Correlation between the level of vitamin D and Bone mass index in primary osteoporotic patients in Taif, KSA

Osteoporosis [OP] is considered as one of the commonest metabolic bone diseases in orthopedics, characterized by a reduction in bone mass density and micro-architectural deterioration of bone tissue leading to diminished material properties with an increase in bone fragility and susceptibility to minor trauma fractures. The aim of this cross sectional study was to detect the level of vitamin D in patients suffering from primary osteoporosis and to correlate their levels with bone mass index. This work was performed - at the Orthopedic Outpatient Clinic of King Abdul Aziz specialist Hospital, Taif, [KSA] - on 115 patients [77 females and 38 males] fulfilling WHO revised criteria of 1994 for osteoporosis. The mean age of patients was 67.5 +/- 8.2. A medical history was taken and bony pains, fragility fractures, and loss of height, were elicited, with Inclusion criteria in the form of a T-score

Ventilator associated pneumonia: incidence and risk factors in a university hospital

Ventilator associated pneumonia [VAP] is a type of nosocomial pneumonia associated with increased morbidity and mortality. Awareness about the risk factors can be used to implement simple and effective preventive measures.To determine the factors associated with development of VAP and its mierobial profile among patients admitted to ICUs. A nested case-cohort study was conducted at Al-Hussein university hospital in Cairo city, Egypt for a period of 6 months from the 1[st] of March 2013 to the end of August 2013. Patients who were on mechanical ventilation [MV] for more than 48 hours were monitored at frequent intervals fordevelopment of VAP. Samples obtained by endotracheal aspiration were ccultured on Blood agar -Chocolate agar - MacConkey agar, plates of which were incubated at 37c for 24 hours. The isolated organism was identified by morphological and biochemical identification. Of the 73 samples which were taken from endotracheal tubes of the patients, 42 cases were diagnosed as VAP with an incidence rate of 57.5%. Early onset VAP occurred in 36 [85.7%], while late onset VAP was observed in the remaining 6 patients [14.3%]. Escherichia coli [40.5%] followedby Klebsiella pneumonia [23.8%] were the most commonly isolated pathogens. Univariate analysis showed that the duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H[2] blocker use were the risk factors associated with VAP [p < 0.05], Logistic regression revealed duration of MV as an independent risk factor for VAP. The incidence of ventilator pneumonia is high in our study. VAP was significantly related to duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H[2] blocker use

effect of lifestyle modification on severity of constipation and quality of life of elders in nursing homes at Ismailia city, Egypt

Constipation has a significant impact on the quality of life [QOL]. Lifestyle modification is widely accepted and recommended by experts as first-line therapy. This study aimed at using education on lifestyle modification to improve the QOL of the elderly in nursing homes suffering from functional constipation [FC]. This study was conducted in nursing homes in Ismailia city, Egypt. It involved 23 elderly patients suffering from FC, who were randomly selected according to the sample equation. They fulfilled the inclusion criteria of being >/= 60 years age and according to Rome II criteria. Participants completed personal characteristics and lifestyle questionnaire, the Patient Assessment of Constipation Symptom questionnaire [PAC-SYM] to assess the severity of symptoms, and the Patient Assessment of Constipation Quality of Life Questionnaire [PAC-QOL] to assess pre- and post-intervention. The intervention was conducted in three sessions, of 30 min each, 2 weeks apart using group discussions to educate the sample about dietary pattern, fluid intake, regular physical activity, and the use of laxatives. Statistical analysis: Data were analyzed using a statistical package for social sciences [SPSS version 20]. The lifestyle modification education on constipation significantly reduced the severity of symptoms as measured by PAC-SYM, including its total score and subscores [P < 0.001]. It also improved the QOL of elderly suffering from constipation as measured by PAC-QOL and reduced total scores of dissatisfaction [P = 0.001] with the exception of the psychosocial subscale. It also significantly increased the satisfaction subscale of PAC-SYM [P < 0.001]. Education on lifestyle modification leads to an improvement in the severity of the symptoms of constipation and the QOL of the elderly in nursing homes

