Prevalence and Molecular Diversity of Legionella pneumophila in Domestic Hot Water Systems of Private Apartments.

Aims: To determine the prevalence of Legionella spp. in domestic hot water systems and evaluate the molecular diversity among these Legionella spp. Isolates. Place and Duration of Study: Sample collection area was the city of Aqaba, Jordan, between May and December 2012. Sample analysis was done in Ben-Hayyan international laboratories, Aqaba city, and the molecular microbiology laboratories, Taibah University, Saudi Arabia. Methodology: Two hundred (200) water samples were collected randomly from hot water tanks of private apartments, and were tested for the occurrence of Legionella spp. using direct membrane filtration method followed by species identification using Gram stain, the API 20NE biochemical system and the Legionella species latex agglutination test. Genotype characterizations of the Legionella isolates was carried out using DNA extraction followed by RAPD-PCR amplification with OP-A3 primer and analysis of the resulting patterns. Results: Of the 200 samples, 17 (8.5%) were positive for the presence of Legionella spp. A total of 15 (88.2%) out the 17 positive samples were confirmed as Legionella pneumophila, 10 of them were of serogroup 1 and 5 isolates were of serogroup 2-14, the remaining two isolate were Legionella species other than L. pneumophila. RAPD-PCR analysis classified all 17 Legionella isolates into three groups. Serogroup 1 isolates were classified into group A, serogroup 2-14 isolates in group B and Legionella spp. isolates in group C. Group A was further sub-clustered into two subgroups, genotype A1 containing isolates collected from hot water tanks of a temperature set at 25-30°C and A2 containing isolates collected from hot water tanks of a temperature set at 55-80°C. Conclusion: This study showed the colonization of the plumbing systems of private houses by Legionella spp. and demonstrated that the temperature of the water tanks maybe one of the most important factors that affect the genotypic behavior of Legionella pneumophila.

effect of anterior stromal puncture using Q-switched Nd:YAG laser on corneal wound healing

Recurrent corneal erosion occurs when the wounded corneal epithelium failed to adhere to the underlying stroma. Therefore, this work aimed to assess the effect of treatment of corneal injury using Q- switched Nd:YAG laser. Twenty one New Zealand male rabbits weighing 2-2.5 kg and 3 months old were classified into three main groups. The control group: did not received any treatment [n=3 rabbits]. The rest of the animals [n= 18 rabbits], corneal epithelium was injured by syringe needle and blade 15 and divided into:[A] Normal healing group: which was divided into three subgroups [n=3 rabbits each], and the animals were left for normal healing for1 day, 1 week, and 4 weeks respectively, [B] Laser treated group: divided into three subgroups [n=3 rabbits each] and subjected to anterior stromal puncture using Q-switched Nd: YAG laser on corneal sub-epithelium or superficial stroma, and the animals were left for 1 day, 1 week, and 4 weeks respectively. After the demonstrated periods, the corneas were isolated for estimation of total protein content, sodium dodecyl sulfate polyacrylamide gel electrophoresis [SDS-PAGE], total antioxidative capacity [TAC], total oxidative capacity [TOC] and oxidative stress index [OSI]. The present results of corneal total protein showed increment in the percentage change in normal healed groups after 1 day, 1 week and 4 weeks by values of 93%, 68% and 39%. In Q-switched Nd: YAG laser treated group the results showed better improvement in corneal protein than normal healed group with percentage changes of 58%, 29%, and 7.5% respectively. In SDS- PAGE, a protein band at 110 KD appeared in the migrating epithelium for both normal healed group and Q-switched Nd:YAG laser treated group with changes in the peaks intensities at middle and low molecular weight regions. Moreover, after 4 weeks the peak at 110 KD disappeared in the wounded epithelium treated with Q-switched Nd:YAG. After four weeks, the OSI in laser treated corneas showed pronounced balance between antioxidative capacity and oxidative capacity. Anterior stromal puncture by Q-switched Nd:YAG laser is an effective, simple, safe and promising procedure to treat recurrent corneal erosion than normal healing

Histological evaluation of retina after photo disruption for vitreous humor by Q-switched neodymium-doped yttrium aluminium garnet [Nd: YAG] laser

