Liver metastases in Egyptian patients with colorectal cancer: incidence and clinico-pathological predictors

Carcinoma of the large bowel is the fourth commonest cancer worldwide. The most frequent site for metastasis is the liver. Overall 30% of patients develop liver metastasis during the course of their illness; of these, 23% to 47% are synchronous lesions. These data are based on western studies. No data are published on patients with colorectal cancer from Egypt. We aimed to assess the incidence of colorectal liver metastasis in Egyptian patients and to evaluate the differences in the clinico-pathological features and tumor behavior in patients with and without liver metastasis. One hundred forty eight patients were prospectively enrolled in the study. Patients were classified into metastatic group [n=78] and non metastatic group [n=70]. In the two groups macroscopic features compared including: tumor size [2 cm, 2-5 cm, and >5 cm], site of primary tumor, side of liver involved, clinical symptoms and liver profile. Carcinoembryonic antigen [CEA] and cancer antigen [CA19.9] levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. No difference was found in the distribution of the primary site and size of the tumor. Jaundice, hepatomegaly and ascites were significantly higher in patients with liver metastases. Patients with liver metastasis had higher levels of CEA, CA19.9, higher frequency of vascular invasion and nodal involvement

Subclinical autoimmune thyroid disorders in Egyptian patients with untreated chronic hepatitis C virus infection

The frequency of anti-thyroid antibodies and subclinical thyroid disorders in Egyptian patients with untreated chronic hepatitis type C was estimated. In addition, it determines the correlation between the seropositivity of anti-thyroid antibodies and serum thyroid stimulating hormone level in chronic HCV positive patients. Also, the impact of hepatic decompensation in inducing thyroid autoimmunity in such patients was evaluated. This study included 56 untreated chronic hepatitis C patients and 28 healthy subjects of the same local population as a control group. The results showed that the mean thyroid stimulating hormone levels were significantly higher in patients with chronic hepatitis C than in controls. Patients with decompensated chronic hepatitis C had insignificantly higher subsequent autoimmune hypothyroidism than the compensated patients. A significant positive correlation between the level of thyroid stimulating hormone and anti-thyroglobulin, but not with anti-thyroperoxidase, was found. Therefore, there is an association between chronic hepatitis C virus infection and subclinical autoimmune thyroid disorders. Thyroid stimulating hormone and anti-thyroglobulin antibodies screening for all chronic HCV patients, even if antiviral treatment will not be initiated, should be done

Diagnostic value of bronchoalveolar lavage in ventilator associated pneumonia of pediatric patients

The major difficulty facing microbial investigation in ventilator associated pneumonia [VAP] is to find a method of choice for distal airway sampling avoiding the contamination of upper respiratory colonizers. Since the inappropriate antibiotic treatment is associated with increased morbidity and mortality therefore the detection of the pathogen causing VAP remains the cornerstone in management. This study was conducted to evaluate the role of bronchoscopic bronchoalveolar lavage [BAL] in the etiologic diagnosis of VAP in Pediatric Intensive Care Unit of Ain Shams University Hospital. In addition, aimed to analyze the pulmonary and systemic inflammatory responses, reflected by levels of serum and BAL interleukin 6 [lL-6] and IL-8, and their association with morbidity and mortality. Thirty VAP patients and 10 mechanically ventilated patients without development of VAP [control group] were enrolled in the study. Endotracheal aspirate [ETA], BAL, and blood samples were collected from VAP patients for microbiological diagnosis. ETA and BAL samples were cultured quantitatively and the isolated organisms were identified by standard techniques. Antimicrobial susceptibility testing was done by disc diffusion method. Blood samples were collected from patients and controls for estimation of serum levels of IL-6 and IL-8. Also levels of these cytokines were estimated in BAL of VAP patients. Twenty four [80%] BAL cultures and 14 [46.7%] ETA cultures were considered positive [thresholds of >/= 10[4] and >/= 10[6] CFU/mL]. Blood cultures were positive in 8 [26.7%] patients. The concordance between BAL and ETA culture results was 66.7% with fair agreement [K= 0.359] while it was only 46.7% between blood and BAL culture results with poor agreement [K= 0.167]. Staphylococcus aureus isolates were recovered from patients with early-onset VAP. Pseudomonas aeruginosa and enteric Gram negative bacilli were the isolated pathogens in late-onset VAP and showed a wide range of antibiotic resistance. The rate of positive BAL culture was significantly higher in late-onset VAP patients [P<0.050]. Serum levels [ng/mL] of lL-6 and IL-8 were significantly higher in VAP patients than controls. VAP patients with sepsis had higher levels of serum and BAL IL-8 and IL-6 than VAP patients without sepsis [p < 0.0001]. BAL IL-6 had the greatest ability to discriminate between patients with and without lung injury. Serum and BAL lL-6 and IL-8 showed a statistically significant [P<0.001] increase in non-survivors among VAP patients and serum IL-8 had the greatest discriminating ability between survivors and non-survivors. Quantitative culture of BAL samples had the potential to be a useful tool for the etiological diagnosis of VAP among mechanically ventilated pediatric patients. However, lowering of the diagnostic threshold to discriminate infection from colonization in patients with prior antibiotic therapy has to be considered. BAL and serum levels of IL-8 and IL-6 might be promising markers for morbidity and poor prognosis in mechanically ventilated pediatric patients