Plasma proteosome level as a potential marker for hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a fatal malignancy. Effective curative surgery is achieved when HCC is detected earlier. Proteosomes, the main non-lysosomal proteolytic structures organising the cellular mechanisms of cleaving proteins, can be considered a tumour marker in many kinds of malignancies. The aim of this study was to assess the plasma proteosome level in HCC and cirrhosis and, accordingly, evaluate its potential diagnostic ability in the detection of HCC in cirrhosis. This study included 60 patients, divided into two groups: the HCC group and the liver cirrhosis group. Twenty normal subjects served as a control group. Serum levels of proteosome and alpha-foetoprotein [AFP] were measured using the enzyme-linked immunosorbent assay [ELISA] technique. Plasma proteosome levels were significantly higher in patients with HCC and in patients with cirrhosis without HCC when compared to controls individually [p > 0.002 and p > 0.001, respectively] but did not reach a significant differentiating level between them [area under curve [AUC] = 0.641, p = 0.061]. Moreover, the plasma proteosome level was not correlated with the severity of HCC by the Milan criteria or with AFP level. In addition, it was not significantly related to laboratory or Child-Pugh scoring. Moreover, the combined use of plasma proteosome level and AFP measurements for the diagnosis of HCC was not effective. In this study, the plasma proteosome level was comparably recorded in both patients with cirrhosis and patients with HCC [mean value +/- standard deviation were 5.796 +/- 1.46 and 7.176 +/- 2.48 microgml[-1], respectively], not reaching a significant differentiating level between them, although predictability of HCC using the plasma proteosome level was significant [p = 0.017]

Immunohistochemical characterization of telocytes in rat uterus in different reproductive states

Telocytes are a new type of interstitial tissue cells that were recently discovered in the myometrium of nonpregnant uteri and have been suggested to modulate uterine contraction. This work was conducted to extend this research on uteri at different reproductive states and verify whether the morphology and number of telocytes are modified. This study included 24 apparently healthy female albino rats equally classified into four groups: immature rats, adult nonpregnant rats, pregnant rats, and postpartum rats. The middle one-third of the right uterine horns were processed for H and E staining and immunohistochemical detection of telocytes using a c-kit antibody. The count of c-kit-positive telocytes per high-power field in both the endometrium and myometrium was determined and statistically analyzed. C-kit-positive telocytes were detected in the endometrium, mainly around the endometrial glands, and in the myometrium. They were oriented parallel to circular smooth muscles while being located predominately on the boundaries of longitudinal muscle bundles. Immature uteri contained a small number of telocytes in both the endometrium and myometrium that significantly increased in adult nonpregnant uteri. Pregnant uteri showed further significant increase in endometrial telocytes but a significant decrease in myometrial telocytes, possibly to prevent preterm delivery. Postpartum uteri showed the highest count of myometrial telocytes, which could reflect their role in postpartum involution. Telocytes are present in both the endometrium and myometrium of the rat uterus in different reproductive states. Their functions in the endometrium seem to be glandular support and stromal cell communication, whereas in the myometrium they possibly initiate and coordinate myometrial contraction

Can human cord blood-derived stem cells improve statin-induced myopathy in rats? A histological and immunohistochemical study