Rabbits' eyes were exposed to vitreous humor liquefaction with Q - switched [sometimes called " giant pulses"] Neodymium-Doped Yttrium Aluminium Garnet [Nd: YAG] laser using two different energy protocols [5 mJ X 100 pulse and 10 mJ X 50 pulse] with and without vitamin C administration. The histological changes in the retina were investigated to evaluate the protective role of vitamin C. The rabbits were divided into four main groups [n= 12 each]. The first group was divided into three subgroups [n=4] and then treated with 5 mJ X 100 pulse [X means times] delivered to the anterior, middle and posterior vitreous humor respectively. The second group received a daily dose of 25 mg/Kg vitamin C for two weeks then was divided into three subgroups and treated with laser in the same manner as the first group. The third group was divided into three subgroups [n=4] and then treated with 10 mJ X 50 pulse delivered to the anterior, middle and posterior vitreous respectively. The fourth group received a daily dose of 25 mg/Kg vitamin C for two weeks then was divided into three subgroups and treated with laser in the same manner as the third group. After two weeks, rabbits were decapitated and histological examination for the retina was performed. The results showed that, the anterior vitreous group exposed to 5mJX100 pulse and supplemented with vitamin C, showed no obvious change. Furthermore, all other treated groups showed alteration in retina's tissues histology after laser. Application of Q-switched Nd: YAG laser in vitreous humor liquefaction induces changes in retina's layers. Although there were some sorts of improvements in retinas supplemented with vitamin C, it cannot protect them against laser oxidative damage.

Photothrombosis of corneal neovascularization by photodynamic therapy utilizing verteporfin and diode laser

The aim of the present study was to evaluate the effect of photodynamic therapy in the treatment of experimental corneal neovascularization [NV] with benzoporphyrin derivative [BPD]. One group was considered as control [n=6 eyes] then, corneal NV was induced in 30 New Zealand male rabbits [n=60 eyes] by placing 7.0 silk sutures at midstromal depth approximately 1mm from the limbus. Fifteen rabbits with corneal NV were left without any treatment, and 15 rabbits were subjected to photodynamic therapy [PDT] by intravenous injection with Verteporfin at a dose of 1.5 mg /Kg. Diode laser [660 nm] was applied after 15 minutes for 5 minutes with a power of 50 mW/cm[2]. All rabbits were successively followed up by slit lamp examination for periods of 1 day, 1, 2, 3 and 4 weeks. Three rabbits were selected and sacrificed weekly [n=6 eyes each] and the corneas were isolated for histopathological examination. The results of slit lamp examination indicated the gradual regression of the cornea neovascularization 4 weeks of PDT. Furthermore, regression of corneal neovascularization was documented clinically by decrease number and length of blood vessels and by histopathological examination. PDT with Verteporfin can provide efficacious treatment of corneal neovascularization

Capillaria philippinensis: a cause of chronic diarrhea in Upper Egypt

Capillaria philippinensis is a rare zoonotic intestinal parasite that is endemic in Philippines and Thailand. A few cases have been reported in Japan, Iran, Egypt, and Taiwan. The outcome of C. philippinensis may be fatal if untreated in due time. C. philippinensis is an emerging infection in Egypt as a cause of chronic diarrhea; thus, we carried out this study to determine the presence and frequency of C. philippinensis in patients with chronic diarrhea in Upper Egypt. The study included 113 patients with chronic diarrhea attending the Department of Tropical Medicine and Gastroenterology, Assiut University Hospital. All patients were subjected to full history taking, clinical examination, and laboratory investigations including stool examination, complete blood count, and assessment of blood urea and serum creatinine, serum albumin, and electrolytes [sodium, potassium, and calcium]. Also, gastroduodenoscopy, duodenal biopsy for histopathological examination, and colonoscopy were performed for every patient. C. philippinensis was reported in seven patients. All of them were young female patients with severe chronic diarrhea, associated with vomiting, abdominal pain, anorexia, borborygmi, weight loss, and ankle edema; three patients had mild ascites. The seven patients had hyponatremia, hypocalcemia, marked hyokalemia, and hypoalbuminemia. The diagnosis of C. philippinensis was established on finding the characteristic egg of C. philippinensis in the stool of all cases; histopathological examination of the duodenal biopsies indicated heavy cellular infiltration around the adult worm in one of them and larvae in another one. Six patients recovered completely with albendazole treatment 200 mg twice daily for 21 days, whereas one patient died of heart failure because of severe hypoalbuminemia and hypokalemia. Capillariasis is one of the parasitic causes of chronic nonbloody diarrhea in patients in Upper Egypt

Spontaneous viral clearance of chronic HCV infection in Upper Egypt: a community-based study with a 10 year follow-up