Neurophysiological assessment of skeletal muscles in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is a chronic debilitating disease with disabling symptoms. It has recently become apparent that skeletal muscle dysfunction is common in patients with COPD, and may play a role in reducing exercise tolerance. The peripheral muscles seem to be more affected than the respiratory muscles, especially those of the lower limb in comparison to those of the upper limb. In this thesis the relation between skeletal muscles dysfunction and the severity of COPD was studied. The form of dysfunction emphasized in this study was the muscle strength; being measured as amplitude and envelope or as torque. Thirty COPD patients and ten control subjects were included in this study. All were submitted to the following a- thorough history taking. b-Clinical examination. c- Chest X-ray. d- Arterial blood gases, e- Resting spirometry, f- Isokinetic dynamometry, g- Quantitative Interference pattern electromyography. Results were tabulated and statistically analyzed. There was statistically significant difference between the COPD patients and the control group regarding the strength of the muscle represented in this study by: quadriceps muscle in isokinetic dynamometry and Vastus medialis, in particular, in EMG. There was also a significant correlation between smoking index represented by pack years and the weakness of the muscle. Ex. smokers were found to be more affected. The COPD patients, whether they showed manifestations of hyperinflation or chronic bronchitis, had significant correlation with muscle weakness by surface EMG. However, the correlation was not significant regarding the isokinetic dynamometry, measuring the torque of the muscle, although it was evident that the isokinetic dynamometry was much lowered in COPD in relation to the control group. So, COPD patients diagnosed by clinical assessment, radiology and resting spirometry, showed significant impairment of the strength of their quadriceps muscle; especially, the vastus medialis muscle. The weakness of peripheral muscles was attributed to severity of COPD, and smoking habits

Visual function evaluation of Egyptian beta-thalassemia major patients on long-term desferal therapy

The success of the iron chelator desferal [DFO] in the treatment of beta - thalassemia is limited by its lack of bioavailability. Also, high dosage has been associated with toxicity of the eyes, ears and others. To investigate a possible subclinical visual neurotoxicity, 30 Egyptian p-thalassemia major [BTM] patients on long-term, recommended DFO dosage were studied using visual evoked potentials [VEPs] and electroretinogram [ERG]. We also aimed to clarify the relation of the possible abnormalities to various clinical, hematologic and biochemical parameters. Ten healthy age - matched individuals were enrolled as controls. Sixteen/30 [53.3%] patients showed subclinical abnormalities using VEP and/or ERG. Nine/30 [30%] had VEPs abnormalities, 10 [33.3%] had ERG abnormalities and 3 [10%] revealed abnormalities by both methods. An interesting observation was the significant association of abnormal VEP and MALE sex [P=0.0002]. No significant correlation was found between neurophysiologic abnormalities and all data studied as: age, frequency of blood transfusion, DFO dosage/ duration, splenectomy, CBC values; S. ferritin, Serum Copper, S. Zinc and S. vitamin E. A single patient could have subclinical DFO-induced visual toxicity using VEP as his "toxicity" index [TI] was high [0.078]. the abnormalities can not be mostly attributed to long-term DFO therapy. Serial visual monitoring [including VEP and ERG] of all BTM patients is warranted. It is worthwhile to compare the long-term toxicity of the oral chelating agents [e.g. L 1 and ICL670] with that of DFO before definite conclusions are drawn on any visual neurotoxicity and its relation with the disease state or drug therapy

use of [ELISA] for diagnosis and epidemiology of brucella infection in some farm animals in Assiut governorate

