]. The mechanism of tumor responsiveness to taxol associated with increased expression of TGF-[Beta1] is discussed

Clinical immunological and pathological study of thyroid swellings in children and their management

Thyroid swellings in childhood pose an important diagnostic and therapeutic problem. The study was conducted to determine the different causes of thyroid swellings in children in Alexandria and their management; and to evaluate the different noninvasive diagnostic tools. Thirty three patients [22 girls and 11 boys][mean age 10.5 +/- 3.6 years] presenting with thyroid swellings and 13 healthy children [8 girls and 5 boys] were included in the study. Serum total triiodothyronine [RIA], total thyroxine [RIA], thyroid stimulating hormone [RIA], and antithyroid peroxidase [TPO] antibodies [ELISA] were measured in all subjects. The thyroid gland was scanned using real time high resolution ultrasonography. Histopathologic examination was performed in 17 cases treated surgically. Fifteen patients [45.5%] had diffuse goitre while solitary and multiple nodules were present in 30.3% and 24.2% of the patients, respectively. Chronic lymphocytic thyroiditis [CLT] constituted the most common cause of goitre [36.4%], followed by: Graves' disease [12.1%], simple colloid goitre [12.1%], dyshormonogenesis [9.1%], follicular adenoma [9.1%], simple multinodular goitre [9.1%], papillary carcinoma [6.1%], simple cyst [3%], benign teratoma [3%], and amyloidosis [3%]. Serum antiTPO antibodies were positive in 83.3% and 75% of patients with CLT and Graves' disease, respectively, but negative in all other conditions. Ultrasonography gave an accurate differentiation between nodular [solitary or multiple] and diffuse disease. All subjects with hyperthyroid goitre were due to Graves' disease. CLT and dyshormonogenesis were responsible for the hypothyroid goitre. Sixty percent of solitary thyroid nodules were due to focal CLT and follicular adenoma. Papillary carcinoma represented 20% of these nodules. Appropriate surgery was performed mainly in nodular goiter

Echocardiographic assessment of systolic and diastolic functions in athletic hearts

To evaluate the effects of relatively long term, minimum 3 years physical training on left ventricular [LV] systolic and diastolic functions, a total of 80 subjects [S] with age ranging between 18-40 years, were classified into 4 groups [G] and studied. GI, isometric exercise [20] S, GII, isotonic exercise [20] S, GIII, subjects retired for 3 years from endurance sporting program for at least 33 years. GIIIa, retired from isometric exercise [10] S, GIIIb, retired from isotonic exercise [10] Ss, IV, control [20] S. Clinical, ECG and Echo-Doppler examinations were done. Compared to the control G, GI and GII has significantly decreased heart rates, GI had significant increase in LV posterior wall thickness, while GII and IIb had significant increase in end diastolic dimensions or EDD. Left atrial size, LV mass, pulmonary peak velocity [PFV] and average acceleration were significantly increased in GI, II and III. Ejection fraction [EF] and mitral deceleration half-time were significantly increased in GII. Compared to GIIIa, PFV, mitral peak velocity; time velocity integral; deceleration time and deceleration half time as well as aortic time velocity itegral and average acceleration were significantly increased in GI. Compared to GIIIb, only tricuspid peak E. velocity was significantly increased in GII. In conclusion, the changes in systolic function in athletes in practice, GI and II are minimal except for EF which was increased in GII secondary to an increase in FDD. The changes in diastolic function are due probably to the increase in LV mass. Both of them did not return to the pre-exercise levels especially in GIIIb

Electrocardiographic and echo-doppler study in Duchenne muscular dystrophy

Twenty six patients with Duchenne muscular dystrophy [DMD] [4-18 years] and 16 controls [4-18 years] were subjected to cardiac and neurological examination. Patients were divided into gp I [early Duchenne 17 patients] and gp II [late Duchenne, 7 patients]. The electrocardiogram showed sinus tachycardia [77%], sinus arrhy thmias [69%] P wave abnormalities [19%], tall R in v 1 and V 2 [35%]. RSr [31%]. R/S >1 [54%], deep Q [42%] and ST-T changes in [58%]. Six cases [23%] had mitral valve prolapse by echocardiography. Ejection fraction [EF%] and fractional shortening [FS%] were significantly less in Duchenne patients compared to controls [p < 0.01]. EF and FS were significantly less in gp II [late Duchenne] compared to gp I [early Duchenne] [p < 0.01]. Significant impairement was also reported in peak velocity of early diastolic inflow [PE] [p < .05] and PE/peak velocity of late diastolic inflow PE/PA [p < 0.01] in the total gp and gp I compared to controls. PE/PA was significantly less in gp II compared to controls [p < 0.01] and compared to gp I [p < 0.01]. In 14 of the 26 patients we found significant impairment in atrial filling rat [p < 0.01] and rapid filling index [p < 0.05] as compared to controls. In other 10 patients impairement was reported in maximal diastolic posterior wall endocardial velocity [p < 0.001] and deceleration of early diastolic filling [p < 0.05]. We concluded that ECG is a sensetive tool in detecting cardiac involvement in DMD. Both systolic and diastolic functions are affected by myocardial dystrophy, such impairement is progressive throughout the course of the disease