Detection of Helicobacter antigen in stool samples and its relation to H. Pylori positive cholecystitis in Egyptian patients with chronic calcular cholecystitis

Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its non-invasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay [EIA] based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. -Fifty patients were included presented with symptomatic cholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients [90%] by laparoscopic Cholecystectomy and 5 patients [10%] by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that [82%] were females with mean age [42.6+1years]. The mean BMI was [29+7.2] H. pylori-specific antigen in stool samples was detected in 40% of patients and38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases

Acanthamoeba contamination of hemodialysis and dental units in Alexandria, Egypt: a neglected potential source of infection

Ubiquitous free-living amoebae of the genus Acanthamoeba can be pathogenic and can serve as carriers of other pathogenic organisms. These amoebae are potentially dangerous when they contaminate health facilities, and these organisms may act as a source of infection for medical personnel and those seeking medical care. The purpose of the present study was to evaluate the extent to which Acanthamoeba species contaminate hemodialysis and dental units in Alexandria, Egypt. Seventy samples were collected aseptically from these systems and cultivated on non-nutrient agar at room temperature, followed by morphological confirmation of the identity of Acanthamoeba using trichrome-stained smears. This study revealed that 42.9% of water samples from the hydraulic systems of both hemodialysis and dental units were positive for Acanthamoeba, with no statistically significant difference between the two unit types or between pre- and post-disinfection samples for each type of unit. The surgical category of dental clinics had the highest contamination rate [72.7%], whereas no contamination was observed for water samples from pediatric dentistry clinics. In conclusion, the hydraulic systems of hemodialysis and dental units in Alexandria are contaminated withAcanthamoeba species, and to minimize the risk of human infections, there is an urgent need to implement effective preventative measures, such as the installation of water filtration units

Study of the relationship between obesity, body mass index and migraine: is it a possible risk factor

To assess the influence of body mass index [BMI] on the prevalence, attack frequency and clinical features of migraine. As well as studying the relationship between BMI and level of migraine-related disability. This is a cross-sectional comparative study of 437 patients reviewing the obesity clinic in primary care center and medical outpatient clinic in general hospital. The participants were divided into 4 categories based on BMI: normal weight [18.5-24.9], overweight [25.0-29.9], obese [30.0-34.9], and morbidly obese [>35.0]. Migraine prevalence and clinical features were assessed as a function of BMI. Among individuals with migraine, very frequent migraine attacks [10-14 d/mo] occurred in 16% of the overweight [OR 1.3], 44% of the obese [OR 2.9] AND 24% [OR 5.7] subjects, compared with 2% of those with normal weight. Among migrainures, 31.1% of those with normal weight had some disability compared with 36.9% of the overweight, 37.8% of the obese and 41.1% of the morbidly obese subjects. Our study support that obesity is an exacerbating factor for migraine and was propose that migraine and obesity may share same path physiological biological mechanisms that would be advices to undergo further researches to explore more about it

Incidence of central venous catheter colonization and blood stream infection: role of methicillin resistance in staphylococcus biofilm formation

Objective: to assess the incidence of central venous catheters [CVCs] colonization and its relation to peripheral bacteremia in ICU patients. Also to detect the effect of methicillin resistance on biofilm formation in the isolated Staphylococci as one of the commonest CVC reported contaminant

Method: 12-month [April 2008 to April 2009] prospective study included all patients undergoing CVC application in 12-bed Anathesiology ICU at Tanta University Hospital. Microbiological detection of CVC colonization and blood stream infection [CR-BSI] was done by quantitative cultivation of catheter tips with simultaneous heamoculture of peripheral blood. CVC biofilm formation was analyzed by scanning electron microscope

Results: CVC-BSI incidence density was 14.2 per 1000 CVC days with CVCs colonization rate of 43.1%. Duration of CVC insertion and catheter colonization were the only independent risk factors in our CR-BSI patients. Collectively, Gram-negative bacilli were predominant as a cause of CVC colonization [44.4%] and BSI [48.2%] with Ceftriaxone-resistant Enterobacteriaceae and Fluoroquinolone-resistant P. aeruginosa frequencies of 71.4% and 60%, respectively. On species level, coagulase negative Staphylococci [CNS, 27%] and Staphylococcus aureus [S. aureus, 26%] were the predominate isolates colonize CVCs and causing CR-BSI, respectively. There were high frequencies of MR [72.7%] among isolated Staphylococci [S. aureus: 85.7% and CNS: 50%]. Biofilm was identified in 60% of Staphylococcus isolates with significantly more frequency in MR- [84%] than MS-Staphylococci [20%, p=0.0001], MRSA than MSSA [92.9% vs 20%, p=0.006] and MR-CNS than MS-CNS [72.7% vs 20%, p=0.03]. Biofilm thickness was nearly similar in different Staphylococci studied but with difference in its appearance in CNS from S. aureus