The prevalence of brucella infection among different species of farm animals in Assiut Governorate was estimated by using Rose Bengal plate test [RBPT], Buffered acidified plate antigen test [BAPAT], Tube agglutination test [TAT], Rivanol test [Riv. T.] and Enzyme linked immunosorbent assay [ELISA]. A total number of 197 cattle blood samples were examined serologically. Brucellosis incidence all over Assiut Governorate was 3.6%. On the other hand, slaughter houses revealed the highest infection rate [7.1%] followed by private flocks [1.6%]. While governmental farms did not record any infection rates in this study. A significant correlation between sexually mature animals and the rate of infection was observed. The incidence of brucellosis among cattle was varied according to sex from 0.00% in males to 6% in females. Seroprevalence of brucella infection among 129 sheep blood samples was 11.6% all over the governorate. A highest attack rate [50%] was observed among the age group 2.3-2.6 years. The incidence of brucella infection was 12.2% in ewes while no positive cases were recorded in rams. The serological examination of 32 buffaloes' sera did not detect any positive reactors. The role of these animals in transmitting infection to humans was discussed. The public health hazard from detecting brucella antibodies in 7.3% of the composite milk from 41 dairy cows was also clarified

use of ELISA for diagnosis and epidemiology of brucella infection in humans in Assiut governorate

The prevalence of brucella infection among hyumans in Assiut Governorate was stimated busing Rose Bengal plate test [TAT], and Enzyme linked immunosorbent assay [ELISA]. The seroprevalence of brucellosis among humans in Assiut Governorate was 32.3%. Subjects professionally exposed to livestock including farmers [40.3%] and veterinarians [18.2%] represent a high risk group for brucella infection. The positive butcher case recorded in our study reflects the possibility of abattoir workers to attain the infection. Infections of the occupational groups including students [44.4%], children [40%], manual workers [14.3%] and others [66.7%] explain the role of consumption of raw milk and milk products as well as inadequately cooked meat, liver and spleen in spreading of that zoonosis among humans. A higher brucella prevalence was recorded in men [36.6%] than in women [26.8%]. Also, the rural population shows a higher infection rate [38.7%] than the urban one [14.7%] and this may be attributed to the local dietary customs and habits. Intensification of the infection [40%] among the age group less than 16 years gives a spot light on the serious role of raw milk and milk products in the epidemiology of brucellosis among humans in Assiut Governorate

Biochemical assessment of E selectin and von willebrand factor as markers of atherosclerosis damage in Egyptian hypertensive patients

The aim of the present study was to evaluate levels of von Willebrand Factor and E-selectin in essentional hypertensive patients, before and after successful hypertension therapy, although correlated them with other traditional atherosclerosis risk factors [lipid parameters, blood pressure values and BMI] as well as an attempt to answer the question whether Von willebrand factor and E-selectin can be useful in predicting atherosclerosis in essential hypertensive patients. The study was conducted on 30 essential hypertensive patients before [GI] and after [GII] hypertensive therapy, in addition to 15 healthy age and sex matched normotensive adults as a control group. All members of the study were subjected to: Throughout clinical examination, Liver function tests. Kidney function tests. Determination of body mass index, Blood pressure measurements, in addition to evaluation of levels of fasting and post prandial blood sugar, total cholesterol, HDL-chole, LDL-chole, triglycerides, E-selectin in serum and plasma vonWillebrand Factor. The results of the study showed a significant elevation in serum cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and plasma vonWillebrand Factor in GI [essential hypertensive patients before hypertension therapy] and GIl [essential hypertensive patients after hypertension therapy] as compared to control group. There was a significant reduction in the elevated parameters after 6 months ofantihypertension therapy. The plasma vWF level showed a positive significant correlation with body mass index [BMI] in all studied groups [GI, GII and C]. The levels of E-selectin showed a non significant in GI and GII as compared to control group. The plasma vWF, serum T.cholesterol, LDL-cholesterol. and triglycerides in essential hypertensive patients were higher than those in normotensive control. Also, plasma vonWillebrand Factor had a positive significant correlation with body mass index [BMI] in all studied groups [an important atherosclerotic risk factor], So, WFcould play some role in pathogenesis ofendothelial damage in essential hypertensive patients, it can be used as a complementry test with T.cholesterol, LDL-cholesterol and triglycerides to detecte essential hypertensive patients at risk of atherosclerosis.