Hepatitis C virus [HCV] infection is a global blood-borne disease with the highest prevalence in Egypt. The natural course of HCV infections in highly variable. The reason why the infection persists in some patients and resolves spontaneously in others is not known. The aim of this study was to detect the frequency of spontaneous clearance of chronic HCV infection in Upper Egypt and to determine the predictors of persistence of HCV infection. In 1997, a community-based study was performed in Sallam village in Upper Egypt. Out of the 329 patients who had the start of the study and those who had received specific treatment for HCV infection. These patients were followed up every six months prospectively starting from 2004 till 2007 by clinical, ultrasonographic, and laboratory examinations [liver functions, complete blood count, prothrombin time and concentration]. Serum HCV-RNA was tested for at the end of the follow up period. After a 10-year follow-up, spontaneous clearance of chronic HCV infection was detected in 35 [17.5%] out of 200 patients. Most of clinical and laboratory abnormalities were detected in patients with HCV-RNA persistence than those who had cleared HCV-RNA. By ultrasonographic examination, normal liver echopattern was found in 30 [85.7%] cases with HCV-RNA clearance and in75 [45.5%] patients who had HCV-RNA persistence. Evidence of liver cirrhosis was found only in 9 cases with HCV-RNA persistence [5.5%]. Old age [>60 years] was the strongest predictor of persistence of HCV infection followed by obesity and history of blood transfusion. Spontaneous clearance of chronic HCV infection could occur without any specific antiviral therapy in 17.5% of patients. Older age was the strongest predictor of persistence of HCV infection followed by obesity and infection by blood transfusion

Comparative study between the use of rectal misoproostol versus intravenous syntometrine in the active management of the third stage of labour

Postpartum hemorrhage is one of the major maternal killers. The use of uterotonics reduces the occurance of atonic postpartum hemorrhage. Oral Misoprostol [prostaglandin E1 analogue] used for the prevention of peptic ulcer disease was reported to prevent postpartum hemorrhage The present study is to compare between the effectiveness and side effects of rectally administered PG E1 analogue [misoprostol] and IV Syntometrine [0.5 mg a methyl ergometrine plus 5 IU of syntocinon] for prevention of atonic postpartum hemorrhage minimizing blood loss during the early postpartum period. Prospective randomized study. Three hundred cases who attended in El-Shatby Maternity Hospital, Obstetrics and Gynecology Department, Alexandria University were included in the study. All patients had a fuliterm living single fetus, presenting by the vertex, with a smooth course of the 1st and 2nd stages of labour. Cases were categorized into 3 groups: Group A [100 cases]: received Syntometrine in intravenous infusion of 500 ml saline immediately after delivery of the baby. Group B [100 cases]: received 2 tablets of Mesotec [total of 400 ug] rectally immediately after delivery of the baby. Group C [100 cases]: received IV infusion of 500 ml saline without any medications and placebo tablets rectally immediately after delivery of the baby. The amount of blood lost was evaluated by visual estimation, calculation, and lab parameters. Misoprostol with its rapid onset of action was more effective than intravenous infusion of syntometrine and placebo in terms of minimization of the amount of blood loss, shortening the duration of the third stage, in addition to decreasing the rate of postpartum hemorrhage. It is also cheap, more stable, and has less side effects

Evaluation of the levels of circulating carbohydrate antigen and anti-SWAP antibodies in patients with active Schistosoma haematobium infection and its relation to morbidity changes

The immune responses of schistosomiasis and its relation to morbidity changes is important to understand the pathogenesis of this disease. The aim of this study is to evaluate the levels of circulating antigen and anti-SWAP antibodies and its relation to morbidity changes in patients with active Schistosoma haemtobium infection. An antigen enzyme-linked immunosorbent assay [ELISA] employing monoclonal [mAb] 128C3/ 3/21 was used to detect circulating parasite-derived antigen in the sera of 35 of actively infected schistosoma haematobium patients [31 males and 4 females, 5 to 25 years of age] seen in the out patient clinic of Assiut University Hospital. AntiSWAP [soluble adultworm antigen preparation] immunoglobulins IgG1. IgG4 and IgE were performed for 25 of them. Patients were treated with praziquantel [PZQ] and re-evaluated after 1, 3, and 6 months. Changes in morbidity were evaluated using ultrasonographic grading of urinary bladder lesions. It was found that all patients had significantly high levels of circulating antigens in their sera i. e. above the cut-off value. The antigen level fell significantly in the follow cup visits [p<0.001]. Although the mean antigen level was still significantly reduced [p<0.001] at 6 months visit, 16 patients had high mean antigen level and 9 had rising levels of antigenaemia, reflecting reinfection in 6 patients and persistence of infection in the others. On the other hand, all patients had positive ELISA reaction for IgG1 and IgG4, while 5 patients had negative reaction for IgE through the different visits before and after treatment. The decrease in the mean levels of IgG1 and IgG4 were statistically significant only after 6 months of treatment, but the mean levels of IgE showed significant drop at 3 and 6 months of treatment. A significant correlation was found between the circulating antigen and the anti SWAP IgE during the active infection, but no significant correlation was found between the antigen level and IgG1 and IgG4. There was a significant correlation between the level of circulating carbohydrate antigens and morbidity changes of the urinary bladder. On the other hand there was no significant correlation between the anti-SWAP antibodies and morbidity changes. We conclude that ELISA assay for detection of circulating carbohydrate antigen of S.haematobium is valuable and sensitive in diagnosis of active infection, measurement of intensity of infection and detection of reinfection as well as evaluation of the efficacy of treatment. Its level correlates with anti-SWAP IgE during active infection. In addition it correlates significantly with

