Evaluation of dermatophyte identification medium for recovery of keratinophillic fungi from clinical samples

Dermatophyte test media [DTM] and Sabouraud's dextrose agar [SDA] are well established media for recovery of dermatophytes from clinical samples of dermatophytosis. Skin, hair and nail samples were mycologically examined from 112 patients attending Outpatient Clinic of Dermatology and Veneriology in Mansoura University Hospital in an attempt to compare dermatophyte identification media [DIM] with DTM and SDA for recovery and identification of dermatophytes. One hundred and sixteen fungi were recovered from 112 patients. The most common clinical lesions were onychomycosis 35.7% [40/112] and tinea capitis 17.86% [20/112]. The most common recovered keratinophilic fungi were T. mentagrophytes [31/116], followed by T. rubrum [15/116]. On comparing DIM with SDA and DTM sensitivity was 95.74% and 94.74% respectively while specificity of DIM with DTM was 86.67%.So DIM culture is an inexpensive, rapid, specific, and accurate method for the presumptive recovery of dermatophytes from clinical samples

Microsurgery Training for the Twenty-First Century

Current educational interventions and training courses in microsurgery are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess current training tools in microsurgery education and devise alternative methods that would enhance training. Simulation is an increasingly important tool for educators because, whilst facilitating improved technical proficiency, it provides a way to reduce risks to both trainees and patients. The International Microsurgery Simulation Society has been founded in 2012 in order to consolidate the global effort in promoting excellence in microsurgical training. The society's aim to achieve standarisation of microsurgical training worldwide could be realised through the development of evidence based educational interventions and sharing best practices.

Towards a Global Understanding and Standardisation of Education and Training in Microsurgery

With an increasing emphasis on microsurgery skill acquisition through simulated training, the need has been identified for standardised training programmes in microsurgery. We have reviewed microsurgery training courses available across the six continents of the World. Data was collected of relevant published output from PubMed, MEDLINE (Ovid), and EMBASE (Ovid) searches, and from information available on the Internet of up to six established microsurgery course from each of the six continents of the World. Fellowships and courses that concentrate on flap harvesting rather than microsurgical techniques were excluded. We identified 27 centres offering 39 courses. Total course length ranged from 20 hours to 1,950 hours. Student-to-teacher ratios ranged from 2:1 to 8:1. Only two-thirds of courses offered in-vivo animal models. Instructions in microvascular end-to-end and end-to-side anastomoses were common, but peripheral nerve repair or free groin flap transfer were not consistently offered. Methods of assessment ranged from no formal assessment, where an instructor monitored and gave instant feedback, through immediate assessment of patency and critique on quality of repair, to delayed re-assessment of patency after a 12 to 24 hours period. Globally, training in microsurgery is heterogeneous, with variations primarily due to resource and regulation of animal experimentation. Despite some merit to diversity in curricula, there should be a global minimum standard for microsurgery training.

A Systematic Review of Evidence for Education and Training Interventions in Microsurgery

Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.

Cytoplasmic nucleophosmin [cNPM] in acute myeloid leukaemia: Relation to disease characteristics

Nucleophosmin/B23 [NPM] is a 38 kDa molecular phosphoprotein involved in ribosome assembly and transport. Findings have revealed a complex scenario of NPM functions and interactions, pointing to proliferative and growth-suppressive roles. NPM appears to be more abundant in tumour cells than in normal cells. The aim of the work was to identify cytoplasmic localization of NPM using bone marrow clot biopsy and correlate it with disease and patient characteristics and the known prognostic factors, induction chemotherapy response and survival after 12 months of follow up. The present work was undertaken on 50 cases of normal karyotype acute myeloid leukaemia classified according to modified FAB system. Bone marrow aspirates were obtained, clotted and a formalin-fixed, paraffin embedded cell block was prepared. Sections were immunostained for NPM. Twenty-six cases [52%] had cytoplasmic positivity [cNPM+] while the remaining 24 cases [48%] had nuclear restricted NPM [cNPM]. cNPM positivity was significantly variable among the different FAB subtypes being the most prevalent among M5 and M2 cases, was associated with high blast and white blood cell count at diagnosis. It was significantly correlated with CD34 negativity, CD14 positivity but not with FLT3 mutations. Clinically no relation between cNPM positivity and age, sex nor extramedullary involvement of the studied patients was proven. The cytoplasmic positivity for NPM was significantly correlated with increased survival and better outcome after cycles of chemotherapy. So it can be regarded as a good prognostic marker. FLT3 positivity affected the survival of the cNPM negative group of patients remarkably, denoting the importance of combining both their statuses to predict outcome of therapy and survival. Our data confirm that cytoplasmic NPM1 immunoreactivity is predictive of NPM1 mutations and can be included in the routine diagnostic and prognostic workup of AML