Clinical spectrum associated with some structural cerebellar abnormalities

To review the clinical, neuroimaging, cytogenetic, and biochemical studies obtained in 20 patients with different cerebellar structural abnormalities presenting at variable ages of onset with variable signs and symptoms. These patients visited the Clinical Genetics Department, National Research Center, Cairo, Egypt during the period from September 2002 to September 2003. All patients were subjected to complete personal and family history taking 3 generation family pedigree construction and full clinical examination, including complete eye evaluation. Metabolic screening, chromosomal examination and brain CT or MRI, or both, were also carried out. Patients with cerebellar structural abnormalities were broadly divided into those with cerebellar hypoplasia [15 patients; 75%], cerebellar atrophy [3 patients; 15%] and cerebellar white matter abnormalities [2 patients; 10%]. Further, cerebellar hypoplasia was subdivided into cerebello-vermal hypoplasia [4 patients; 20%], vermal-cerebellar hypoplasia [3 patients; 15%] and associated with involvement of other features such as brain stem [4 patients; 20%], posterior fossa [1 patient; 5%]; and intracranial calcification [3 patients; 15%]. This study showed that the type of cerebellar structural abnormality is not the main determining factor of the clinical outcome, but rather the underlying etiology. A high incidence of mostly autosomal-recessive inheritance was diagnosed in 65% of the patients with cerebellar structural abnormalities. Nevertheless, the high rate of consanguinity [18 cases; 90%] with mean inbreeding coefficient of 0.05312 and the similarly affected sibs highlights the role of the autosomal recessive gene in our country

Effect of the pesticides carbofuran [Carbamate] and Profenophos [Organophosphorus] on Biomphalaria alexandrina and on its infection with Schistosoma mansoni miracidia

Carbofuran [carbamate pesticide] and Profenophos [organophosphorus pesticide] showed molluscicidal effect on Biomphalaria alexandrina snails, with the LC[50] 1.42 ppm and 1.29 ppm, respectively Maintaining Biomphalaria alexandrina at sublethal concentrations of these compounds [0.5, 0.75, and 1.0 ppm] reduced the snail survival rate and net reproductive rate [R[0]] [E L[x]M[x]] compared with the control snail group. The percentage reduction in R[0] was 86.9, 90.8, and 93.9 for the tested concentrations of Carbofuran and 86.8, 82.9 and 88.5 for the tested concentrations of Profenophos, respectively. The susceptibility of Biomphalaria snails to infection with Schistosoma mansoni miracidia and further infectivity of this parasite were also reduced. Increasing the pesticide concentration increased the magnitude of reduction reaching 80.7% and 89.3% for the two pesticides, respectively. Pesticide may be considered one of the factors contributing in the disappearance of snail vectors on reaching water bodies as residues from pesticidal activities and consequently hindering schistosomiasis transmission

influence of naringin on the oxidative state of rats with acute hyperglycaemia

To investigate the effect of naringin [a citrus flavonone] on streptozotocin [STZ]-induced hyperglycaemic rats to evaluate the possible hypoglycaemic and antioxidant activity of naringin in diabetes. Setting: Biochemistry Department, National Research Center, Cairo, Egypt. Design: Male diabetic Sprague-Dawley rats were treated with various doses [0, 10, 20, 40, or 80 mg/kg body weight] of naringin. The level of blood glucose, insulin, hydrogen peroxide [H2O2], and thiobarbituric acid reactive substances [TBARS] as well as erythrocytes total antioxidant, and antioxidative enzymes catalase [CAT], superoxide dismutase [SOD], glutathione peroxidase [GPx], paraoxonase [PON] were evaluated. In comparison to the normoglycaemic group, the treatment of rats with a single dose of STZ [65 mg/kg body weight] only revealed significant increase [P<0.05] in plasma H2O2 by 230%, TBARS as index of lipid peroxidation level by 69%, while total antioxidant was decreased by 36%, with consistent significant decrease [P<0.05] in the activity of erythrocytes antioxidative enzymes CAT, SOD, GPx, and PON. Exogenous administration of individual gradual doses of naringin to hyperglycaemic rats causes a dose dependent decrease of glucose level; increase of insulin concentration; decrease of H2O2 and TBARS levels, as well as increase of total antioxidant status with increase of antioxidant enzyme activities [CAT, SOD, GPx, and PON]. Our data suggest that naringin is able to reduce oxidative stress intensity in acute hyperglycaemia. The protective effects of naringin may be connected with the normalization of hyperglycaemia, the inhibition of glucose auto-oxidation and as a result, the reduction of free radical generation, however the greatest effect of naringin was observed at 80 mg/kg