Spread of schistosomiasis mansoni to middle and upper Egypt

Following the construction of Aswan High Dam, Schistosoma mansoni seems to be a growing problem and may be replacing S. hematobium along the River Nile in Egypt. This is due to relative increase of the snail vector of S. mansoni Biomphalaria alexandrina compared with the reduction of the snail vector of S. hematobium Bulinus truncatus. This retrospective study presented the results of cases of S. mansoni diagnosed in four schistosomiasis research projects performed in Middle and Upper Egypt. S. mansoni was detected in 103 out of 29683 subjects studied in these four studies. It was also detected in 35 out of 93 villages and satellites screened. S. mansoni ova were detected in urine of 14 out of 9555 in Assiut and in 9 out of 12327 in Qena. It was detected in both urine and stool in three cases. Sixty-six of the cases were among the age group below twenty years. Most of the cases had mild infection with ova <50 ova/g. It was concluded that this retrospective study showed that the spread of S. mansoni to Middle and Upper Egypt seems to be progressive and not in limited foci as reported before and it was detected in 40% of the villages screened. Further prospective epidemiological studies are recommended to evaluate and investigate this serious phenomenon

Association between chronic hepatitis C virus infection and diabetes mellitus in Egyptian patients

This study included three groups of patients [284 patients with liver cirrhosis, 93 with type II DM and 63 HBsAg, HCV-Ab and/or HCV-RNA positive blood donors]. All cases had history and clinical examination, abdominal ultrasound, blood glucose, liver function tests, HBsAg and HCV-Ab. HCV-RNA by PCR was performed for 83 cases, islet cell antibodies for 63 and cryoglobulin for 104 cases of liver cirrhosis and glycosylated hemoglobin for 63 seropositive blood donors. The frequency of DM was significantly more in cirrhotic patients with positive HCV-Ab and/or HCV-RNA [40.5%] than those with positive HBsAg [3.3%]. There was no relation between presence of DM and severity of cirrhosis due to HCV, presence of either islet cell antibodies or cryoglobulins. The percentage of blood donors with positive HCV-Ab and/or HCV-RNA who had raised glycosylated Hb 31[68.8%] was significantly more than that with positive HBsAg 3 [16.6%]. The percentage of HCV-Ab was significantly more in patients with type II DM 44 [47.3%] than that of HBsAg 1 [1.1%]

Clinical and ultrasonographic evaluation of patients with hepatic periportal thickening

This work aimed to study different clinical conditions other than schistosomiasis in which HPT may occur. The study included 460 patients with active S. hematobium infection seen consecutively in the Outpatient Clinic and 107 urban patients with pyrexia for more than a week without previous exposure to schistosomiasis and 246 healthy urban controls. US was performed using a portable machine. HPT was graded as followed; 0 [< 3 mm], I [3-5 mm] and II [5-7 mm]. HPT was significantly more in patients with S. hematobium [33.6%] and controls [12%]. It was detected more often in patients with S. hematobium than controls. Among different causes of pyrexia typhoid fever was the most significant cause of HPT. Grade II lesions were present only in 0.2% of patients with S. hematobium. It was concluded that mild grades of HPT could occur in numerous condition other than schistosomiasis as typhoid fever, while advanced grades were not present in either patients with pyrexia or controls. It seems that cellular infiltration in the portal tract gave the US appearance of grade I HPT

Evaluation of eosinophiluria in active schistosomiasis haematobium and its relation to morbidity changes in the urinary tract

