Histopathological and immunohistochemical study of antiosteoporotic efficacy of the earthworm Allolobophora caliginosa extract in orchiectomized rats / Estudio histopatológico e inmunohistoquímico de la eficacia antiosteoporótica del extracto de lombriz de tierra Allolobophora caliginosa en ratas orquiectomizadas

SUMMARY: Osteoporosis is a bone condition marked by a loss of bone mass and a disruption of bone microarchitecture. Men lose bone density as they age, resulting in brittle bones. The loss of free testosterone is one of the key factors. The objective of present study was to evaluate Allolobophora caliginosa extract (AcE) for its anti-osteoporotic and antiapoptotic activity in orchiotomized rat model at two different dose levels. Twenty eight male rats were divided into two groups. The first group represented sham operated rats while the second group underwent bilateral orchidectomy (OCX). After one week of recovery from orchidectomy surgery, the second group was randomly subdivided into 3 subgroups. The first OCX subgroup was administered orally distilled water daily for 10 weeks. The other two OCX subgroups were administered AcE (100 or200 mg/kg body weight/day) orally for 10 weeks. Orchiectomy induces remarkable loss of the cortical as well as trabecular bone loss; which, could be counterbalanced by Allolobophora caliginosa extract (AcE) that prevented cortical as well as trabecular bone loss. Allolobophora caliginosa extract (AcE) at Dose 200 mg/kg/day was found to be effective at a highly significant level in osteoporotic bone, as determined by histological images and immunohistochemical study, where Dose (100 mg/kg/day) was found to be moderately significant.In the present study, it is suggested that AcE may inhibit steroid-induced osteoblasts apoptosis, potentially via upregulation of Bcl-2 and downregulation of caspase-3. Allolobophora caliginosa extract demonstrates anti-apoptotic and anti-oxidant properties. Therefore, AcE may be used for the prevention of steroid-induced bone damage.

RESUMEN: La osteoporosis es una afección ósea caracterizada por una pérdida de masa ósea y una alteración de la microarquitectura ósea. Los hombres pierden densidad ósea a medida que envejecen, lo que resulta en huesos quebradizos. La pérdida de testosterona libre es factor clave en este proceso. El objetivo del presente estudio fue evaluar el extracto de Allolobophora caliginosa (AcE) debido a su actividad antiosteoporótica y antiapoptótica en un modelo de rata orquiectomizadas con dos niveles de dosis diferentes. Se dividieron veintiocho ratas macho en dos grupos. El primer grupo incluyó ratas con operación simulada, mientras que el segundo grupo se sometió a orquidectomía bilateral (OCX). Después de una semana de recuperación de la orquidectomía, el segundo grupo fue subdividido en 3 subgrupos. Al primer subgrupo de OCX se administró diariamente agua destilada por vía oral durante 10 semanas. Los otros dos subgrupos de OCX se administraron por vía oral AcE (100 o 200 mg / kg de peso corporal / día) durante 10 semanas. La orquidectomía induce una pérdida notable del hueso cortical y trabecular; el cual podría ser contrarrestado por el extracto de Allolobophora caliginosa (AcE) que previno la pérdida de hueso tanto cortical como trabecular visualizado en imágenes histológicas y estudio inmuno- histoquímico, donde se encontró que la dosis (100 mg / kg / día) era moderadamente significativa. En el presente estudio, se sugiere que la AcE puede inhibir la apoptosis de los osteoblastos inducida por esteroides, potencialmente a través de la regulación al alza de Bcl 2 y la regulación a la baja de caspasa 3. El extracto de Allolobophora caliginosa demuestra propiedades anti apoptóticas y antioxidantes. Por lo tanto, AcE puede usarse para la prevención del daño óseo inducido por esteroides.