Primary myopathies of skeletal muscle are diseases with worldwide prevalence for which effective treatment is urgently needed. The aim of this study was to investigate the ability of human umbilical cord blood [HUCB] stem cells to repair damaged skeletal muscle in a rat model of statin-induced myopathy. This study included 24 adult male albino rats divided equally into four groups: the control group; the myopathy group in which myopathy was induced by administration of simvastatin [80 mg/kg/day orally for 6 weeks]; the stem cell-treated myopathy group in which myopathy was induced by administration of simvastatin with subsequent local injection of 1×10[6] HUCB stem cells in the right gastrocnemius; and the untreated myopathy group in which myopathy was induced by administration of simvastatin and then left without treatment for 2 weeks. Specimens of the right gastrocnemius from all rats were prepared, sectioned, and subjected to H and E, Prussian blue, and Masson's trichrome stains in addition to immunohistochemical staining for alpha smooth muscle actin to reveal myofibroblasts. The area% of collagen and muscle fibers and the number of myofibroblasts/high-power field were ascertained. All measurements were statistically analyzed. The gastrocnemius of the myopathy group showed frequent necrotic and damaged muscle fibers, which were replaced by fibrous and fatty tissues. Compared with control rats, there was significant decrease in the area% of muscle fibers and significant increase in the area% of collagen and in the number of myofibroblasts. Two weeks later, there was partial repair of the muscle with no significant differences between stem cell-treated and untreated myopathy groups, which reflects the failure of stem cells to repair damaged myofibers. HUCB stem cells have poor therapeutic effect for myopathy and might be hindered by the complex environment of a severely inflamed and degenerated muscle

Assessment of rat endometrial pinopodes in normal cycles and following HCG ovarian hyperstimulation with or without progesterone supplementation: scanning electron microscopic study

Pinopodes, mushroom-like projections, arise from the endometrial surface at or just before the time of implantation. They have been proposed as a method of identifying endometrial receptivity for transferred embryo in programs of IVF. The present work was planned to assess the expression of pinopodes in rat endometrium in normal cycles and following ovarian hyperstimulation with or without progesterone supplementation as a trial to estimate the optimal date for successful embryo transfer in IVF programs. Forty-five adult female albino rats were divided equally into three groups. In the control group, ovulation was induced by mechanical vagino-cervical stimulation. Group II was subjected to ovarian hyperstimulation using human chorionic gonadotrophin [HCG] 350 IU/kg injected intraperitoneally [two injections 48h apart and vagino-cervical stimulation was performed on the evening of administration of the second injection. Group III was treated in the same way as group II, followed by a daily subcutaneous injection of progesterone 35mg/kg. All rats were sacrificed 3, and 5 days after vagino-cervical stimulation. The middle third of the right uterine horn were processes for scanning electron microscope examination. The mean number of pinopodes was statistically analyzed. In control rats, pinopodes started to appear on day 4 and significantly increased in number on day 5. In the HCG-ovarian hyperstimulated group, there was an early appearance of pinopodes on day 3, which increased in number on day 4 and regressed on day 5. With progesterone supplementation, there was an obvious increase in the number of pinopodes especially on day 4. It could be concluded that ovarian hyperstimulation using HCG may cause early expression of pinopodes and premature formation of an implantation window. Also, progesterone supplementation could enhance endometrial receptivity. This should be taken into consideration in IVF programs to synchronize embryo and endometrial development, which could improve pregnancy rates

Implication of umbilical cord in preeclampsia

To investigate the role of biochemical changes in the umbilical cord and placenta in developing preeclampsia [PE]. Thirty women with PE and 15 healthy pregnant women as controls were enrolled in this study. Vascular endothelial growth factor [VEGF], soluble vascular endothelial growth factor receptor 1 [sVEGFR-1], platelet-derived endothelial cell growth factor [PD-ECGF], neutrophil elastase and nitric oxide [NO] were measured. Both serum [maternal and fetal] and tissue [placenta and umbilical cord] levels of VEGF, sVEGFR-1, PD-ECGF and neutrophil elastase were significantly increased, whereas NO was significantly decreased [except placental tissue showed no changes] in preeclamptic patients. The cord serum level of PD-ECGF was significantly higher in severe PE compared to mild PE and normal pregnant women. The placental and cord tissue levels of PD-ECGF and neutrophil elastase were significantly higher in severe PE, while the cord tissue level of NO was significantly lower in severe PE. Our data showed that umbilical cord vessels and stroma can serve as an additional source of vasoactive and angiogenic substances that contribute to the biochemical Changes OCCUrring in PE

Effect of origanum majorana on some hospital resistant microbes and reference bacterial strains