Conclusion: the present study has provided a benchmark for ICU CVC associated infections in Egypt, highlighted the problem of CVC associated BSI in our ICUs and the prevalence of multi-drug resistant bacterial strains and has provided insight into the need for definite protocol for CVC insertion, care, and follows up. Also, we support the role of MR in developing Staphylococcus biofilms, thus the need of effective approaches to deal with

Neonatal late onset sepsis: the use of TNF-alpha as a marker for antibiotic sensitivity

Objectives: Early and accurate treatment of an infant with suspected sepsis is the gold for his survival. Cytokines are important proinflammatory mediators in the early phases of the sepsis syndrome. Recent investigations have demonstrated that some antibiotics, in addition to their antimicrobial effects, can interfere with cytokine production. This study was designed to determine the level of serum TNF-alpha in late neonatal septicemia [LOS] before and after antibiotic therapy to assess its role as a marker of success or failure of such therapy

Methods: Forty preterm neonates with culture proven LOS who were admitted to NICU, Pediatric Department, Tanta University Hospital during the period from January 2009 to January 2010 in addition to ten healthy full term and ten healthy preterm control neonates and 36 cases received final diagnosis of non-sepsis were included in this case control study. Selected neonates were classified into four groups according to the results of antibiogram. Group I: received ampicillin and cefotaxime and were sensitive to one or both of them. Group II: received ampicillin and cefotaxime and were resistant to them. Group III: received ampicillin and amikacin and were sensitive to one or both of them. Group IV: received ampicillin and amikacin and were resistant to them. The causative micro-organisms and their antibiograms were microbiologically determined with estimation of serum TNF- alpha using ELISA technique before and 24 hours and 72 hours after start of antibiotic treatment

Results: Forty neonates with laboratory confirmed LOS were enrolled in this study. klebsiella [42.5%] and coagulase negative staphylococci [25%] constituted the majority of the isolated organisms. LOS cases had significantly high serum level of TNF-alpha than preterm and fullterm controls as well as no-sepsis group [P<0.0001]. Only in group I and III, there was significant increase [P<0.0001 and P= 0.0001, respectively] in the levels of TNF-alpha after 24 hours of treatment as compared to TNF-alpha level before treatment, and significant decrease [P<0.0001] in TNF-alpha level after 72 hours of treatment as compared to 24 hours level

Conclusion: TNF-alpha is a powerful early predictor of LOS. Measurement of serum TNF- alpha during empiric treatment of neonatal sepsis could be a powerful indicator of appropriateness of antibiotic therapy. Therefore, increase of TNF - alpha level during initial treatment especially during the first day of treatment of neonatal sepsis may be taken as indication for sensitivity to initial antibiotics, even before sensitivity of microbiological causes to given antibiotics is known

Study of the relationship between serum cortisol and dehydroepiandrosterone sulfate [DHEAS] levels and degree of cognitive impairment in the aged with Alzheimer's disease and vascular dementia