Predictors of medically intractable childhood epilepsy: clinical, electroencephalographic and neuroimaging factors

Predicting which children are destined to develop medically intractable seizures would be very helpful in developing treatment strategies that would be more aggressive than in children with easily controlled epilepsy. Little is known about the natural history, particularly the time course of development, of refractory epilepsy. To identify clinical, electroencephalographic [EEC] and neuroradiological factors associated with both seizure control and medical intractability in children with epilepsy and to be acquainted with predictors of uncontrolled seizures. A case-control study to identify predictors of medically intractable epilepsy in children. Cases were children who had an average of one seizure or more a month over a 2-year period and who, during that time, had failed trials of at least three different anti-epileptic drugs [AEDs]. Controls were children who had epilepsy, who had been seizure-free for >/= 2 years, and who had never, before becoming seizure-free, met the definition for intractable epilepsy. Features of clinical findings, EEG and Magnetic Resonance Imaging [MR1] were compared in 20 children with well controlled seizures and 40 with intractable epilepsy using contingency 2x2 tables for inference of associations, odds ratios, predictive values, sensitivity and specificity. Logistic regression -was performed for multivariate analysis. Strong associates of clinical factors with intractability included: age at onset; duration of epilepsy; multiple types of seizures; complex partial, simple partial, tonic, atonic and myoclonic seizures; initial seizure frequency; history of status epilepticus; history of febrile seizures; duration of fit at onset; lapse of time before treatment; receiving more than one A ED; a symptomatic etiology of the seizures, and abnormal magnetic resonance imaging [MRl] of the brain. Strong associates were noted between intractability and several EEG factors: abnormal EEG background including diffuse slowing, asymmetry and high frequency spikes. These factors were predictors of refractory epilepsy. With multiple logistic regression, independent predictors of intractability included: early risk factors, complex partial seizures and multi-focal or focal epileptic discharges with secondary generalization. There are a number of clinical, EEG and neuroradiological features that can be identified early in the course of childhood epilepsy that are predictive of outcome. These findings will need to be verified in a prospective study

Neurological prognosis of perinatal asphyxia: a clinical and electroencephalographic study

Perinatal asphyxia complicated by hypoxic ischemic brain injury still remains the source of serious and definitive neurological lesions. To establish a relation between clinical signs, EEC and outcome of perinatal asphyxia. A cohort of 64 neonates from the Neonatal Intensive Care Unit [NICU] Faculty of Medicine, Cairo University was enrolled in a prospective study. All the newborns had at least one criteria of perinatal asphyxia. Full clinical assessment and staging was done immediately after birth and one month later. An early electroencephalogram [EEG] was carried out on seventh day of life. Multivariate analysis based on the intake variables identified hypotonia, spasticity, weak or absent crying and EEG epileptogenic activity as independent predictors of poor outcome. All patients with mild encephalopathy had normal EEG background activity. Severe stages of asphyxia were significantly associated with low amplitude background, burst suppression pattern and other forms of background abnormalities as well as non-reactivity. Epileptogenic activity in EEG of these neonates increased the likelihood of uncontrolled seizures. Our study confirms the interest of the association of clinical settings and EEG tracings in the diagnosis and the prognostic of the hypoxic-ischemic encephalopathy in neonates

Influence of some natural and synthetic substances on certain fresh water organsisms and the snail vectors of Schistosomiasis and Fascioliasis

