Pericardial effusion in prosthetic and native valve infective endocarditis

Background Pericardial effusion (PE) is widely believed to signify more advanced infective endocarditis (IE) and a generally worse outcome. Purpose To determine the prevalence and clinical significance of PE in a series of patients with confirmed native and prosthetic valve infections. Methods Data were collected from 338 consecutive patients with definite or possible IE who visited a single referral center; these patients were examined for the presence of PE as detected by transthoracic echocardiography. Clinical characteristics, the incidence of complications, and outcomes were compared between patients with IE with and without PE. IE patients with PE were then divided into two subgroups: those with and those without cardiac prostheses. Results Eighty-eight patients out of the total 338 (26%) were found to have PE. Compared with patients who did not have PE, patients who did were significantly younger (32.9 ± 13.4 vs 29.0 ± 9.2, p = 0.003), had more left-sided vegetation (55.6% vs 77.3%, p < 0.001), more root abscesses (9.2% vs 25.0%, p < 0.001), needed surgery more frequently (68.0% vs 84.1%, p = 0.001), and had a higher mortality rate (22.0% vs 32.9%, p = 0.03). PE was not found to be a predictor of mortality. No significant difference was found between IE patients with PE with (n = 13) and without (n = 75) prostheses with regard to causative organisms, clinical characteristics, or clinical outcomes. Conclusion Regardless of whether the IE was in native or prosthetic valves, compared with patients without PE, patients with PE had more severe infections and a worse prognosis, but PE was not an independent predictor of mortality.

Cost-Effectiveness analysis of family planning services offered by mobile clinics versus static clinics in Assiut, Egypt

Cost effectiveness studies of family planning (FP) services are very valuable in providing evidence-based data for decision makers in Egypt. Cost data came from record reviews for all 15 mobile clinics and a matched set of 15 static clinics and interviews with staff members of the selected clinics at Assiut Governorate. Effectiveness measures included couple years of protection (CYPs) and FP visits. Incremental cost-effectiveness ratios (ICER) and sensitivity analyses were calculated. Mobile clinics cost more per facility, produced more CYPs but had fewer FP visits. Sensitivity analysis was done using: total costs, CYP and FP visits of mobile and static clinics and showed that variations in CYP of mobile and static clinics altered the ICER for CYP from $2 -$6. Mobile clinics with their high emphasis on IUDs offer a reasonable cost effectiveness of $4.46 per additional CYP compared to static clinics. The ability of mobile clinics to reach more vulnerable women and to offer more long acting methods might affect a policy decision between these options. Static clinics should consider whether emphasizing IUDs may make their services more cost-effective

Production of New Almond-Peach Hybrid Rootstocks Resistance to Root-Knot Nematode.

Aims: This research was conducted to hybridize almond (Om El-fahm and M. Dalet) female parent with Okinawa peach rootstock as a male parent to introduce new almond rootstock resistance to root-knot nematode. Methodology: Okinawa peach rootstock used in crosses with both of Om El-fahm and M. Dalet almond cvs. and the resulting hybrids identified by SSR and STS markers for the presence and/or absence of the expected resistance marker. Inoculation by M. incognita with suspension of 2500 eggs per plants through holes in the soil to evaluate hybrids resistance. Results: Fruit set percentage was higher with Om El-fahm than M. Dalet while, the opposite was true for fruit drop. No significant differences were observed for seed germination with the used females. Hybrid no.3 resulting from M. Dalet x Okinawa crosses showed the highest significant value of vegetative growth parameters. The STS marker; the OPA11 primer pair with Okinawa x Om El-fahm showed the resistant marker at the expected size (166 bp) for all of the tested hybrids except for hybrids no. 7 and 8. Meanwhile, only one hybrid (no. 8) of Okinawa x M. Dalet failed to amplify the resistant marker. The Okinawa parent was clustered with hybrids no. 1, 2, 3, 4 and 14 for Om El-fahm and hybrids no. 1, 2, 3, 4, 5 and 6 for M. Dalet indicating a common genetic resistance for root-knot nematode. Conclusion: Hybrid rootstocks slightly varied in their resistance to the root-knot nematode Meloidogyne incognita. However, line no. 6 (Okinawa × Om El-fahm) could be considered as highly resistant (HR).