Dementia is the general term that refers to the decline of mental abilities including memory and other thinking skills while a person is alert and awake. Dementia is considered a late-life disease because it tends to develop mostly in elderly people. The two most common forms of dementia in older people are Alzheimer's disease and multi-infarct dementia [vascular dementia]. Alzheimer's disease accounts for around 60% of all cases of dementia, while vascular dementia accounts for up to 20% of all cases of dementia. Cortisol and dehydroepiandrosterone [DHEA] and its sulfate ester [DHEAS] are adrenal steroid hormones. These hormones have been suggested to have a role in many aging related diseases and perhaps in aging itself. These hormones have been shown to multiple effects on the function of the hippocampus, which is involved in learning and memory processes. These adrenal steroids may thus be associated with cognitive impairment, which is a major symptom of dementia. To study the relationship between serum cortisol and dehydroepiandroesterone sulfate [DHEAS] levels and degree of cognitive impairment in the aged persons with Alzheimer's disease and vascular dementia. Study was conducted on 30 elderly demented patients selected randomly from the general population. Their ages ranged from 52 to 85 years with a mean of 68.5 years and they were 13 males and 17 females, they were divided into two groups; group I: 15 patients [7 males and 8 females] with probable Alzheimer's disease diagnosed according to diagnostic and statistical manual of mental disorder [DSM- IV criteria], group II: 15 patients [6 males and 9 females] with vascular dementia, group III consisted of 15 elderly healthy volunteers, matched for age and sex with no evidence of dementia have been served as control group. All were submitted to morning collection of blood for determination of the plasma cortisol and DHEAS measured by chemiilluminescence. The 30 points Mini Mental State Examination [MMSE] was used to assess cognition. The present study firstly showed that mean serum cortisol level increase while mean serum DHEAS level decrease with age and mean serum cortisol levels was higher in both AD and VD than normal controls while mean serum DHEAS levels in both AD and VD] was lower than normal controls. Gender did not play a significant role in variability of cortisol and DHEAS. Also, most of Alzheimer's disease patients were none educated in comparison to vascular dementia patients and this indicates that a low level of education has been associated with a greater risk of developing AD. There is an association between serum cortisol and DHEAS levels and severity and duration of dementia and cognitive decline in demented patients. There is a strong association between cortisol and DHEAS and prevalence of dementia in the elderly. There was a trend of high serum cortisol level in males and high serum DHEAS level in females but, gender did not play a significant role in variability of cortisol and DHEAS. Low level of education has been associated with a greater risk of developing dementia and there is association between serum cortisol and serum DHEAS levels and duration and severity of dementia

Renovascular disease and cognitive impairment in elderly: a novel risk maker

Renal artery stenosis is most commonly due to either fibromuscular dysplasia or atherosclerosis. Atherosclerosis accounts for 90 percent of cases of renal-artery stenosis. Renal-artery stenosis may occur alone [isolated anatomical renal-artery stenosis] or in association with hypertension, renal insufficiency [ischemic nephropathy], or both. The aim of the present work was to study the role of renovascular disease as a novel risk marker of cognitive impairment in elderly. The study included 80 patients divided into 4 groups: Group 1: 20 cases of elderly patients above 65 years and suffering from grade 2 or 3 CKD. Group II: 20 cases aged 20-40 years and suffering from grade 2 or 3 CKD. Group III: 20 healthy controls aged above 65 years. Group IV: 20 healthy controls aged 20-40. They had been evaluated for their: Clinical condition, including physical examination and history taking, ECG, BMI estimation, MMMS examination, Routine investigation including: complete blood picture with differential counting, bleeding and coagulation time, liver functions tests, lipid profile, fasting and post-prandial plasma glucose, renal function tests, complete urine analysis, 24-hours proteins in urine, assessment of glomerular filtration rate [GFR] by MDRD and creatinine clearance and in addition specific laboratory investigations were done including: Serum CRP using turbidimetry, Microalbuminurea using turbidimetry, v-WF Ag by ELISA, s-ICAM. By ELISA and Duplex study was performed on carotid and renal arteries. The results of the present study showed that there was a significant increase in the BMI in groups land II in comparison to group III which was higher than group IV. The MMMS test was significantly lower in group I in comparison to groups II and III which were in turn significantly lower than group IV. Hemoglobin was significantly lower in groups I and II than group III and IV. Platelets count was significantly lower in groups I and II than group III which was also significantly lower than group IV. Creatinine clearance was significantly lower in groups I and II than in groups III and IV vWF levels were significantly lower in groups land II than in groups III and IV s.ICAM I was significantly higher in groups I and II compared to groups Ill and IV. CRP was significantly increased in groups I and II in comparison to groups III and IV Carotid plaque score was significantly higher in group I than group II which was higher than groups III. Resistive index was significantly lower in groups land II than in groups III and IV Acceleration index was significantly lower in groups I and II than in groups III and IV. A significant positive correlation was found between age and urinary albumin, CRP, and s.ICAM. A significant negative correlation between age and cereatinine clearance and MDRD in groups I, II and III. Reno vascular disease is common in elderly and the most important cause is atherosclerosis in this group of patients. There are many risk factors for cognitive impairment in patients suffering from renovascular disease and most of them are correctable. Renovascular disease can be considered as a novel risk factor of cognitive impairment through many interacting mechanisms

Mannose binding lectin: serum level, gene polymorphism in SLE patients and its relation to lupus nephritis