Study of neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory marker for diabetic nephropathy in type 2 diabetic patients

Background: Diabetes mellitus [DM] is a systemic disease having serious microvascular and macrovascular complications. DN in T2DM has an inflammatory pathology. Many inflammatory markers have been found to be related to DN, such as interleukin1 [IL1], IL6, IL8, transforming growth factor beta 1[TGF-Beta1] and tumor necrosis factor alpha [TNF Alpha]. However, their measurement is not used routinely as it is not easy to do it, in this respect. Search for inflammatory markers for the disease is a continuous process to enhance the diagnostic and treatment process

Aim of the Work: To assess neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory markers for diabetic nephropathy in type 2 diabetic patients

Patients and Methods: This study is a prospective one that was carried out on one hundred [100] type 2 Diabetes mellitus [T2DM] patients attending to internal medicine outpatient clinic and inpatient department of internal medicine at Al-Azhar university hospital, Damietta and twenty five [25] apparently healthy volunteers as a control. The populations of the study were classified into three groups according to their level of albuminuria. All were subjected tofull history and Clinical examination, Laboratory tests include Fasting mid-stream urine samples were obtained and examined for complete urine analysis and albumin/creatinine ratio [UACR],Complete blood count [CBC], HbA1c,Fasting blood sugar, Renal Function Tests,eGFR and Abdominal ultrasonography, Fundus examination and ECG and Assessment of NLR and PLR

Results: Our study showed that there was high statistically significant increased NLR, PLR and UACR in group IB when compared to group IA, II and III. Also there was statistically significant increased NLR,PLR and UACR in group IA in comparison to group II and also there was statistically significant increased NLR,PLR and UACR in group II in comparison to group III

Conclusion: Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] was significantly associated with diabetic nephropathy [DN] and high Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] values may be considered as a predictor and a prognostic risk markers of diabetic nephropathy [DN]

Correlation between peptidyl arginine deiminase type 4 polymorphism and disease activity in polyarticular juvenile idiopathic arthritis in egyptian patients

Background: juvenile idiopathic arthritis [JIA] is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age affecting one or more joints, lasting for at least 6 weeks. PADI4 is one member of PADI gene family. The PADI gene region is located at chromosome 1p36. It codes for enzymes responsible for the posttranslational conversion of arginine residues into citrulline. There are likely to be different genetic risk factors for JIA in different ethnic groups. Therefore, here we sought an influence of HLA-SE and PADI4 on JIA susceptibility in Japanese, because both HLA-SE and PADI4 were reported as significant genetic risk factors for RA independent of ethnicity. Recently, association of PADI4 gene polymorphisms with ACPA positivity and disease activity in polyarticular JIA

Aim of the Work: the aim of this work is to investigate PADI polymorphism rs2240340 to determine whether this polymorphism could be a marker of susceptibility to JIA in Egyptian children and adolescents and whether this single nucleotide polymorphism [SNP] is correlated with clinical parameters in JIA

Patients and Methods: the ethical approval was obtained from the hospital ethical research committee and each patient entering the study will sign an informed consent. Thirty patients included in this study with polyarticular types of juvenile idiopathic arthritis and all of them fulfilled ILAR classification criteria [2004]. All were under the age of sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from January 2018 to June 2018. In this study we measure PADI4 polymorphism and correlate with disease activity in polyarticular JIA in Egyptian patients

Results: association of PADI4 gene polymorphisms with ACPA positivity and disease activity in polyarticular JIA and PADI4 gene polymorphism can be used as a marker of susceptibility to polyarticular JIA

Conclusion: PADI4 gene polymorphism became a marker of susceptibility to polyarticular JIA and gene polymorphism correlated with disease activity in ACPA positivity in polyarticular positive JIA

Cable tie seton in surgical treatment of high perianal fistula

Background: Seton is any string-like material which when tied through the fistula tract causes an inflammatory reaction which stimulates fibrosis that fixes and prevents retraction of the sphincter continuity when it is divided. In this way, it maintains sphincter continuity during cutting process

Aim of work: was to evaluate the cable tie seton technique in surgical treatment of high perianal fistula, regarding the rate of fecal incontinences and recurrence

Patients and Methods: This prospective study included a total of 20 cases having single tract, high perianal fistula, primary or recurrent and who were managed by cable tie seton from October 2016 till September 2017. Patients were enrolled from General Surgery Department, Al-Hussein Hospital. Patients were instructed to follow up weekly for 10 weeks with continuous tightening of the seton

Results: All the patients were followed up for the state of incontinence for flatus, liquid and solid stool and follow up for recurrence, slippage of cable: Incontinence: There is 3 cases noticed in early 2 weeks incontinent for flatus. Incontinence for liquid stool noticed in 2 cases in early 1 week. Incontinence for solid stool not noticed in our study. In all cases, the cable tie seton was kept in its position and didn't dislodged or slipped