Co-application of corticosterone and growth hormone upregulates nr2b protein and increases the nr2b:nr2a ratio and synaptic transmission in the hippocampus

This in vitro study aimed to investigate the possible mechanism underlying the protective effect of growth hormone [GH] on hippocampal function during periods of heightened glucocorticoid exposure. This study was conducted between January and June 2005 at the Joan C. Edwards School of Medicine, Marshall University, in Huntington, West Virginia, USA. The effects of the co-application of GH and corticosterone [CORT] were tested at different concentrations on the field excitatory postsynaptic potentials [fEPSPs] of the hippocampal slices of rats in two different age groups. Changes in the protein expression of N-methyl-D-aspartate receptor [NMDAR] subunits NR1, NR2B and NR2A were measured in hippocampal brain slices treated with either artificial cerebrospinal fluid [ACSF], low doses of CORT alone or both CORT and GH for three hours. The co-application of CORT and GH was found to have an additive effect on hippocampal synaptic transmission compared to either drug alone. Furthermore, the combined use of low concentrations of GH and CORT was found to have significantly higher effects on the enhancement of fEPSPs in older rats compared to young ones. Both GH and CORT enhanced the protein expression of the NR2A subunit. Simultaneous exposure to low concentrations of GH and CORT significantly enhanced NR2B expression and increased the NR2B:NR2A ratio. In contrast, perfusion with CORT alone caused significant suppression in the NR1 and NR2B protein expression and a decrease in the NR2B:NR2A ratio. These results suggest that NMDARs provide a potential target for mediating the GH potential protective effect against stress and age-related memory and cognitive impairment

Ameliorative effect of vitamin C on nicotine-induced changes in the liver and the kidney of the adult male albino rat

Vitamin C is a vital antioxidant that may antagonize the deleterious effects of smoking. While previous literature indicated the role of cigarette smoking in exacerbation of chronic renal and hepatic diseases, its impact on the healthy kidney and liver tissues needs to be elucidated. To evaluate the effects of administration of high dose of nicotine alone for three weeks or combined with vitamin C on the antioxidant defense status, functional, histological changes, and immunohistochemical demonstration of proliferating cell nuclear antigen [PCNA] expression in the liver and kidney tissues of the rat. Twenty four adult male albino rats were used. They were divided equally into four groups. Group I was the control group, Group II was given vitamin C only [300mg/kg i.p.], Group III was given nicotine only [5mg/kg i.p.] all were for 3 weeks. Group IV was given vitamin C for 3 days prior to nicotine injection then for 3 weeks with nicotine and for 2 days thereafter. Nicotine exposure caused significant reductions in the total body weight, relative liver and kidney weights, and significant elevations of oxidative stress marker; malondialdehyde in liver and kidney. In addition, in group III the levels of liver alanine transaminase, aspartate transaminase, and alkaline phosphatase were significantly increased compared to other groups. The liver and kidney of group III showed marked structural changes with epithelial shedding and cellular necrosis of parts of proximal and distal convoluted tubules, with partial loss of the brush border. The liver showed vacuolated hepatocytes cytoplasm, lipofuscin granules, peroxisomes, mitochondrial destruction, with dilated central vein and sinusoids. Dense PCNA immunostaining was detected in the liver and the kidney of group III Concomitant administration of vitamin C with nicotine revealed a noticeable amelioration of these structural and .functional changes. Vitamin C exerted a protective effect against nicotine-induced liver and kidney damage

Effects of tramadol versus indomethacin on gastric mucosa in rat model of nociception: a structural, immunohistochemical and hormonal study

Background: Tramadol is centrally acting analgesic that is frequently used clinically but its mechanism of action is still unclear

Aim of work: To evaluate tramadol analgesic activity, and its effect on gastric mucosa and hormones