Systemic lupus erythematosus [SLE] is an autoimmune disease in which the complement system plays a crucial role in its pathogenesis. Mannan-binding lectin [MBL] is a recognition molecule of the lectin pathway of complement activation. The presence of several polymorphisms at the promoter and coding regions of the MBL-2 gene determines alterations at MBL serum concentration. MBL variant alleles that lead to low serum levels and/or functional deficits of MBL are postulated to contribute to the susceptibility of SLE. Moreover, the influence of MBL variation on antibodies production and renal involvement in SLE patients remains controversial. MBL serum level and genotypes were studied in SLE patients with evaluation of its role in auto antibodies production and lupus nephritis development. MBL genotypes and serum level were screened in a case control study included 30 SLE patients as well as 30 healthy controls. MBL polymorphism at exon 1 codons 54 and 57 was detected by PCR using sequence-specific priming [SSP] and serum MBL level was determined by ELISA technique. There was predominance of AA genotype [80%] in control group. Genotype frequencies of MBL variants in patients with SLE showed significant differences when compared with controls [AA 53.3% vs 80%, P=0.03, OR = 0.29 and A O+O O 46.6% vs 20%, P = 0.03, OR =3.5, respectively]. Serum MBL in SLE patients [900 ng/ml] was significantly lower than that of the control group [2750 ng/ml, P = 0.001] with positive correlation with low MBL genotypes. SLE patients with mutant alleles were more likely to produce anti dsDNA [92.8% vs 75%, OR = 4.3] and anti-Smith antibodies [35.7% vs 18.7%, OR = 2.3]. Patients carrying MBL-low genotypes have an increased risk of development of lupus nephritis than those carrying MBL-high genotypes [64.7% vs 35.2%, P - 0.02, OR= 2.4]. MBL gene polymorphism associated with low MBL serum levels that were found with significantly increased frequency in SLE patients may be one of the genetic factors that determine the susceptibility to develop lupus nephritis

Antibiotic use and resistance in single orthopedic department, Egypt

Antimicrobial use and subsequently antimicrobial resistance among bacterial pathogens is a global problem, but in Egypt data are sparse. Orthopedic departments reflect this problem because in them surgery constitutes the main manipulation and septic diseases constitute common complications, both need guided antimicrobial therapy otherwise antimicrobial resistance will emerge. To highlight these issues, we define the pattern and appropriateness of antibiotic use and identify the infecting microorganisms and their resistance patterns in a prospective study carried out in Orthopedic Department, Tanta University Hospital, Egypt, within 9 months. High antimicrobial prescription rates [98.1%] with low rates of appropriateness [11.3%] were detected. Eighty-one percent of prescribed antimicrobial agents belong to cephalosporins and penicillins classes and 54.2% of all antimicrobial use consisted of cefotaxime [42.1%] and amoxicillin-flucloxacillin [12.1%]. High rates of resistance were found in most of the bacteria studied. 53.3% of Staphylococcus aureus [S. aureus] and 66.7% of coagulase negative staphylococcus [CNS] isolates were oxacillin resistant. Multi-resistant [MR] strains represented 48.6% of the isolated gram negative bacilli of which 29.2% were ESBL [Klebsiella 62.5% and E.coli 33.3%] while 19.4% were MR Pseudomonas and Acinetobacter isolates. Antibiotic treatment in our Orthopedic Department appears to be substantial. Increasing and justifying efforts are needed to improve appropriateness of antimicrobial therapy and minimize the development of antimicrobial resistance. We call for a nationwide surveillance programme to monitor microbial trends and antimicrobial resistance patterns in Egypt

Parasitological, bacteriological and clinical study of wound Myiasis with a trial of maggot therapy in intractable wounds