Conclusion: It could be concluded that cable tie seton is safe, low cost, ubiquitous, pragmatic, precise, and accost effective option for the treatment of high perianal fistula. We there for recommended it for treating fistula in ano requiring the placement of aseton. It does not carry the disadvantages of repeated anesthesia and visits to the operating theater and reduce the morbidity, inconvenience, and cost to the patient

Detection of biofilms and their interaction in wound infection: role of N-ACYL homoserine lacton and other virulence factors in enhancement of biofilm formation

The deleterious effect of microbial infection on wound healing has been recognized for decades and control of bioburden is considered as an important aspect of wound management. Biofilms play a role in prevention of wound healing. Biofilm-related diseases are typically persistent infections. The aim of this study involves assessment of wound infection through isolation and identification of infected wound-associated pathogens, determination of their ability for biofilm formation, study of interspecies interaction and their antimicrobial resistance pattern. A total of 52 swabs taken from different wounds revealed 80 isolates, that were identified by cultural, microscopic and biochemical tests. These isolates were examined for their biofilm forming capacity by modified microtiter plate assay. For selected culture mates, some virulence factors, which are involved in quorum sensing as well as production of N-Acyl homoserine lactone were determined. Furthermore, antibiotic susceptibility testing of all isolates was done. In total, 27% of the isolates were Pseudomonas species, 33% Staphylococcus aureus, 19% coagulase negative staphylococci, 15% Escherichia coli, 1% and 5% Klebsiella and Proteus species, respectively. All Pseudomonas and Staphylococcus isolates were biofilm formers but with different intensities. Among Pseudomonas and Staphylococcus isolates, 29% and 11% were strong biofilm formers, respectively. All the Pseudomonas isolates were N-Acyl homoserine lactone-producers but with different intensity in its production. A relation between the level of N-Acyl homoserine lactone-production and the expression of virulence factors was observed. A multidrug resistance pattern was observed throughout the different isolates. Biofilm is highly implicated in wound infections caused by either single or mixed species demonstrating a multidrug resistance pattern. Such behavior along with other virulence factors might be controlled by quorum sensing in case of Pseudomonas species and the production of N-Acyl homoserine lactones signaling molecules

Scanning electron microscopy and histopathological study of the effect of estriol on the endometrium of women using long acting injectable contraceptives with irregular uterine bleeding

Hormonal contraceptives are female sex steroids, synthetic estrogen and synthetic progesterone [pro gestin], or pro gestin only. They can be administered in the form of oral contraceptives "OC", implants, and injectables. A large part of the modem medical research has focused on studying the effect of different forms of the hormonal contraception on the human endometrium whether by the conventional dilatation and curettage or by outpatient pipelle to study the endometrial histopathological changes either by light microscope or scanning electron microscope; and to correlate the findings detected by both modalities, in order to develop an effective method for diagnosis and treatment of different forms of eridometrial pathology. The aim of the present study was to evaluate the effect of estrogen treatment on the endometrium of women using pogestational injectable contraceptive [Depo-provera] [R]and complaining of irregular uterine bleeding using: Clinical assessment, transvaginal ultrasound and studying endometrial samples by: The ordinary light microscope and the scanning electron microscope. In this study 30 women using depo provera as a contraceptive method and all of them complaining of irregular uterine bleeding were randomly categorized into 2 groups; group A included 15 cases who received estriolfor 3 months, and group B included 15 cases who received Diosmine for the same period. Both groups were subjected to endometrial sampling by an out patient pippelle before and after treatments then the endometrial tissues were examined by the ordinary light microscope and the scanning electron microscope, results were then tabulated and statistically analyzed using the standard statistical tests. Microscopic examination of-the endometrial biopsies from all women receiving depot inedroxyprogesterone acetate revealed variable degrees of endo, netrial atrophy. The glandular architecture was cystic in cases and budded in the others. The glands were lined by mitotically inactive bland-looking cuboidal or flattened cells with rare pseudostratfication. The glands were embedded' in a mitotically inactive spindled stroma that exhibited varying degrees of collagenation. The ratio of glands to stroma was near one with predominant stroma. in many foci. Microscopic examination of the endometrial biopsies of the 15 patients that received Diosmine for 3 months didn't reveal any proliferative change in 12 of them and only weak prohferative changes were noted in 3 of them. All atrophic endometria examined with the SEM revealed inconsistency in cell size and shape, cellular loss and separation, infrequency of ciliated cells and absence of uterodomes. Epithelial surface was usually flattened, with cells often displaying raised cell borders; Microvillous cells were thinly populated with very low, blebbed microvilli. Afew to moderate number of glands with large openings were observed. Pitted cells were observed in 2 of the specimens that were treated with Diosmine. Number of injections and time lapse since the last injection had a role in the endometrial changes but age, gravidity and parity had no role. Depotmedroxyprogesterone acetate [DMPA] is one of the most effective hormonal iontraceptive methods used by women in reproductive age to prevent pregnancy. Discontinuation of DMPA is mainly due to menstrual irregularities including unpredictable bleeding or spotting; this bleeding is mainly due to endometrial atrophy. Estriol is considered the friendly estrogen and can he used in treatment of vaginal bleeding during DMPA use by changing the endometrium front vrophic to prolfirative so it causes building up of a new endometrium without evident side effects Endometriutn either under effect of DMPA or estriol is easy to be studied by combined scanning electron microscopy and ordinary light microscopy cfter endometrial sampling by outpatient pipelle