Relations between serum essential fatty acids, cytokines [Il-6 and IL-8], apoptotic marker [SFAS], and free radicals in egyptian patients with autoimmune diseases

Eicosanoids, lymphokines, free radicals and apoptotic marker are known to participate in the pathogenesis of inflammation. The aim of this study was to investigate the relations between free radical generation, interleukins [IL-6 and IL-8], apoptotic marker soluble Fas [sFas], and the level of essential fatty acids and their metabolites in patients with autoimmune diseases. The study was conducted on 37 patients admitted to Rheumatology Unit Hospital of Ain Shams University, in addition there was 10 control subjects. The patients suffered from different types of autoimmune diseases according to their criteria, Rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], systemic sclerosis [SSC] and overlap syndrome. Serum levels of total glutathione [reduced; GSH and oxidized; GSSG] were estimated by HPLC; serum MDA, IL-6, IL-8 and sFas were also assayed. In addition serum fatty acids were determined by using GLC. The inflammations resulting from the studied autoimmune diseases induced significant decrease in serum level of GSH, and marked increase in the levels of GSSG, MDA, IL-6, IL-8 and sFas whereas serum fatty acid revealed that Linoleicacid [LA] and alpha linolenic acid [ALA] were significantly decreased in the studied cases. LA metabolite [arochidonic acid; AA] is markedly increase while ALA metabolite [eicosapentaenoic; EPA] and docosahexaenoic [DHA] were significantly increased. These results suggest that essential fatty acid metabolism is altered in autoimmune diseases. The interactions between essential fatty acids, eicosanoids, lymphokines and free radicals suggest that new therapeutic strategies can be devised to modify the course of these diseases

Effect of chromium- picolinat on biochemical and histopathological altrations in rats

Chromium III tris [picolinate] [Cr[pie][3]ps a popular nutritional supplement; however its safety has been questioned, especially with regard to its ability to act as a clastogen. The aim of the preset work was to evaluate the biochemical and moiph01gicd changes in the liver following oral administration of Cr-picolinate and the possible protective effect of ascorbic acid [vitamin C] in rats. Fifty male Sprague Dawly rats were divided into five groups included the control group, the rest four groups treated orally with picolinte [0.8 and 1.5 mg 7100 g b. w] alone or in combination with Vitamin C [0.5 mg 7100 g b. w] for 8 weeks. The results indicated that animals treated with Cr-picolinate alone at the high dose level [1.5 mg/100 g b.w] showed a significant decrease in reduced glutathione [GSH] level and activity of glutathione peroxidase [GPx] in liver homogenate or blood accompanied with a significant increase in serum sFas; 8-hydroxy-2 -deoxyguanosine and malondialdehyde [MDA] levels.The hepatocytes showed some degenerative changes in the form of swollen cells and degenerating nuclei, yet some cells showed regeneration by division of their nuclei The methyl green pyronin [MGP] stain showed less level of DNA in the nuclei, the cells appeared swollen and fused in some areas. It could be concluded that consumption of Cr-picolinate for a long time is contributing to health hazards and induced several hazards to liver. Supplementation with extra amounts of vitamin C may be useful to restrain the chromium-induced biochemical and morphological changes to the liver. It is believed that oxidative stress due to Cr- picolinate is a factor contributing to this health hazards