Myiasis is the infestation of human and animal tissues with dipterous fly larvae, commonly referred to as maggots. Over the past few years, there has been resurgence in the use of maggot debridement therapy [MDT] for cleaning non-healing wounds. This work threw some light on the wound myiatic cases in patients attending Tanta University Hospitals and other affiliated hospitals in two years. Identification of the isolated larvae and breading them to adult stage with monitoring of bacterial diversity in those patients were done. Also, MDT was tried in three intractable wounds as a preliminary study. In the present study, 9 cases of wound Myiasis were recorded, average age was 36years. The higher incidence was among males and most cases were recorded in summer months. The accused larvae were Megaselia scalaris [33.3%], Lucilia sericata [22.2%], Sarcophaga haemoroidalis [22.2%] and Musca domestica [22.2%]. Mixed bacterial isolates were reported in 7 cases and a single organism in the remaining 2 cases with a total of 18 isolates. MDT was applied in two settings and resulted in hastened growth of granulation tissue, greater wound healing rates, disappearance of foul odour and marked improvement of pain in the two leg ulcer cases while in neuropathic ulcer, no marked difference was detected. Except for Proteus, MDT showed remarkable ability to eliminate most of the infecting organisms including MRSA and the majority [2 cases, 66.7%] of Pseudomonas infection with decrease in its bioburden in the remaining [33.3%] case. Therefore, it could be concluded that the problem of wound Myiasis is always the end of neglection of careful wound dressings. MDT could be considered as a promising tool in cleaning and healing enhancement of chronic ulcers with mixed resistant bacterial communities including MRSA and Pseudomonas with special consideration when dealing with Proteus. However, further studies with larger scale of patients are needed to support these findings

Tuberculosis arthritis of the elbow, a diagnostic problem

Recently, there has been an epidemic of tuberculosis, with increasing incidence of infected persons in UK. In the past 20 years, with the pandemic of the human immunodeficiency virus and the increase in immunocompromised people, we have observed a resurgence of tuberculosis. Tuberculosis arthritis of the elbow joint is not commonly seen by orthopaedic surgeons. Spinal and monoarthritis of weight-bearing joints such as the hip or knee are most frequently involved. The aim of this case report is to describe a rare case of occult tuberculous arthritis of the elbow in young Indonesian lady and the diagnostic problems that may arise and lead to a delay in treatmen. It is a case report where we used different laboratory test as CBC, ESR, CRP, hepatitis screening and AIDS Antibody test to help in diagnosis.Plain X-ray for elbow and chest used. CT scan for elbow, aspiration of synovial fluid for culture and synovial biopsy taken. Tuberculous arthritis remains low on the index of suspicion of many clinicians working outside the field of respiratory or infection diseases3 Involvement of the skeletal system is relatively rare. Musculoskeletal TB is responsible for between 1.3% and 5% of all cases of TB. Osteoarticular TB should be suspected in patients of south Asian and African origin presenting with bony and soft tissue infective lesions

Rare case of tuberculous arthritis of the elbow a diagnostic problem. Case report

Recently, there is an epidemic of tuberculosis, with an incidence rising of 1.200 in 100.00 persons in UK. In the past 20 years, with the pandemic of the human immunodeficiency virus and the increase in immunocompromised people, we have observed a resurgence of tuberculosis. Tuberculous arthritis of the elbow joint is not commonly seen by orthopaedic surgeons. Osteoarticular involvement has increased, too. Spinal and monoarthritis of weight-bearing joints such as the hip or knee are most frequently involved. The elbow joint is an uncommon location of osteoarticular tuberculosis. The aim of this case report is to describe a rare case of occult tuberculous arthritis of the elbow in young Indonesian lady and the diagnostic problems that may arise and lead to a delay in treatment. It is a case report where we used different laboratory test as CBC,ESR,CRP, hepatitis screening and AIDS Antibody test to help in diagnosis. Plain X-ray for elbow and chest. CT scan for elbow, aspiration of synovial fluid culture then synovial biopsy taken. Tuberculous arthritis remains low on the index of suspicion of many clinicians working outside the field of respiratory or infection diseases Involvement of the skeletal system is relatively rare. Musculoskeletal TB is responsible for between 1.3% and 5% of all cases of TB. Osteoarticular TB should be suspected in patients of south Asian and African origin presenting with bony and soft tissue infective lesions

Study of pro-hepcidin level and renal functions in nephrotic syndrome, chronic renal failure and hemodialysis patients