Impact of farmers on agriculture pesticides health hazards

Farmers can be exposed to pesticides and its toxicity in different routes. especially farmers in developing world they facing the greatest risks from pesticide exposure because most of them cannot read and are not aware of precautions. Pesticides are adverse group of chemicals which have been developed to kill, prevent, or suppress a wide variety of pests. The study aimed to assess health hazards of pesticide's exposure among farmers. The study was conducted at the farmland in Meat-Kenana Village, [Qaliobia Governorate]. The sample selected included 70 male farmers. Using two tools: the 1St for assessing socio-demographic characteristics, their knowledge and practices when using pesticides and the 2[nd] for assessing the farmers' health status. The study revealed that more than two thirds of the sample [69.5%] have unsatisfactory knowledge about hazards of pesticides exposure and there is a highly statistically significant relation between farmer's knowledge and total health hazards, the study showed that more than half 58.5%] have unsafe practices related to pesticides handling and 80% of farmers buying pesticide before using and storage it at their home. The study was detected no one use self protective measures when dealing with pesticides and a highly statistically significant relation between self protective measures and total hazards, also the study showed that a highly statistically significant relation between health habits during spraying and health hazards. The study recommended an educational program for the farmers about pesticides, their effects on health and availability and use of self protective measure when handling pesticides, as well as periodical checkup for farmers

Apoptosis and histopathological lesions in parasite-infected species of bivalve molluscs

Apoptosis [programmed cell death] is an important mechanism for preservation of a healthy and balanced immune system in vertebrates. Little is known, however, about how apoptosis processes regulate invertebrate immune system. Thus, the present histopathological study was performed to search for the level of apoptosis on hemocytes of three bivalve species namely, Macoma edentula, Hiatula rupelliana and Gastrana fraglis in the Timsah Lake infected with branchial Rickettsia-like parasites and ciliated parasites in the digestive gland. Microscopically, special to elongated intracytoplasmic Rickettsia-like colonies were observed in the base of gill filaments of the clams. Histologically, the distribution and shapes of apoptotic cells were classified into three main types. The aggregation of apoptotic cells were observed in the apical and the basal parts of the ciliated cells lining the gill epithelium. These results provide a first insight into apoptotic processes in mollusc immune cells