National survey of Prevalence of Mental Disorders in Egypt: preliminary survey

This study is an initial step for the National Survey of Prevalence of Mental Disorders in Egypt. We conducted a door-to-door household survey of 14 640 adults aged 18-64 years in 5 regions in Egypt. Mental disorders were diagnosed using the MINI-Plus diagnostic interview. Overall prevalence was estimated at 16.93% of the studied adult population. The main problems were mood disorders, 6.43%, anxiety disorders, 4.75%, and multiple disorders, 4.72%. Mental disorders were associated with sociodemographic factors [e.g. being female, being unemployed, being divorced] and physical illness [e.g. heart disease, kidney disease, hypertension]

status of antioxidant defences in glucose-6-phosphate dehydrogenase deficient patients. The role of antioxidants to ameliorate hemolytic crisis

In human, G6PD deficiency is the most common enzymopathy affecting over 400 million people throughout the world. It is associated with higher potential for oxidative damage due to chronic redox imbalance in red cells that often results in clinical manifcstation of mild to severe hemolysis. The NADPH product of G6PD is required for the reductive biosynthetic reactions as well as for the stability of catalase, and the preservation of the reduced form of glutathione [GSH]. The aim of this study was to clarify the role of G6PD in cellular antioxidant defense; the level of glutathione, catalase, NADPH and estimate the level of malondialdehyde which reflect the oxidative stress across the cell membrane. Also to study the effect of antioxidant treatment [vitamins C and E] to ameliorate high sensitivity of red cells to oxidative stress. This study was carried out on fifty G6PD-deficient children during the attack. The children were classified into two groups: Group 1: received blood transfusion only, and considered as an antioxidant-untreated group. Group 2: Received blood transfusion as group I in addition to antioxidant therapy [antioxidant-treated group], and healthy control subjects as control group, Our study proved that hemolytic attack in G6PD deficient patients is due to a concomitant impairment of the two main mechanisms of detoxification of H[2]O[2] in RBCs; GSH system and catalase. The most important finding in this study is the efficiency of treatment with a combination of vitamin E and vitamin C may improve antioxidant status in G6PD deficient patients and in reducing the symptoms of hemolytic crises

IgA/transferrin ratio for the early prediction of latent liver cirrhosis

The B.C of our study was to assess the level of IgA and transferrin of patients with liver cirrhosis to determine the relation between liver cirrhosis and IgA/transferrin ratio. The study involved 32 subjects classified into patients without liver cirrhosis [n=12], and patients with liver cirrhosis [n=10] as well as a group of normal healthy subjects [n=10] for comparison. In all of these subjects, serum alanine [ALT] and aspartate [AST] aminotransferase activity as well as serum IgA and transferrin level were determined. Our results revealed that the mean values of both ALT and AST activities were significantly high in both groups of patients without liver cirrhosis and with liver cirrhosis [P<0.05], although the activity of both enzymes was relatively higher in patients with liver cirrhosis than in those without liver cirrhosis. Furthermore, the amount of IgA immunoglobulin showed very highly significant decreased values in patients without liver cirrhosis while very highly significant increased values were obtained in cirrhotic patients as compared to their corresponding values in normal group. The concentration of serum transferrin showed insignificant values in cases without liver cirrhosis whereas these values showed moderately significant decreased level in cases of liver cirrhosis. It is of interest that the values of IgA/transferrin ratio, although showed insignificant values in patients without liver cirrhosis these values were significantly high in cirrhotic patients. In addition, it has been found that in liver cirrhotic patients the mean values of IgA/transferrin ratio were nearly 2.5 times as compared to the ratios in normal or non-cirrhotic patients. From the present study, the determination of IgA and transferrin in serum or plasma may open up a very simple and safe way for the early detection of latent cirrhosis. IgA/transferrin>2.5 ratio was found to be significantly increased in latent cirrhosis as compared to patients without cirrhosis or normal subjects. This value can be considered as an indicator of latent cirrhosis in children associated with liver diseases