Anemia is associated with worse outcomes in patients with chronic kidney disease [CKD]. Hepcidin is a recently discovered protein produced mainly by the hepatocytes as a pre-prohormone, pre-prohepcidin. It is a key regulator of iron metabolism in different iron disorders. To study serum pro-hepcidin levels in nephrotic syndrome [NS], chronic renal failure [CRF], and hemodialysis [HD] patients. The study included 4 groups. Group I: 20 patients with NS, group II: 20 patients with CRF on conservative treatment, group III: 20 patients on regular HD, and group IV: 20 healthy subjects as a control group. All groups were age and sex matched, and subjected to physical examination, abdominal ultrasound, and laboratory investigations including: Complete blood cell count, serum iron, iron indices, serum pro-hepcidin, serum high sensitivity C-reactive protein [hs-CRP], renal functions, liver functions, and other necessary tests. CRF and HD patients had a statistically significant higher mean serum pro-hepcidin than NS patients and controls [P <0.001], with no statistically significant difference between the NS and control groups. All patient groups had a statistically significant higher serum hs-CRP, and a significantly lower hemoglobin concentration, serum iron, and transferrin saturation compared with controls [P<0.001]. The mean serum ferritin was statistically significantly increased in the HD group only [P <0.001]. Serum pro-hepcidin showed a statistically significant positive correlation with serum hs-CRP [a marker of inflammation], serum ferritin, blood urea and serum creatinine in all patient groups, with serum uric acid in NS and CRE patients, and with serum albumin only in NS patients. It showed a statistically significant inverse correlation with serum iron and transferrin saturation in all patient groups, with hemoglobin concentration and creatinine clearance in NS and CRF patients [HD patients were anuric], and with urinary albumin excretion only in NS patients probably due to increased pro-hepcidin loss with the proteinuria. In patients with CKD, the presence of a chronic inflammatory status offsets the inhibitory effect of anemia on pro-hepcidin production with a net increase in serum pro-hepcidin levels. This inflammation related dysregulation of pro-hepcidin might result in a functional iron deficiency, thus aggravating the anemia. Pro-hepcidin is unlikely to be beneficial in monitoring anemia of CKD. However, it could be a future therapeutic target in managing anemia in these patients

Serum phosphorus and magnesium levels in patients with metabolic syndrome

Metabolic syndrome is defined as the co-occurrence of at least three of the following features: hyperglycemia, hypertension, central obesity and dyshpidemia. It is considered an atherogenic cardiovascular risk factor that has recently become a public health problem. Disturbances in phosphate and for magnesium metabolism may have potential pathophysiological implication in the pathogenesis of this duster of cardiovascular risk factors. We performed a cross-sectional study to examine the relationship between serum phosphorus and magnesium levels in Kuwaiti patients with metabolic syndrome. Two hundred Kuwaiti individuals were entailed [109 subjects diagnosed as having metabolic syndrome and 91 as control group]. Their mean age was 48.6 +/- 9.9 years. Both males and females, smokers and non-smokers were included in our study. The diagnosis of metabolic syndrome was based on Adult treatment Panel III guidelines which includes central obesity, hyperglycemia, hypertension and dyslipidemia. Patients with metabolic syndrome showed significantly lower phosphate and magnesium levels compared with controls in addition to non significant differences in the rate of urinary excretion of phosphorus and magnesium between diabetics and control groups. We assume that hypophosphatemia and hypomagnesaemia patients with metabolic syndrome could be attributed to decreased directly intake, as well as internal redistribution of this clement. Kuwaiti Patients with. metabolic syndrome show significantly lower phosphate and magnesium levels compared with healthy individuals. These electrolyte disturbances could be considered as one of the diagnostic criteria for diagnosis of metabolic syndrome. In addition, this electrolyte imbalance may have a role in pre-vention and/or treatment of the metabolic syndrome. Further studies arc needed to support this finding

[ inhibitory effects of garlic and pan ax ginseng extracts against the genotoxicity, biochemical and histological changes induced by ethylene- diaminetetraacetic acid [EDTA] in male rats]

EDTA is widely used in food and other industries to sequester metal ions and to prevent their disadvantageous effects. The objective of the current study was to evaluate the protective effect of Panax ginseng and garlic against EDTA-induced biochemical, cytogenetic and histological changes in rats. Forty male rats were divided into eight treatment groups. They were treated for 7 days as follow: the control group, the group treated with EDTA [20 mg/kg b.w] and the groups treated with Panax ginseng extract [20 mg/kg b.w], garlic [5 mg/kg b.w], panax ginseng plus garlic alone or in combination with EDTA. In vivo bone marrow micronucleus test and random amplified polymorphism DNA [RAPD] method were performed to assess the antigenotoxic effect of both protective agents. The results indicated that EDTA administration caused a significant decrease in the serum biochemical parameters, Alanine aminotransferase [ALT], Aspartate aminotransferase [AST], Lactate dehydrogenase [LDH] Blood urea nitrogen [BUN]. Increased the incidence of Micronucleated Polychromatic Erythrocytes [MnPCEs] as well as appearance of some changes in polymorphism band patterns, and induced different histopathological lesions in the livers, kidneys and testis Treatment with Panax ginseng, garlic alone or plus EDTA significantly improved all the tested parameters. Moreover, Panax ginseng extract was found to be more effective than garlic in restoring the parameters that were altered by EDTA