Effect of discharge planning for patients with stoma on lifestyle pattern

This study aimed to evaluate the effect of discharge planning for patients with stoma on their lifestyle pattern. A quasi experimental design was used in carrying out this study. This study was conducted at El- Demerdash Hospital affiliated to Ain Shams University and the National Cancer Institute affiliated to Cairo University. The purposive sample was carried out in the period from February2006 until April 2007. The actual number of patients enrolled in the study was 60, they were divided into two equal groups, the study group [n=30] and the control group [n=30], adult male /female patients who were admitted with new colostomy or iliostomy under inclusion criteria. Five tools were used to collect data:l] Ostomy patient assessment sheet [OPAS] .2] Patient questionnaire sheet [PQH], 3] Observation check list for stoma care and 4] lifestyle questionnaire for patient with an ostomy. Tools number 2, 3, 4, were utilized as pre and post tests. The fifth tool was discharge planning [Education program] designed for the study group. They revealed a positive feedback of discharge planning for patients with stoma on lifestyle pattern in the study group [under study] versus the control group during discharge planning till the end of follow -up period [6 months], [p <0.05 and 0.001] respectively. As well a statistically significant difference was found between the study and control groups as regards their lifestyle pattern. The present study answered the researcher hypothesis: There is a positive relationship between the discharge planning for patients with stoma and lifestyle pattern. An Arabic booklet to be provided for patients with ostomy as guidance. The educational program should be hold for staff nurses newly appointed to work in surgical unit

Cytokeratin 20: a new promising marker for colorectal carcinomas

Colorectal carcinoma [CRC] is one of the most common malignancies. Inspire of successful resection of the primary Tumour, metastasis is one of the most important factors determining the patient's prognosis. The present study was initiated to detect disseminated cancer cells in LNs and peripheral blood of patient's with CRC via detection of cytokeratin 20 [CK20] mRNA expression by conventional and real time reverse transcriptase polymerase chain reaction [RT-PCR]. This study included 34 patients with early stage CRC who have undergone total tumor resection, and were proved to be node negative histopathology. The study also included two control groups; a pathological control group [n = 10] suffering from ulcerative colitis and a healthy control group [n = 21], who have undergone pelvic repair for rectal prolapse and were otherwise completely free. For all subjects, serum CEA was measured in addition to cull routine laboratory investigations. Conventional PCR for detection of CK20 mRNA was [lone in both peripheral blood and lymph node samples for all participants. Whereas, quantitative real time RT-PCR for detection of CK20 mRNA was done for lymph node samples of the patient group only. Results of' the present study showed that all peripheral blood samples tested by conventional PCR were consistently negative for CK20 mRNA expression, whereas, mRNA was detected in the LN tissues of 16 of the 34 patients included in this study. Quantitative real-time RT-PCR appeared to be more sensitive than conventional PCR as it was able to detect CK20 mRNA in 20 out of the 34 patients included in this study. Based on the results of our realtime PCR, time patient group was divided into 20 patients with detectable mRNA and 14 with undetectable CK20 mRNA. The results of CEA levels were elevated in the former goup than time latter one, however this elevation was not statistically significant. on comparing nodal expression of CK20 mRNA in different histologic tumour types, 85. 7% of mucinous carcinoma patients showed nodal expression versus 51.9% of adenocarcinoma patients. Patients with Dukes' stag B2 showed 92.8% nodal expression versus only 35% patients with Dukes' B1 stage. Poorly differentiated tumours showed 100% nodal expression of CK20 mRNA versus 38.1% for time moderately differentiated and 66.7% for the well differentiated tumour group. In conclusion, CK20 mRNA is a valuable tool for monitoring early stage dissemination of CRC malignant cells. Real time PCR provides a more sensitive and reliable technique for detection of' disseminated cancer cells in CRC patients than the traditional PCR technique. Besides, CK20 mRNA is a promising predictor of poor prognosis being increased in mucinous, poorly differentiated and Dukes' B2 CRC patients

Relations of serum aldosterone and microalbuminuria to left ventricular hypertrophy in patients with essential hypertension

Left ventricular hypertrophy [LVH] is an independent risk factor for cardiovascular morbidity and mortality in hypertensive patients. The identification of risk factors for the initiation of LVH in patients with hypertension [HTN] is important including microalbuminunuria [MAU] and hyperaldosteronism. Evaluation of the relationship of MAU and plasma aldosterone to blood pressure [BP] and LVH in patients with essential HTN. Thirty male patients with essential HTN and 15 healthy subjects as a control group were subjected to thorough clinical examination, transthoracic echocardiography, lipid profile, serum potassium, and serum aldosterone estimation. MAU was evaluated with dipstick Micral-II Test of fasting midstream morning urine on two successive days. Left ventricular mass index [LVMI] was calculated and values >134gm/m[2] were considered as LVH. Patients with LVMI >134 gm/m[2] had higher serum aldosterone, BMI, Interventricular septal thickness [IVST], Posterior wall thickness [PWT] and Relative wall thickness [RWT]. Serum aldosterone was significantly higher among the test hypertensive group and was positively correlated correlated with LVMI, RWT, PWT, IVST, LVM and negatively correlated with LV diastolic dimensions. MAU was positively correlated with systolic BP, Pulse pressure, BMI and LVMI and a strong relationship between MAU and serum aldosterone was detected. Aldosterone is an important contributor to the development of LVH and hypertensive nephropathy and strong relation between microalbuminuria and aldosterone is detected. The Value of selective aldosterone blockers in preventing target organ damage [TOD] awaits further investigation