The effect of plants Anagallis arvensis, Calendula micrantha and Ambrosia maritima and the synthetic chemical molluscicides bayluscide and copper sulphate on survivorship, egg production of the snail vectors of schistosomiasis [Biomphalaria alexandrina] and fascioliasis [Lymnaea natalensis] and on some fresh water organisms were studied. Anagallis arvensis and Calendula micrantha showed good molluscicidal action against B. alexandrina and L. natalensis where LC90 values were 88 and 93 ppm, respectively, for A. arvensis and 135 and 100 ppm, respectively, for Calendula micrantha. The cumulative mortality of B. alexandrina [70%] was considerably high after 4 weeks of continuous exposure to A. arvensis. Complete inhibition of egg production was obtained for B. alexandrina after 2 weeks of exposure to low concentration of C. micrantha, bayluscide and copper sulphate. A. arvensis increased the maximum standing crops of algal biomass of Sirogyra [1.1358 g] and daily specific growth rate [0.0586 g.], while the control was 1.0106 g. and 0.0503 g., respectively. A low toxic effect on Daphnia pula was obtained under the effect of Anagul1is arvensis [5% mortality] and calendula micrantha [25% mortality] compared with synthetic molluscicides suggesting the use of the tested plants as molluscicides

Effect of copper sulphate, certain plants and adjuvants on the snails Biomphalaria alexandrina and Lymnae natalensis and on the zooplankton [Daphnia pulex]

The snails Biomphalaria alexandrina and Lymnaea natalensis were exposed to 1/10 LC50 of copper sulphate or of the plants Anagallis arvensis, Calendula micrantha and Ambrosia maritima. The snails were exposed firstly to copper sulphate then to each of the tested plants and vice-versa. The results showed that the pre-exposure of snails to A. arvensis and C. micrantha plants increased the molluscicidal action of copper sulphate against B. alexandrina and L. natalensis where it caused an additive effect. The pre-exposure to A. maritima caused different effects with copper sulphate, where it showed antagonistic effect on B. alexandrina and additive effect on L. natalensis snails. The pre-exposure of snails to copper sulphate increased the molluscicidal action of the tested plants against B. alexandrina and L. natalensis where it caused synergistic effect in case of Anagallis arvensis and Calendula micrantha against L. natalensis and additive effect in the rest of the treatments. Mixing of copper sulphate with each of the tested plants at different ratios caused antagonism in the molluscicidal activity of copper sulphate against B. alexandrina and L. natalensis snails. The addition of each of the following adjuvants; mono-ethylene glycol mono-oleate, mono-ethylene glycol di-oleate, potassium di-hydrogen phosphate and KZ mineral oil to copper sulphate increased the molluscicidal activity of copper sulphate against B. alexandrina, where it caused synergistic effect. In case of L. natalensis, mono-ethylene glycol mono-oleate and mono-ethylene glycol di-oleate caused an additive effect; while, potassium di-hydrogen phosphate and KZ mineral oil induced antagonistic effect. The result of examination of the toxic effect of copper sulphate in combination with each of the tested adjuvant against Daphnia pulex indicated that the treatment of copper sulphate and mono-ethylene glycol di-oleate increases the molluscicidal activity of copper sulphate and at the same time reduces its toxic effect against non-target organisms [Daphnia] and is the best for application

Clinic blood pressure measurements versus ambulatory blood pressure monitoring

To compare clinic [office] blood pressure [BP] measurement and ambulatory blood pressure monitoring [ABPM] in the clinical evaluation of hypertensive subjects. Hundred middle aged and pharmacologically untreated hypertensive subjects were studied [80 men and 20 women]. All subjects were referred fro m outpatient clinic in Farwania Hospital with BP greater than 140/90 mmHg. Resting ECG and echocardiography were done to assess left ventricular hypertrophy [LVH]. In order to exclude patients with ischemia an exercise ECG was done. Ambulatory blood pressure was recorded with an auscultatory device. There was a non -significant difference between the three clinical sessions in the measurement of the office systolic and diastolic BPreadings, [P= NS]. There was no significant intra-recording variation between the first and the second ABPM recordings when considering awake Aly M Hegazy, Bader AAbdel Kader Department of Medicine, Farwania Hospital, Kuwait and asleep maximum SBP, minimum systolic BP, maximum diastolic BP and minimum diastolic BP [P = NS]. Stepwise logistic analysis showed that ambulatory sleeptime and 24-hour systolic blood pressure had a significant relation to the presence of left ventricular hypertrophy [P < 0.05]. There was a good agreement between clinic BP readings and ambulatory daytime systolic and diastolic BP recordings as there was a good distribution of values between upper and lower limits of a g reement [mean +/- 2SD]. There was a significant c o r relation between office systolic BPreadings and awake systolic ABPM recordings [r = 0.954, P < 0.01]. Measured by non-physicians, clinic BP is as reliable as ambulatory BP monitoring in the clinical evaluation of untreated hypertensive patients. Asleep ABP, 24-hour ambulatory BP and daytime systolic BP variability were also shown to be good indicators of left ventricular hypertrophy