Phytoremediation of chromium polluted soil

Heavy metal-contaminated land is an important environmental, health, economic, and planning issue in Egypt. Phytoextraction involves use of plans to remove metals from soil. In a greenhouse experiment, Zea mays, Helianthus annuus and Sorghum bicolor plants were grown in tannery effluent polluted soils and non-polluted reference soils. After 8 weeks of growth, the plants were harvested and the dry weight and the content of Cr were determined. The relationship between mycorrhizae and plans indicates that the percentage of mycorrhizal colonization in all plant species grown in un-polluted soils were higher than plants grown in polluted soil. Roots of all three plan species growing on both soils possessed Arbuscular mycorrhizal [AM] colomization in their roots and AM propagules in the associated rhizospheres. High Cr contents adversely affected the number and diversity of Am SPECIES. The order of Cr foliar accumulation was Z. mays > S. bicolor > H. annus. The effect of AM fungi on heavy metal uptake is dependent upon the initial soil metal concentration. The uptake of heavy metals by Z. mays, H. annus and S. bicolor was affected by the colonization of roots with [AM] fungi

Continuous epidural analgesia with bupivacaine 0.125% or bupivacaine 0.0625% plus sufentanil 0.25 ug.mL-l: a study in singleton breech presentation

Epidural analgesia is the most efficient technique for labor pain relief. However, its resultant motor block might impair the mode of delivery, particularly in breech presentation where the risk of dystocia is high. In the present trial, continuous epidural infusion of bupivacaine 0.125% was compared with a combination of a low concentration of bupivacaine [0.0625%] and sufentanil [0.25 ug.mL[-1]]. Analgesia, maternal and fetal/neonatal side effects and obstetric outcome were compared between bupivacaine group [n =23] and bupivacaine-sufentanil group [n =35]. A greater number of patients in the bupivacaine 0.125% group required more than two top-ups [32% vs. 8%, P =0.03] while pain scores were similar. Motor block at delivery was more pronounced in the bupivacaine 0.125% group. Nausea and pruritus were more often encountered in the bupivacaine-sufentanil group. There was a non-significant decreased rate of assisted or operative delivery in the bupivacaine-sufentanil group [92% vs. 74%, P = 0.09]. Fetal/neonatal data did not differ between groups. Epidural analgesia with bupivacaine-sufentanil required fewer additional top-ups and produced less motor block than did bupivacaine 0.125%. However, there was a non-significant difference in mode of delivery between the two analgesic regimens

Pattern of erectile dysfunction in Jeddah city

The aim of this study was to determine the demographic features of erectile dysfunction patients attending different specialized clinics in Jeddah city, and to identify possible risk factors associated with erectile dysfunction problem. All newly erectile dysfunction patients [n=388] who attended 6 andrology and urology clinics within a period of 3 months were subjected to a modified structural interview questionnaire to collect demographic data and risk factors for erectile dysfunction. The study revealed the following results among erectile dysfunction patients; Saudi patients constituted [81%]. The age ranged from 20-86 years with mean age of 43.23 +/- 12.56 years, 73% were married with one wife, 23.5% married with two wives, and 8% were single. About one-half [43%] were less than secondary education level. Retired patients constituted [13%] of all patients. Lack of exercise was the most frequent risk factor among 82% of patients, followed by smoking [56%], use of regular medication [44%], diabetes [30%], hypertension [15%], history of pelvic surgery [14%] alcoholism [13%], and drug addict [8%]. Erectile dysfunction is a problem of not only old age but also of middle and young age. This might be attributed to the high frequency of some risk factors such as diabetes mellitus, hypertension, smoking, alcohol consumption, and drug addiction. This finding may reflect the necessity for construction of prevention strategies

Interleukin-6 in maternal and umbilical cord blood as a predictor of chorioamnionitis and neonatal sepsis in patients with preterm premature rupture of membranes