Material and Methods: Thirty two adult male albino rats were used. Rats were divided into three groups: group [I] was injected with 3 doses of physiological saline [2ml kg[-1] every 12 h, i.p.], served as control; group [II] was injected with 3 doses of indomethacin [10 mg kg[-1] every 12 h, i.p.]; and group [III] was injected with 3 doses of tramadol [10 m kg[-1] every 12 h, i.p.]. 30 min after the first dose of injections, all groups were given 10 ml k[-1] of 1% acetic acid-saline i.p. to induce writhing. After 10 min following acetic acid injection, writhes numbers were counted over 20 min. Gastric mucosa was examined macroscopically and microscopically. Gastrin expression was detected by immunohistochemistry. Serum prostaglandin [PG], E2, ghrelin, and histamine concentrations were measured using ELISA kits

Results: Tramadol has lower analgesic effect compared to indomethacin. The gastric ulcer index was significantly lower in tramadol- versus indomethacin-treated group [P <0.0001]. Immunohistochemistry demonstrated higher gastrin immunoreactivity in indomethacin- and tramadol-treated groups versus control. Ghrelin serum levels were significantly suppressed by tramadol and indomethacin versus control that were coincident with gastric mucosal lesions. No significant changes in serum levels of PGE2 and histamine were obtained

Conclusion: Our results suggested that tramadol-induced gastric lesions are probably mediated by reduction of ghrelin and increase in gastrin expression. The antinociceptive and gastric effects of tramadol suggest that tramadol is relatively safe clinically in pain therapy

Clinical significance of serum TNFalpha and -308 G/A promoter polymorphism and serum Il-6 and -174 G/C promoter polymorphism in systemic lupus erythematosus patients

Systemic lupus erythematosus [SLE] is a disorder of immune regulation where cytokine imbalance and genetic factors are implicated in its pathogenesis. To evaluate the clinical significance of serum levels of tumor necrosis factor alpha [TNFalpha] and its -308 G/A promoter polymorphism as well as the IL-6 and -174 promoter polymorphism in SLE patients and find any association to the clinical and laboratory features as well as to the disease activity and severity. We studied 37 female SLE patients and age and gender matched healthy control. Demographic, clinical and serological data were evaluated and the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] and the Systemic Lupus International Collaboration Clinics/ACR Damage Index [SLICC] were assessed. Serum TNF-alpha and IL-6 levels were measured using enzyme-linked immunosorbent assay [ELISA] and DNA genotyped for TNF-alpha promoter [-308 G/A] and IL-6 promoter [-174 G/C] by polymerase-chain reaction-restriction fragment-length polymorphism [PCR-RFLP] analysis. Serum TNF-alpha and IL-6 levels were significantly higher in the SLE patients compared to control. Regarding IL-6, there was a statistically significant difference between the levels in the three groups according to the promoter polymorphisms. Patients with constitutional symptoms showed higher level of IL-6 while the TNF-alpha level was significantly lower in those with pulmonary manifestations. There was a tendency to a higher TNF-alpha and IL-6 level in those with neuropsychiatric manifestations. Serum TNF-alpha, -308 G/A promoter polymorphism, IL-6 and -174 G/C were higher in SLE patients than in healthy controls. To confirm our results we propose that larger scale, multicenter studies with longer evaluation periods are needed

Anti-C1q and anti-dsDNA antibodies in systemic lupus erythematosus: Relationship with disease activity and renal involvement in Sharkia governorate, Egypt