The antimicrobial activity of marjoram essential oil was determined using Staphylococcus aureas ATCC 6923, Pseudomonas auregonosa ATCC 9027, Bacillus subtilis ATCC 6633, E. coli ATCC 8736, and two hospital resistant microbes isolates 16 and 21, marjoram oil was found to be effective against used pathogenic bacteria. The chemical composition of the essential oil was analyzed by GC-Ms. The major components were Terpineol, cis-beta, Alpha-terpieol, l-terpinen-4-ol. Linalool and I, 6-octadien-3-ol, 3. 7 dimethyl-, 2aminobenzoate. Inhibition was observed at concentration [4-7 micro l/ml] with reference strain and [10 - 15 micro l/ml] with hospital resistant microbes using disk diffusion and micro dilution methods

Protein substitution to produce a processed cheese with high branched-chain amino acids of medical and genetic importance

The most important metabolic impairment in patients with advanced liver disease is characterized by low levels of circulating branched chain amino acids [BCAAs]. The etiology of such abnormal amino acid metabolism is multifactorial including protein restricted diet or inadequate nutritional intake as in protein energy malnutrition. Multiple studies report the beneficial effects of BCAAs supplementation to improve plasma amino acids imbalance, several neurologic diseases, protein energy malnutrition, and subsequently the survival rate of cirrhotic patients. In the present study we used a protein substitution technique to synthesize a new processed cheese as a dairy source rich in BCAAs, with low phenylalanine content manufactured from Ras cheese, kariesh cheese, butter oil and phenylalanine-free milk. Chemical composition, amino acids analysis, rheological properties and sensory evaluation were done to all of the cheese samples. L-Phenylalanine was selected to induce hepatic and brain affections in Begg Albino strain c [BALB/c] mice model. Effect of 2.5%, 5% and 10% protein-replacement cheese formulas was evaluated among mice groups including histopathological sections of the liver and brain; colorimetric determination for liver enzymes; serum total and differential cholesterol profile, serum albumin, globulin and total protein along with phenylalanine levels determinations. Analysis of the processed cheese sample with 10% protein substitution revealed that the protein content was 7.42 mg/g [about 50% of the content in the standard processed cheese] while fat content, acidity and moisture were nearly the same. The sensory score for all the formulas ranged from 79-88. Highest content of BCAAs along with least phenylalanine content was attained in the processed cheese with 10% protein substitution. Weight of mice fed on different substitution formulas ranged from 22.8 +/- 2.2-24.66 +/- 2.5 g compared with 17.8 +/- 1.9 g in the untreated diseased mice [P< 0.05]. Serum phenylalanine was 1.822 +/- 0.42 mg/dl in the mice fed on 10% protein substitution formula compared to 6.2 +/- 1.32 mg/dl in the untreated mice [P < 0.01]. There was a highly significant difference [P <0.01] between untreated mice and mice fed on 10% substitution cheese formula as regards the serum protein, Aspartate Transaminase [AST] and Alanine Transaminase [ALT]. The improvement in histopathological findings was more apparent in the mice fed on 10% formula cheese. The manufactured processed cheese with 10% protein substitution was proved to have a more nutritional therapeutic potential that can help in the implementation of dietary management in many medical and genetic disorders with liver and brain affections

spirometry and cardiopulmonary exercise performance in pateints with thalassemia major

Lung function abnormalities in patients with thalassemia major are various, complex and of different etiological backgrounds. To evaluate the pulmonary function changes during both rest and integrated cardiopulmonary exercise in patients with thalassemia major, we studied 30 thalassemia major cases with mean age of 18 +/- 13.34 years. Nineteen healthy subjects were enrolled as a control group. Routine laboratory tests as well as assessment of pulmonary function test during both rest and integrated cardiopulmonary exercise were performed for cases and controls, Both forced vital capacity [FVC] and forced expiratory flow in the first second [FEV1] were significantly reduced in cases than in controls [p<0.01 for both], pointing to a restrictive pulmonary dysfunction. Seventy percent of cases had FVC below the normal predicted value. Functional capacity, anaerobic threshold and °2 pulse were significantly reduced in cases than controls [p<0.05]. There is a statistically significant inverse correlation between serum ferritin levels and functional capacity. In the studied thalassemics, restrictive pattern of pulmonary dysfunction is the predominant abnormality. Poor cardiopulmonary exercise performance occurs and is multifactorial