Some biochemical risk factors of deep vein thrombosis in type - 2 diabetes mellitus

Introduction: hyperhomocysteinemia is associated with premature peripheral vascular, cerebrovascular and coronary artery disease. The relation between B-vitamins and vascular disease re- mains poorly defined. Patients with mild hyperhomocyteinemia are asymptomatic until the third or fourth decade when premature coronary artery disease may develop, as well as recurrent arterial and venous thrombosis. Increased plasma total homocysteine [tHcy] level is the most common cause of mortality in patients with type 2 diabetes

Aim of the work: The study was carried out to access the role of homocysteine, vitamin B12 and folic acid as risk factors for deep vein thrombosis in type 2 diabetes mellitus

Material and Methods: The present study was conducted on 45 diabetic female patients of type 2, they were dived into 3 groups: group I [GI]; 15 patients having recently diagnosed diabetes [less than 4 months], group II [GII]; 15 patients having diabetes for the past 7-10 years and not suffering from any diabetic complications and group III [GIII] 15 patients having diabetes for the past 7-1 1 years complicated with deep vein thrombosis. All diabetic patients in GI, I1 and III were treated with metformin and were not taking vitamin supplementation before the study. Also 15 healthy females of matched age were involved in the study as a control group. In all groups and control plasma homhocysteine, serum folic acid and vitamin B12 were measured, also fasting serum glucose and glycosylated hemoglobin [HbA1c] were measured to all diabetic groups and control

Results and Conclusion: there were significant increase in plasma tHcy levels and significant decrease in serum folate levels in diabetic females in all groups [GI, IGIIand GIII] as compared to the control group, also there were significant increase in serum folate and significant de- crease in plasma tHcy levels in uncomplicated diabetic females in GII as compared to GI and GIII. Serum folate and vitamin B12 levels were significantly decreased while plasma tHcy levels were significantly increased in GIII as compared to controls, GI and GII. These findings suggest that people with type 2 diabetes complicated with deep vein thrombosis and treated with metformin without vitamin supplementations have elevated levels of plasma tHcy and increasing risk factor for vascular diseases. Therefore, we recommended those people to consume adequate quantities of fresh green vegetables and fruits and to take folate, vitamin B12 supplementation

Hormone receptors and her-2 expression in early breast ductal carcinoma; frequency, and impact on outcome of tamoxifen therapy

Recent clinical data have suggested that efficacy of tamoxifen in reducing the risk of local recurrence in breastductal carcinoma [DC] is limited to estrogen receptor [ER] positive lesions, however, a group of these patientshave conflicting results. The purpose of this study was to assess the frequency of Progesterone receptor [PR] and HER-2overexpression in [ER] positive breast ductal carcinoma, in relation to each other, to important prognostic factors,and to correlate the results to patients' response to tamoxifen.Methods: We have analyzed the clinical outcome of selected 100 cases of ER +ve breast ductal carcinoma atclinical stage O-II, represented to pathology and oncology departments, Medical Research Institute in the period January-March 2002, with a follow up period of four years [median 34.5 months]. The patients were treated with standard adjuvant therapy of Tamoxifen [alone or after chemotherapy]. For each case ER, PR and HER-2 wereimmunohistochemically determined. In 100 cases ofER+ breast duct carcinoma, 89% were PR+, and 22% were HER-2+ve. There was a strongpositive correlation between ER and PR [p<0.001], and strong negative correlation between both hormones andHER-2 [p<0.001]. It was found that ER+/PR - tumors were more frequent in older patients [P=<0.001] and withhigher tumor grade [P=0.018], while ER+/HER-2 +ve tumors were significantly associated with patient's age [P=0.005], tumor size [P<0.003] and tumor grade [P< 0.001].On median follow up period of 34.5 months; the overall recurrence rate was 6%, and was restricted toHER-2[3+] +cases. ER+/PR tumors express higher levels of HER-2 and display more aggressive features thanER+/PR+ tumors. Overexpression of HER-2 might limit or negate the beneficial effects of tamoxifen in ER+vebreast DC

Orfxin A level and its relation to sleep disorder among chronic renal failure patients on maintenance hemodialysis