Renal involvement is one of the main determinants of poor prognosis of systemic lupus erythematosus [SLE]. Kidney biopsy is an invasive procedure and accompanied by potential risks. Thus defining a reliable biomarker of kidney involvement in SLE is highly desirable. To assess the role of anti-C1q Ab in combination with anti-dsDNA Ab in detection of SLE disease activity and renal involvement [lupus nephritis]. Anti-C1q Ab and anti-dsDNA antibodies were determined in 60 randomly selected adult SLE patients one of them refused the biopsy and those who completed the study were 59. The control group included 25 age and sex matched volunteers. According to lupus nephritis [LN] and SLEDAI score, patients were divided into four groups: group 1, 11 patients had active disease with LN; group 2, 20 patients had inactive disease with LN; Group3, six patients had active disease without LN; group 4, 22 patients had inactive disease without LN. A significant association of active lupus nephritis detection and the presence of either one or both of the studied antibodies [anti-C1q Ab or anti-dsDNA]. None of the patients of group 1 had anti-C1q Ab only, and none was negative for anti-C1q Ab and anti-dsDNA Ab together. Levels of anti-C1q Ab and anti-dsDNA Ab were significantly higher in more active LN than less active LN. Anti-dsDNA and anti-C1q antibodies sensitivity and specificity for detection of more active LN was 85.0% and 64.0% and 70.0% and 55.0%, respectively, and 75.0% and 91.0% for both. Both antibodies had a positive correlation with SLEDAI score and proteinuria and a negative correlation with C3 reduction. A high significant positive correlation was detected between anti-C1q Ab and anti-dsDNA Ab. Anti-C1q Ab, in combination with anti-dsDNA Ab may serve as potential reliable and none invasive markers of SLE disease activity and renal involvement to avoid unnecessary renal biopsies

Evaluation of right and left ventricular systolic and diastolic function in patients with type I diabetes using echocardiography and tissue doppler imaging

Impairment of cardiac function in patients with type 1 DM represents one of the serious complications and, if present, may affect the quality of life and prognosis of the disease. Conventional and tissue Doppler echocardiographic imaging can predict early stage and progression of diabetic cardiomyopathic changes. The aim of this study is to assess the effect of type 1 diabetes on cardiac systolic and diastolic functions in both ventricles in patients without evidence of coronary artery disease or hypertension. The study included 30 patients with type 1 DM [18 females and 12 males] and 10 healthy individuals, their age 14.2 +/- 2.4 years, and diabetes duration of 5 years or more. Cardiac functions were assessed by conventional echocardiography, and tissue Doppler imaging studies. The study showed that there is statistically significant difference as regard end diastolic volume [EDV], right ventricular wall thickness [RVWT], Peak systolic myocardial velocity [Sm] velocity of inferior and septal segments of LV, Peak late diastolic myocardial [Am] velocity and Em/Am ratio of lateral segment of RV, between diabetic and non diabetic population. Also, there is significant negative correlation of diabetes duration to Peak early diastolic myocardial velocity [Em] of anterior segment [r = -0.492, p<0.006], Am of anterior segment [r = -0.355, p<0.048] and Em of septal segment of the left ventricle in patient group [r = -0.448, p<0.013]. No significant correlation between diabetes duration and all other echo-cardiographic parameters, age or HgAlc level. Ventricular interaction was also demonstrated since significant relations were found between right and left ventricular, diastolic and systolic, functional indices, as regards [1] positive correlation between the mitral and tricuspid [E,A] velocities in diabetic patients [r=0.371, p<0.044], [r=0.438, p<0.015] respectively, [2] positive correlation of Em/Am ratio of the lateral segment of the RV to Em/Am ratio of the septal segment of LV [r =0.465, p< 0.010], [3]positive correlation of right ventricular end-diastolic diameter [RVEDd] to interventricular septum systolic diameter [IVSs], [r = 0.401, p<0.028], posterior wall thickness at end systole [LVPWTs], [r=0.443, p<0.014] and [EDV] of LV [r=0.366, p<0.047]. There were no significant correlation between age and HgAlc blood level with Doppler [E/A ratios] and pulsed tissue Doppler [Em/Am ratios] of both ventricles in diabetic population studied. Patients with type 1 DM have impaired diastolic function, in both ventricles before the development of myocardial systolic dysfunction when assessed with either conventional or tissue Doppler imaging. These alterations in myocardial function were related to the duration of DM and may be attributed to ventricular interdependence as well as the uniform effect of diabetes on cardiac function. Serial echocardiographic assessment, and particularly tissue Doppler imaging, are warranted in patients with type 1 DM to follow the progression from ventricular subclinical involvement to the development of symptomatic ventricular dysfunction