This study included 80 pregnant women with preterm-PROM and their newborns. Maternal serum was obtained at time of admission and delivery for measuring total leucocytic count [TLC], C-reactive protein [CRP] and IL-6. Chorioamnionitis was diagnosed clinically and histologically. Umbilical cord blood at time of delivery was obtained for measurement of IL-6. The clinical outcome of neonates was followed up and documented. IL-6 [maternal and umbilical cord blood] seemed to be a promising predictor for early onset chorioamnionitis and neonatal sepsis

Role of Nitric oxide and some cytokines in neonatal septicemia

Bacterial sepsis is a life-threatening event. Some cytokines and recently, nitric oxide [NO] have been incriminated in the pathogenesis of sepsis, especially in the mechanisms by which sepsis progresses to septic shock. The aim of the present work is to determine whether NO level is increased in neonates with bacterial sepsis and if it is related to the levels of the inflammatory mediators namely interleukin-6 [/L-6] and tumor necrosis factor-alpha [TNF-alpha]. The study was conducted on twenty neonates with bacterial sepsis proved by history, clinical examination and laboratory investigations. Ten healthy age and sex matched-neonates were taken as a control. All cases were subjected to blood, cerebrospinal fluid and urine cultures and estimation of serum tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and serum NO [nitrite+nitrate] [the stable and catabolic products of NO]. Neonates with bacterial sepsis had a significantly higher serum TNF-alpha serum /L-6 and serum NO [nitrite + nitrate] than controls. There were significant positive correlations between serum levels of TNF-alpha [ng/ml], 12-6 [pg/ml], NO [nitrite +nitrate] [[micro mol/L] and I/T leukocytic ratios, Complete cure had occurred in 14 cases [70%], while 6 cases had succumbed [30%]. All succumbed cases had low systolic pressure <50 mmHg and oliguria, a picture denoting septic shock. In conclusion, levels of serum IL-6, TNF-alpha and plasma nitric oxide are elevated in neonatal septicemia. However, these mediators may be prognostic for survival rather than diagnostic, since, immature/total leukocytic ratio is still a rapid and easy method for suspicion of the case, together with the clinical picture

Effect of different modalities of treatment on the quality of life of breast cancer patients in Egypt

The impact of breast cancer therapy on the quality of life [QL] of Egyptian women was studied. Patients were divided into four groups: 1: mastectomy alone; 2: surgery plus radiotherapy; 3: surgery plus chemotherapy; and 4: triple modality. The results revealed that all the four domains of QL of women having adjuvant therapy [groups 2, 3, or 4] were significantly altered compared to those who underwent mastectomy alone. Triple modality adversely affected global QL the most compared to radiotherapy or chemotherapy; radiotherapy had significantly less effect on QL compared to chemotherapy. Triple modality predicted the worst QL. QL measures should be incorporated with the traditional end points for evaluation of treatment and patients given health education on the effects of each therapy

Reirradiation in the management of locally recurrent breast cancer

Thirty one female patients with breast cancer recurring in previously irradiated fields were reirrdiated. The fields were previously treated by 45 Gy/4 1/2 weeks of elective postoperative irradiation, eight to 34 months before recurrence. Reirradiation was given on a daily fractionation basis, with a dose per fraction of 2-3 Gy, to a total dose of 30-40 Gy, using megavoltage irradiation or electron beam therapy. Systemic treatment was used in 19 cases due to the presence of metastatic disease. Six patients showed complete regression and 14 cases showed partial regression. The median duration of response was 5 months. Acute skin reactions in the form of moderate to severe erythema and/or moist desquamation were seen in 12 patients. Late radiation effects seen before reirradiation did not show any increase during the follow up period of 2 to 9 months. A higher radiation dose was associated with a higher probability of complete response and acute skin reactions [P<0.05]. Reirradiation is tolerable and offers a good means of palliation in recurrent breast cancer, in previously irradiated fields