Decreased vagal dependent time-domain heart rate variability in hypertensive patients with left ventricular diastolic dysfunction

To evaluate the role of the autonomic nervous system in determining the appearance of diastolic ventricular dysfunction in patients with previously unrecognized and untreated essential hypertension. We studied 100 middle-aged and pharmacologically untreated hypertensive subjects [88 men and 12 women] and 50 normotensive subjects [44 men and 6 women] as a control group [group I]. A l l patients were referred from the outpatient clinic in Farwania Hospital with blood pressure more than 140/90 mmHg as detected by ambulatory blood pressure monitoring with an auscltatory device. Echocardiography was done to assess left ventricular diastolic function. Exercise ECG test was done to exclude patients with ischemic heart disease. Holter ECG monitor was done for all subjects to assess heart rate variability. Hypertensive patients were classified into two groups: group II included 50 patients with diastolic dysfunction and group III included 50 patients with normal ventricular diastolic function. With respect to age, gender, left ventricular mass index and left ventricular systolic function there were no significant difference between all groups of study [P = NS]. The hypertensive patients of group II had a significant decreased E/A ratio [P < 0.05], a significant decreased r-MSSD and p-NN50 [P < 0.05] and a significant increased daytime and nighttime heart rate [P < 0.05] than subjects and patients of groups I and III. There was a significant correlation between vagal dependent parameter [r-MSSD] and E/A ratio [r = 0.875, P < 0.05]. Stepwise logistic analysis revealed no significant relation between age, gender and ambulatory systolic and diastolic blood pressure and the presence of left ventricular diastolic dysfunction in hypertensive patients. Left ventricular diastolic dysfunction in hypertensive patients without left ventricle hypertrophy is related to reduced parasympathetic activity and this supports the use of non-pharmacologic treatment that increases diastolic vagal tone

effect of the plant Furcraea gigantea on Biomphalaria alexandrina snails and Schistosoma mansoni miracidia and cercariae

Crude saponins and ethanol extracts were significantly more potent than the water extracts at LC50 28 ppm and 80 ppm, respectively, against B. alexandrina. Boiled water extract was approximately twice as potent than cold water extract. B. alexandria was less susceptible to the plant than B. truncatus. The boiled water extract LC50 for B. alexandrina and B. truncatus were extract 280 ppm and 210 ppm, respectively. The crude saponins were as lethal to snail eggs as to the adult snails. Miracidia and cercaria were also affected by the plant extracts, although the value of this observation in practical control terms may be limited

Infrared laser per se or with ultrasound in management of carpal tunnel syndrome

The aim of this study was to find out the role of laser therapy in the treatment of carpal tunnel syndrome [CTS]. Thirty female patients suffered from CTS participated in this study, their age ranged between 20 and 40 years with a mean of 30.83 +/- 7.15 years. They were classified into two groups of an equal number: Group 1 received infrared [IR] laser only, while group 2 received both IR laser and pulsed 1:4 ultrasound [US]. IR laser in each group was applied for ten minutes on the skin of the palmar surface of the affected hand, started 3 cm proximal to flexor retinaculum, then passed distally across the retinaculum to pass laterally 2 cm over thenar eminence. Pulsed US was applied for 15 minutes on the area which extends from wrist crease to palmar region to cover an area of 3-5 cm length and 2-2.5 cm width. Both groups received three sessions per week for four weeks. The patients were assessed clinically [visual analogue scale and pinch dynamometer] and electrophysiologically [motor and sensory distal latencies and sensory conduction velocity] before and after treatment program