Schistosoma hematobium was reported as a cause of eosinophiluria. In this study, evaluation of the relationship between eosinophiluria using Hansel's strain and urinary morbidity as detected by ultrasound in 75 patients with active S. hematobium infection. The control group included 91 subjects [20 normal, 20 had blood eosinophilia due to causes other than schistosomiasis and 51 had different renal diseases]. All patients received a single dose of praziquantel 40 mg/kg and were followed up after one and three months. The frequency of eosinophiluria was significantly more in patients with active S. hematobium than those with renal disease [46.7%], 12%. Eosinophiluria was not present in either normal controls or patients with eosinophilia due to causes other than S. hematobium. There was a significant positive correlation between the log of ova count and the eosinophil count in both urine and blood. However, there was no relation between either eosinophiluria or eosinophilia and urinary bladder or renal morbidity changes. The sensitivity of eosinophiluria as an indirect index for suggestion of S. Hematobium infection was 33%, the specificity was 93.8%, the positive predictive value was 88.6% and the negative predictive value was 49.2%

Effect of eradication of Helicobacter pylori, using omeprazole and amoxicillin, on the level of serum gastrin, somatostatin and secretin in Egyptian patients with duodenal ulcers

Forty-three patients with duodenal ulcer [DU] diagnosed by endoscopy and fifty-one patients with non-ulcer dyspepsia [NUD] were included in this study. The diagnosis of H. pylori [HP] was performed using urease test and culture of four biopsies from the antrum and corpus. Gastrin was measured by RIA, SO and SEC by ELISA. DUs patients received omeprazole [20 mg/day] for four weeks and amoxicillin [500 mg 3 times/day] for two weeks and follow up was performed for 23 patients with DUs after one month. It was concluded that patients with DUs had higher levels of G and lower levels of SO and SEC than patients with NUD. HP seems to be responsible for increased G and reduced SO in patients with DUs and its eradication led to significant reduction of G and increase in SO with consequent reduction in acid secretion

Isolation of campylobacter in adult patients with chronic diarrhoea and the effects of spiramycin

One hundred adult patients with chronic diarrhea were studied in a trial to determine the frequency of Campylobacter jejuni infection in such cases. The stools of the patients and that of 70 adult controls were cultured for C. jejuni. The organism was isolated in 6% of the patients and it was not isolated from stool cultures of the 70 controls. Campylobacter jejuni was isolated from 2 [28.6%] out 7 cases with ulcerative colitis, 3 [5.4%] out 56 cases with irritable bowel syndrome, and 1 [9.1%] out of II patients who had liver cirrhosis associated with chronic diarrhoea. The duration of diarrhoea in patients with positive culture for C. jejuni varied widely from 25 days to 18 months. Consistency of stools was semi solid in [4 cases] and watery in [2 cases]. Stool samples contained gross blood in two cases. Abdominal pain was a common symptom, but vomiting and fever were less common. We conclude that C. jejuni has a role in patients with chronic diarrhoea, and it should be looked for in the stool of such cases particularly if the diagnosis is not established or the response to treatment is not satisfactory

Different serotypes and clinical course of acute viral hepatitis in pregnancy

Fifty five pregnant and 85 non-pregnant women with acute viral hepatitis were studied in order to find out the relative frequency of each viral serotype in the causation of acute viral hepatitis and to study the clinical course of viral hepatitis during pregnancy in our locality. There was no significant difference in the relative frequencies of the different serotypes between pregnant and non-pregnant patients. Hepatitis B viral infection was the most frequent one, followed by non-A non-B, delta agent, co-infection with A and B viral agents, and lastly type A hepatitis. There was no relation between the clinical course and any of the different serotypes of HBV infection. The percentage of fulminant cases was significantly more in pregnant than in non-pregnant cases [12.7%, 2.4% respectively, P < 0.01]. The clinical course was not different in the two groups except in fulminant cases. Fatal outcome was significantly more in pregnant with fulminant course. On the other hand, the maternal mortality was significantly more in pregnant with fulminant course. On the other hand, the maternal mortality was significantly more in fulminant in patients with non-A, non-B hepatitis. Follow up after 6 months showed that the percentage of patients who had persistent jaundice, hepatosplenomegaly, abnormal liver function tests were more in non-pregnant patients and patients with non-A, non-B hepatitis. The percentage of persistence of HBsAg, after 6 months was more in pregnant than in non-pregnant patients [19.7% and 6.3 respectively]. Routine screening for HBV markers and possible vacclination of susceptible women is recommended in our area