Determination of mycotoxin residues in soya bean meatless burger, kofta and steak in comparison with resemble types of animal origin

Ninety samples of animal and plant origin food as 45, meat products [fifteen each of burger, kofta and meat steak], and 45 meatless products "plant origin" [fifteen each of burger, kofta and steak] were randomly collected from local markets "super markets and traditional grocery" in Giza and Cairo. Samples were analyzed for determination of some mycotoxin residues. Aflatoxins [AFs] [B1, B2, G1 and G2], Ochratoxin A [OA], and Zearalenone [ZEA] were detected. The highest percentage [40%] of AFB1 was present in Burger of plant origin, while the lowest percentage [6.67%] for AFB1 was present in Burger of Animal origin, AFB2 was present in kofta of plant origin, AFG1 was present in kofta of animal origin and AFG2 was present in kofta and steak of plant origin. OA was detected in all tested samples of plant origin; the highest percentage [33.33%] was detected in burger samples. On the other hand, OA was not detected in all tested samples of animal origin. ZEA was detected in all tested samples of animal and plant origin except steak of animal origin and the highest percentage [33.33%] was detected in Burger of plant origin and the lowest percentage [6.67%] was detected in kofta of animal origin. The levels of AFs, OA, and ZEA were estimated in animal and plant origin samples. The public health significance of mycotoxin residues and measures to prevent contamination of food products with mycotoxin were discussed

Neurogenic thoracic outlet associated with carpal tunnel syndrome: is this a clinical example of double crush hypothesis?

The aim of this study was to assess the possible contribution of the double crush hypothesis [DCH] for the association of carpal tunnel syndrome [CTS] with neurogenic thoracic outlet syndrome [NTOS]which -if confirmed- can explain some of the not uncommonly persistent CTS cases despite being confirmed and properly treated, particularly that NTOS is potentially treatable. 137 CTS patients [91 [66.4%] females, 46[33.6%] males], with mean age 39.4, ranging from 23 to 48 years, were included in the study based solely on electrophysiological criteria of CTS [distal motor latency to abductor pollicis brevis > 4 ms, 3 rd digit to wrist orthodromic sensory conduction velocity < 45m/s, or orthodromic median/ulnar latency difference of the 4[th] digit > 0.4 ms]. Patients who proved suffering peripheral neuropathy or entrapment of ulnar nerve were excluded. Twenty apparently healthy individuals, age and sex matched with patients were included as a control group. The patients and control groups were subjected to clinical neurological evaluation. Electrophysiological work up including motor/sensory conduction study of median and ulnar nerves on both sides, and bilateral medial antebrachial cutaneous nerve [MABCN] antidromic sensory, considering side to side MABCN sensory nerve action potentials [MABCN SNAP] amplitude ratio of >2.0 as abnormal. Electrophysiological criteria used for confirming [NTOS], were low median compound motor action potentials [CMAP], low ulnar SNAP, low or normal ulnar CMAP, normal or reduced interference pattern of C8 T1-innervated muscles, and MABCN SNAP interside amplitude ratio >2.0[the latter was used as a mandatory inclusion criterion]. Patients with atypical upper limb pain have undertaken cervical plain X ray. Control group was subjected to complete neurophysiological studies. Student t test was used to compare means of two groups. Ulnar nerve SNAP amplitudes were found normal. Reduction of median CMAP was reported in 19 patients [13.86%] and it was bilateral in 7 [36.84%]. Antidromic MABCN SNAP interside amplitude ratios showed values <2.0 and mean +/- SD was 1.273 +/- 0.221. Needle examination showed incomplete interference pattern in abductor pollicis brevis muscles in 11 patients [8%]. 3 patients [5.26%], 2 males, and 1 female had bilateral bony cervical ribs but non had evidence of NTOS. Neurophysiologically confirmed CTS was not proved to associate NTOS, and the hypothesized relationship between them could not be obtained. This might inspire us to revisit DCH for re-evaluation. Finally, NTOS is still a rare medical condition and scrutinizing suspected cases with thorough clinical assessment, and electrophysiological work up is a must