Duplex guided endo-luminal radiofrequency ablation of the varicosed great saphenous vein "an old technique using the avalible new technology"

Endo-luminal radiofrequency ablation [RFA] has been proposed as a minimally invasive alternative for treatment of refluxing great saphenous vein. The aim of the study is to evaluate applicability and efficacy of duplex guided endo-luminal radiofrequency ablation of the varicosed. great saphenous vein using the available technology and comparing this with the gold standard treatment. Over two years, forty-three patients with primary great saphenous vein varicosities had been selected and randomly divided info two groups; group A [20 patients, 26 limbs] who were planned for sapheno-femoral disconnection and endoluminal radiofrequency [RP] ablation of their great saphenous vein varicosities and group B [23 patients, 30 limbs] who were subjected to sapheno-femoral disconnection and stripping: The RF ablation in this study using a special catheter was done by open technique through one groin crease incision without intraoperative bleeding, postoperative haematoma or ecchymosis. Thermal skin and saphenous nerve injury and superficial thromb-phlebitis were encountered in 2 limbs [7.69%], clinical and duplex recurrence in 3 limbs [11.54%], and cord like sensation in 6 limbs [23.07%]. Endovenous RF obliteration is more expensive, but the patients recovered faster and had significantly shorter sick leaves [3-7 days] than those in the stripping group [7-15 days]. Endovenous radiofrequency ablation using the available technology is effective in eliminating the great saphenous vein from the venous circulation with faster recovery and better cosmetic results than surgical stripping, yet it is still costy and has some adverse effects

Early results of total arterial revascularization in comparison to conventional coronary artery bypass

The issue of total arterial revascularization as opposed to conventional coronary artery bypass grafting, using the left internal mammary artery and venous conduits, remains controversial. In this study, we aim to compare both methods in regards to outcome, and short term follow-up. Group I: Forty patients [male 37; female 3; mean age 60 years] underwent CABG using arterial grafts only [left and right internal mammary arteries, and left and right radial arteries]. Data collected were compared with another forty patients [Group II] [male 36; female 4; mean age 65] who were revascularized by conventional CABG using the left internal mammary artery and venous conduits. Patients with single vessel disease, preoperative renal or hepatic dysfunction, or associated cardiac procedures were excluded from the study. There was no statistically significant difference between the groups with respect to systemic hypertension [67.5%], insulin dependent diabetes [6.3%], non-insulin dependent diabetes [25%], hypercholesterolemia [72%], prevalence of three-vessel disease [90%] and left main stenotic lesion [10%], or preoperative ejection fraction [44%].Operative technique and myocardial preservation was similar in both groups. The mean number of grafted vessels per patient was three grafts. All patients were totally revascularized, defined as bypass of all significant lesions with more than 70% stenosis. In all patients in Group II, the left internal mammary artery was anastomosed to the left anterior descending artery, and saphenous vein conduits to the remaining stenosed vessels. In Group I, total arterial revascularization was achieved using the internal mammary. There was no statistically significant difference between both groups regarding early post operative events, inotropic requirements, use of intra-aortic balloon pump, reinterventions for bleeding, wound problems, or stroke. Group I:One patient showed manifestations of postoperative infarction [2.5%]. There were no early mortalities. One patient died five months post-operatively from perforated peptic ulcer. Five patients were studied postoperatively [8 to 24 months] by coronary angiography revealing graft stenosis in a single free right internal mammary artery conduit, and one radial artery conduit. Group II: Three patients showed manifestations of postoperative infarction [7.5%]. There were two early mortalities from heart failure. Five patients were studied postoperatively [8 to 24 months] by coronary angiography revealing graft stenosis in three venous conduits. In this short-term study, there was no significant difference between total arterial revascularization in CABG, and conventional CABG using the left internal mammary artery and venous conduits, in respect to early outcome and graft patency