Pre-procedural and procedural predictors of significant mitral regurgitation following percutaneous mitral commissurotomy with Inoue balloon technique: a new face of an old story

Despite the high technical expertise in percutaneous mitral commissurotomy [PMC], mitral regurgitation [MR] remains a major procedure-related complication. The aim of this work is to find out the most sensitive and applicable predictors of development of significant mitral regurgitation [SMR] following percutaneous mitral commissurotomy using Inoue balloon technique. We studied the pre-procedural [Clinical, echocardiography, and hemodynamic] and procedural predictors of significant mitral regurgitation [identified as increase of >/= 2/4 grades of pre-PMC MR by color Doppler flow mapping] following valvuloplasty using Inoue balloon in 54 randomized patients with severe mitral stenosis. Multiple stepwise logistic regression analysis was performed for variables found positive on univariate analysis to determine the most important predictor [s] of developing SMR. The incidence of SMR following PMC using Inoue technique was 18.5% [10 patients]. MV scoring systems were the only variables that showed significant differences between both groups [Group A without SMR and Group B with SMR]. However, no clinical, other echocardiographic measurements, hemodynamic or procedural variables could predict the development of SMR. Using multiple regression analysis, the best predictive factor for the risk of SMR post Inoue BMV was the total MR-echo score with a cut-off point of 7 and a predictive percentage of 97.7%. The total MR-echo score is the only independent predictor of SMR following PMC using Inoue technique with a cut-off point of 7

Sequential and combined immunization of infants with oral and inactivated poliovirus vaccines: controlled study of reactogenicty and immunogenicity

We conducted a clinical trial to assess an immunization schedule combining oral [OPV] and inactivated poliovirus vaccines [IPV] in infants residing four rural communities in Abu Homos district, Beheira Governorate, Egypt. Infants in group "A" received OPV during their first month and at 2, 4 and 6 months of age. Infants in group "B" received OPV during their first month and 2 months followed by both OPV and IPV at 4 and 6 months of age [combined-schedule group]. The OPV vaccine is manufactured by Egyptian Organization for Biological Products and Vaccines [VACSERA] in Egypt while the IPV is a product of Pasteur Merieux [France]. Adverse events were monitored for three days after each dose. Blood was collected before immunization and 4 weeks after each dose to assess vaccine specific serological response. A total of 163 infants received 3 correct doses, had inter-dose intervals within the allowable range and provided 4 samples of blood, were included in the per protocol analysis [85 in group "A" and 78 in group "B"]. There was no statistically significant intergroup difference in the percentage of subject reporting the primary safety endpoint [diarrhea, vomiting, fever, irritability or local reactions at the site of IPV injection] during the 3-day after each dose. There was a statistically significant greater reporting of ill feeling in group "A" after dose I and II [p<0.001] compared to group "B". All infants in the two groups acquired protective immunity, determined as possession of neutralizing antibodies at titre > 1:8 after completing vaccination. However, the geometric mean titres to each poliovirus type were significantly higher in vaccinees in group B [p<0.001]. Seroconversion rates [> 4-fold rise in titre] to each poliovirus type were high in the two treatment groups after the last dose. Difference in seroconversion rates between the two treatment groups was not statistically significant. These finding demonstrated that the combined use of OPV and IPV didn't improve immunogenicity over the use of OPV alone. The study protocol and subject-informed consent were approved by independent Ethics Committee of the participating institution [VACSERA] and the National Organization for Drug Control and Research [Egyptian National Regulatory Authority]. The study was conducted according to the Declaration of Helsinki and the International Conference on Harmonization for Good Clinical Practice. Written informed consent was obtained from all subjects prior to conducting study-related procedures