Dialysis patients frequently complain of insomnia, excessive daytime sleepiness, restless leg syndrome and sleep apnea. Uremia is considered as a major factor for developing sleep disorders in chronic renal failure patients. The aim of this work was to study the types of sleep disorders found in uremic patients on maintenance hemodialysis and to try to find the possible role of orexin A in the development of these sleep disorders. This study included forty subjects classified into three groups. Group I [n=20], included those patients with chronic renal failure on maintenance hemodialysis. While group II [n=10] included those patients with chronic renal failure in predialysis stage. and compared with 10 age and sex matched control subjects [group III]. All subjects were subjected to full history taking and complete clinical examination and routine laboratory tests. Overnight polysomnographic study in a specialized sleep lab was done for all subjects. Serum orexin A levels were assayed for all subjects by commercial Kit by EIA. Polysomnographic data in uremic patients, compared with control group showed significant rise in sleep onset and arousal index. Also sleep efficiency and deep sleep were significantly reduced in uremic group of patients. Restless leg syndrome was prevalent in uremic patients with significant increase of limb movement index than in control group. There was no significant difference between patients on hemodialysis and predialysis patients in most sleep parameters. Serum orexin A level was significantly higher among uremic patients compared to the control. Serum orexin A level showed significant positive correlation with arousal index and significant negative correlation with sleep efficiency in the two uremic groups. It was concluded that several sleep disorders as insomnia and restless leg syndrome are prevalent among uremic patients. High serum orexin A level may play an important role in the development of these sleep disorders which did not show any improvement with the conventional hemodialysis

Protective role of fennel oil against polychlorinated biphenyls [PCBs] induced oxidative stress in rats

Polychlorinated biphenyls [PCBs] are environmental contaminants that have been widely used for various industrial purposes. Human and animals are exposed to PCBs via oral ingestion of contaminated food. PCBs were found to induce reproductive toxicity, immune suppression, birth defects, cancer, developmental and behavioral changes. The aim of the present study was to evaluate the protective role of fennel oil against PCBs toxicity. Forty male Sprague- Dawley rats were divided into four groups, control group, group treated with PCBs [250 micro g/kg b.w] and the groups treated with fennel oil [5mg/kg b.w.] alone or in combination with PCBs for 15 days. The results indicated that treatment with PCBs resulted in a significant increase in ALT, AST, cholesterol, triglycerides, uric acid, TNFa., LPO, NO and CEA, whereas it significantly decreased GPX and SOD. Histopathological examination of the liver, kidney and testis showed severe histological changes. Animals treated with fennel oil alone or plus PCBs were comparable to the controls regarding the biochemical parameters or the histological picture of liver, kidney and testis. It could be concluded that fennel oil has a protective effect against PCBs toxicity. Moreover, the oil was safe and may be used pharmaceutically to protect against the hazardous effects of PCBs

Study of infectious diarrhea in the elderly

To evaluate the most common causative agents associated with infectious diarrhea in elderly and to estimate the possible changes of serum IgA that may lead to increase the susceptibility to gastrointestinal infection among them. Sixty patients were included in this study, all of them were suffering from diarrhea, admitted to Alexandria fever hospital. They were divided into two groups: group I, 50 patients aged 65 years and above and group II, 10 patients aged from 20-30 years, all patients and controls were subjected to make stool culture, examination of stool for excess fats and detection of serum IgA by using ELISA technique. The results of this study showed that the percent of patients with normal inhabitant was significantly lower in group I [24%] compared to group II [70%] P= 0.004. The negative samples in stool cultures were submitted to test for IgM rotavirus; the results revealed 8 subjects of group I and 2 of group II were positive for Rota virus IgM. E-coli was present in 42% of group I and 20% of group II with no significant differences [P= 0.191], C.difficile was present in 18% of group I and 0% of group II with no significant difference [P- 0.146], Shigella was present in 16% of group I and 10% of group II with no significant difference [P= 0.628]. In group I, 86% of the patients had fat in the stool and 14% were negative, in group II, all patients were negative and this difference was statistically significant [P= 0.000]. Serum IgA ranged from 100-905 in group I with a mean of 475.15 +/- 246.2, while in group II, it ranged from 77 - 430 with a mean of 178.4 +/- 134.58. It was significantly higher in group I compared to group II, [P= 0.001]. Infectious diarrhea is an important disease in elderly. There is a higher mortality rat among them. Infectious diarrhea may be associated with abnormal immune function of old age [immuno senescence]. Certain bacterial infections are commoner among them [e.g. C.difficile, E.coli 1.57-H.7 and salmonella]