Physical profile and clinical results of concurrent chemoradiotherapy or radiotherapy alone in the treatment of uterine cervix carcinoma using different dose rate brachytherapy

To evaluate physical profile, application techniques and clinical results of conventional external beam radiotherapy [EBRT] with different dose intracavitary brachytherapy [ICRT]. The role of concurrent cisplatin-based chemo-radiotherapy and HDR interstitial brachytherapy technique was also assessed. A total of 108 patients were prospectively studied, distributed into three treatment groups. Treatment was initiated with EBRT in all treatment groups. Groups I and II patients were divided into 2 subgroups [IA, IB], [IIA, IIB]. Both subgroups were treated by a conventional EBRT schedule, and concurrent cisplatin in group II. This was followed by ICRT either low dose rate [LDR] in subgroups IA, IIA or high dose rate [HDR] ICRT in subgroups IB, IIB. Group III patients received concurrent chemoradiotherapy followed by intertistial HDR brachytherapy. The mean age was 48 year. Vaginal bleeding was the most frequent symptom [84%, 80%, and 89% in groups I, II, and III respectively]. Exocervical lesions were the commonest presentation in groups I and II [70%]. Squamous cell carcinoma was dominant in all therapeutic groups. The clinical results showed complete response [CR] in 78% [group I] and 84% in group II, while in group III, only 61% achieved CR. Notably the associated early and late reactions were reported in group III more than the other two groups. Forty-two month actuarial pelvic/locoregional control rates were achieved in 66%, 77%, and 39% in groups I, II and III respectively [p=0.05]. The utilization of HDR ICRT compared to LDR produced a dramatically improved ability for dose distribution and optimization, not to mention patient convenience. The addition of cisplatinum with conventional EBRT and ICRT [LDR and/or HDR] demonstrated a clear positive impact on initial treatment results and subsequent progression-free and overall survival, with minimal differences in treatment related morbidities compared to radiotherapy alone. The utilization of interstitial rather than ICRT techniques, for patients with generally poor pelvic anatomy, producing more improved dose distribution/optimization, resulted in comparable actuarial 3.5-year cumulative overall survival rate

Circulating adrenomedullin [AM] in children with congenital cyanotic heart disease

This study included 16 children [11 males and 5 females] with congenital cyanotic heart disease without pulmonary hypertension [PH] or heart failure [HF] with age ranged from 2 to 7 years [group 1] and 16 children [9 males and 7 females] with atrioventricular re-entrant tachycardia [AVRT] with age ranged from 4 to 9 years as a non-cyanotic controls [group 2]. All children were subjected to clinical examination, complete blood count [CBC], serum creatinine, arterial oxygen saturation, X-ray chest, electrocardiogram [ECG], echocardiogram, cardiac catheterization and plasma levels of AM in samples of pulmonary artery blood [PAB], pulmonary venous blood [PVB] and femoral vein blood [FVB]. The results of this study revealed that the plasma levels of AM at the three sites of sampling were significantly higher in group 1 than that in group 2, and also showed that in group 1 there was a significantly higher plasma level of AM in PAB than its levels in PVB and FVB, but no significant difference between its level in FVB and that in PVB

Intraoperative evaluation of graft patency in off-pump coronary artery bypass grafting

The accuracy of the anastomosis in off-pump coronary artery bypass [OPCAB] is sometimes questionable due to incomplete stability of the anastomotic site and wet field. Transit time flowmetry is a new technology used to evaluate the immediate graft patency intraoperatively. This is a prospective study to evaluate the benefit of this new technology in detecting silent technical errors leading to early graft stenosis or occlusion. In a period of 22 months, a prospective study of 112 patients underwent OPCAB with total number of 308 anastomoses. All grafts were tested by transit time flowmetry. The pulsatility index [PI] and the flow pattern wave were used to evaluate the patency of the grafts. These parameters were acceptable in all but 4 grafts [1.2%]. The cause was a technical error in all 4 grafts which were revised. None of these cases required revision on the pump. ECG and hemodynamics were normal in all 4 cases. We concluded that transit time flowmetry is an effective and reliable method in detecting early anastomotic problems in the operating room. Surgeons should be encouraged to use it routinely in the operating room in off- and on- pump technique