Heavy metal residues in some fresh Egyptian fishes

A total of one hundred and twenty fresh fish samples were randomely collected from Giza and Cairo markets [60 of each; 20 of Tilapis nilotica, Mugil cephalus and Bagrus bayed] to estimate the concentration of Mercury [Hg], lead [Pb], cadmium [Cd], and zinc [Zn]. Residues in flesh of the above mentioned fresh water fishes were estimated by using Atomic Absorption Spectrophotometer [AAS]. The obtained results indicated that the mean values +/- S.E of Hg in examined Tilapia nilotica, Mugil cephalus and Bagrus bayed were [2.2 +/- 0.26 and 2.1 +/- 0.92, 2.01 +/- 0.71 and 1.1 +/- 0.88, 0.115 +/- 0.015 and 0.021 +/- 0.042 ppm] in Giza and Cairo Governorates respectively. Also Pb residues were [1.015 +/- 0.5 and 1.1 +/- 0.84, 1.8 +/- 0.61 and 1.9 +/- 1.01, 1.12 +/- 0 .13 and 0.321 +/- 0.14 ppm] respectively. While the Cd values were [0.85 +/- 0.11 and 1.09 +/- 0.416, 3.1 +/- 0.72 and 2 +/- 0.92 .2.51 +/- 1.51 and 0.62 +/- 0.32 ppm] respectively. Concerning Zn values, they were [12.72 +/- 1.21 and 10.2 +/- 0.51, 12.05 +/- 1.15 and 10.7 +/- 0.63, 11.02 +/- 0.5 and 10.86 +/- 0.119 ppm] respectively. The obtained data were evaluated according to the permissible limits of FAO/WHO [1992] and E.S.S No. 2360 issued by Egyptian Organization for Standardization and Quality Control [EOSQC] [1993]. The public health significance and suggested precautions for minimizing the level of such heavy metals in food were discussed

Role of transesophageal echocardiography in diagnosis of selected cases of congenital heart diseases in pediatrics

The development of pediatric transesophageal echocardiography [TEE] represents an important advance in the diagnosis and management of the patient with congenital heart disease. As with TEE a new echocardiographic window is obtained which enable cardiologist to explore the heart from esophagus and stomach. The purpose of this work is evaluation of the role and efficacy of transesophageal echocardiography [TEE] in diagnosis of selected cases of congenital heart disease whether cyanotic or non-cyanotic in the pediatric age group. TEE [biplane 14mm width] was performed in 25 patients at pediatric cardiology unit in Abou El-Rich hospital, Cairo University between December 2003 and December 2004. The mean age of 16 males [64%] and 9 females [36%] patients was 7.1 years. The anaesthetic protocol which used was Ketamine followed by midazolam. The procedure had terminated early in 2 cases only due to O2 desaturation [upper air way obstruction] in one and the other case need over sedation to sleep. TEE proved significant additional in formation in 22 patients [88%], ASD comprised 32%of them and other CHD 86%. TEE proved a more detailed evaluation of the morphology and function of systemic and pulmonary venous return, the atria, inter-atrial baffles, atrio-ventricular valves and the left ventricular outflow tract. Based on our experience the transesophageal echocardiography is safe and reliable but still semi-invasive, it should be done in selected cases of CHD especially cases of ASD to evaluate size of the defect probably

Apolipoprotein E polymorphism in a healthy Lebanese population

To study the trends of drugs used in labour in Kuwait. A drug survey of a total of 326 mothers was conducted in the labour room of the Maternity Hospital, Kuwait. Data were collected from the prescription sheets and patient files by four doctors from the labour room based on a 4-day duty rotation schedule. Percentages of the prescribed drugs were: analgesics 59.5, tranquilizers 25.5, uterotonics 7.4, antibiotics 5.5, anticonvulsants 0.9, antihypertensives 1.5, and H2 receptor blockers 38.96. Our survey has shown that analgesics, H2 receptor blockers and tranquilizers constitute the most commonly used drugs in labour