Effects of alpha-lipoic acid on induced gastric ulcer in albino rats

This work was designed to study the protective effect of Alpha lipoic acid [ALA] on stress-induced gastric ulcers and to evaluate its effect on gastric secretions in rats exposed to cold restraint stress [CRS], The rats were divided into 2 main groups; [A] and [B] to study the effect of CRS on gastric secretion and ulceration, respectively, and their modulation by Alpha lipoic acid. Group [A] was subdivided into [4] subgroups each consisted of [10] Rats and received ALA in a dose of [50 and 100 mg/kg/day, respectively] for [14 days]. Group [B] was subdivided into [3] subgroups each consisted of [10] Rats and received ALA in a dose of [50 and 100 mg/kg/day, respectively] for [14 days]. The present study showed that, orally administered A LA, in a dose of [50 and 100 mg/kg/day] produced statistically significant reduction of the mean acid concentration and the mean acid output. The mean pepsin concentration was also significantly increased with [P<0.05]: ALA also, produced statistically insignificant reduction of the volume of gastric contents in comparison to the CRS group. ALA [50 mg/kg/day] also, reduced the incidence of ulceration, where the mean ulcer severity score and the ulcer index were significantly reduced with [P<0.05]. The preventive index was [48.8 4%] while ALA in dose [100 mg/kg/day] reduced the incidence of ulceration. The mean ulcer severity score and the ulcer index were insignificantly reduced with [P> 0.05]. With preventive index [28%]. These significant protective effects of ALA may be due to one or more of the following mechanisms; stimulation of PGs synthesis [one of the main inhibitors of gastric acid secretion], increase of the volume of gastric juice probably by an increase in gastric mucus and water secretion and as an antioxidant [ALA is considered as one of the most potent antioxidant, acts intra-and extra-cellular, recycling other antioxidants and possesses metal chelating activity]. It was concluded that; ALA used in the study showed statistically significant effect on all parameters of gastric secretion in comparison to the control group. They also significantly reduced the incidence of ulceration, the mean ulcer severity score and the ulcer index with a good preventive index. This protective anti-ulcer effect may be mediated through PGs whose synthesis is regulated by ALA

Effect of garlic on endogenous antioxidant enzymes and hyperlipidemia induced by cyclosporin - A in albino rats

In this work thirty adult male albino rats were used to study the effect of garlic on antioxidant enzymes and hyperlipidemia induced by cyclosporin A [CsA]. Rats were divided into three equal groups Rats of the first group [control group] were given 1 ml distilled water orally rats of second group were given [25 mg/kg] cyclosporin A intraperitoneally, rats of third group were given [25 mg/kg/daily] cyclosporin A intrapertioneally+garlic tablets 400 mg/kg/daily. At the end of experimental period [28 days] blood level of glutathion peroxidase [G.Px] superoxide dismutase [SOD] and plasma level of malonaldhyde, cholesterol, high density lipoproteins [HDL], low density lipoproteins [LDL] and triglycerides [TG] were determined. The study showed that cyclosporin A produce significant decrease G.Px, SOD, and malonaldhyde and significant increase plasma cholesterol, triglycerides LDL but insignificant changes in HDL as compared to control group. Also the study showed that garlic administration leads to significant increase G.Px, SOD and significant decrease plasma cholesterol, triglycerides, LDL but insignificant changes in plasma malonaldhyde as compared to group treated by cyclosporin A

Protein C, protein S and antithrombin III assessment in Egyptian thalassemic children

Enhanced years of survival have led to the unmasking of management related complications with the recognition of the existence of a chronic hypercoagulable state in thalassemic patients. This study aims at determining the levels of the three main antithrombophilic factors namely protein C, protein S and antithrombin III in Egyptian children with beta thalassemia major. Sixty children with beta thalassemia major with a mean age of 12.2 +/- 1.88 years and male: female ratio 1.7: 1 were enrolled in the study. They were subjected to history taking, clinical examination and laboratory investigations including levels of ferritin by IRMA, protein C, protein S, and antithromobin III by ELISA. Protein C was deficient in 16 [26.7%] of cases, protein S was deficient in 8 [13.3%] of cases while none had deficiency of antithrombin III. None of our cases had a history of thromboembolic events. These abnormalities were not related to the state of HCV infection or to the type of chelation whether oral or subcutaneous. Protein C deficiency was present more in older patients. Abnormalities in protein C, protein S are frequently observed even without manifesting hypercoagulable states in our studied thalassemia major children