Peptone-liver [P-L] a new culture medium for the Egyptian leishmania major

Leishmania major promastigotes isolated from an Egyptian ZCL patient was inoculated 4x106/ml in a new culture medium, peptone-liver [P-L], with a total concentration of 10% of FCS [fetal calf serum] and incubated at 25 +/- 1C. Meanwhile, the same number of promastigotes was inoculated in Schneider's Drosophila medium as a control. On the 10th day, the number of L. major promastigotes reached 29.25x106/ml. The same number was obtained with Schneider's Drosophila medium within four days. The new culture medium or P-L medium is cheap, easily prepared and gave a very good number of promastigotes as in Schneider's Drosophila medium, but in a longer time

preliminary study on dicrocoeliasis in Egypt, with a general review

Dicrocoelium dendriticum [D. Dendriticum] is a lancet-shape liver fluke that affects sheep and mammals including man. Human and animal infections have been reported worldwide, particularly in some of the Eastern Mediterranean sheep raising countries. Infection is acquired by eating the second intermediate host [17 species of ants] with raw fruits, vegetables, herbs or even with the drinking water. As for the first intermediate host, there is about 54 different species of land snails. In spite of the fact that both the first and second intermediate hosts of D. Dendriticum are available in Egypt, data about human and animal dicrocoeliasis is lacking. This investigation was a preliminary study to report on the presence of D. Dendriticum [in sheep, goats and man in North Sinai Governorate] in Egypt

diagnostic role of mediastinoscopy in isolated mediastinal tuberculous lymphadenopathy

Isolated mediastinal tuberculous lymphadenopathy without a pulmonary parenchymal lesion is still a diagnostic challenge. The diagnostic yield of noninvasive methods is low in these cases. From July 1995 to June 2002, 39 patients with suspected isolated mediastinal tuberculous lymphadenopathy without any demonstrable pulmonary parenchymal lesion and with negative diagnostic noninvasive methods underwent mediastinoscopy as a final diagnostic step for diagnosis. These cases where reviewed retrospectively. The mean age was 36.3 years [range, 9 to 64 years] and 24 were male. The most common symptom was cough in 32 patients and 7 were asymptomatic. In all cases chest x-ray [CXR] and computed tomography [CT] chest showed isolated mediastinal lymphadenopathy with Involvement of the right paratracheal nodal group in 33 cases. In 27 patients [group 1], Multiple biopsies of 2 to 4 mediastinal nodal groups diagnosed tuberculous lymphadenitis in all patients; in 4 of them nonspecific inflammatory nodes were also sampled. The diagnostic yield [sensitivity] in group 1 was 100%. In 12 patients [group 2] who had biopsies of one mediastinal nodal group, the diagnosis could not be established in 3 patients and the diagnostic yield was 75%. In both groups the diagnostic yield of mediastinoscopy was 92%. It was concluded that when used effectively, mediastinoscopy was acceptable as a final diagnostic step in patients with suspected isolated mediastinal tuberculous lymphadenopathy without a pulmonary parenchymal lesion because of its high diagnostic yield

Toward safe motherhood in rural community: the effects of health education on mothers practices during puerperium

Health education and increased knowledge of mothers in relation to their health is one of the major concerns of the public health sector throughout the world, and it is a strategy for improving maternal and child health. The aim of this study was to evaluate the effects of health education on the mothers' practices during puerperium. The study sample consisted of 258 mothers residenting in El Khossous village, Qualiobeya Governorate. Three tools were used for data collection. The first tool was an interviewing questionnaire for collecting data related to socio-demographic characteristics, parity and mothers knowledge; second tool was an observation check-list for assessing mothers practices, house sanitation, and signs of illness; the third tool was physical examination for assessing infant growth and development. The results demonstrated significant effects of health education on mothers' knowledge and practices and a reduction in mothers and infants health problems. The study recommended that health education about puerperium care must be given to all pregnant women attending the Maternal and Child Health Center