Cystobiliary fistula in hepatic hydatid disease: diagnostic and therapeutic challenge

In Hydatid disease of the liver cystobiliary fisula [CBF] constitutes an anatomic and a clinicopdthologic entity characterized by the occurrence of a life-threatening cholangitis with increased morbidity and the prolongation of hospital stay. An accurate preoperative diagnosis of this complication is essential for its prompt surgical management. The diagnosis of hydatid disease and the existence of CBF is based primarily on both of the clinical presentation and the characteristic appearance on ultrasonographic [US] and/or computed tomographic [CT] imaging, and confirmed by endoscopic retrograde cholangiography [ERC]. The aim of this work was to study the different diagnostic and therapeutic aspects of cystobiliary fistula in hydatid disease of the liver. From 1996 to 2003, among 63 patients treated for hydatid cysts of the liver, 17 with complicated cysts were included in the current study. They were 11 males and 6 females with a mean age of 34.5 years [ranged from 12 to72 yrs]. According to the clinical presentation, they were divided into 3 groups; group A: nine patients presented with cholangitis, group B: five patients had history of jaundice and group C: three patients presented with jaundice. In 14 patients [groups A and B], the diagnosis of CBF was suspected by abdominal US and/or CT imaging and confirmed by ERC. In the remaining 3 patients [group C], CBF was not documented and they were excluded. Preoperative endoscopic sphencterotomy ES was done in group A with retrieval of hydatid daughter cysts. Among the patients of group A, Seven patients [subgroup Al] were subsequently submitted to surgery entailing endocystectomy in 5 and hepatic resection in two. The remaining 2 patients in group A [subgroup A2] were managed by endoscopic therapy only. Patients of group B [n = 5], were not submitted to preoperative ES and were subsequently managed by hepatic resection in one patient and endocystectomy in four. There was no mortality in the studied group. Postoperative bile leak occurred in four cases; one after hepatic resection and three after endocsytectomy in group B for whom preoperative endoscopic sphincterotmy [ES] was not done. In contrast, none of the patients who were submitted to preoperative ES [subgroup Al] had bile leak. Postoperative wound infection was reported in three patients and minimal subphrenic collection that was aspirated under US guidance was in two. A chest complication in the form of atelecatasis was recorded in one patient. The mean hospital stay was 12.4 days. All patients received albendazole treatment. Surgery still remains the treatment of choice for hydatid cysts of the liver complicated with cystobiliary fistula [CBF]. The results of this work highlight the validity of diagnostic ERC in confirming the diagnosis of CBF in suspected patients with complicated hydatid cysts of the liver. Also, therapeutic ERC has a place in the treatment algorithm of CBF as it was found to be a safe and a reliable therapeutic alternative especially in high risk patients for surgery

Impact of percutaneous balloon mitral valvuloplasty on right and left ventricular functions assessed by tissue Doppler imaging

Pure mitral stenosis affect left ventricular performance as a result of myocardial and mechanical factors. It has been found that, with increase in pulmonary artery pressure, the right ventricle may hypertrophy and dilate, and right ventricular ejection fraction decreases. Pulsed TDI has been used for the evaluation of impaired systolic or diastolic function. Percutaneous mitral valvotomy has proven to be effective technique for the relief of obstruction in patients with mitral stenosis. However, the results of the studies about the effect of percutaneous mitral balloon valvuloplasty [PMBV] on ventricular functions are controversial. Of this study was to assess right and left ventricular functions using Doppler tissue imaging [DTI] before and after percutaneous mitral valvuloplasty two days after and at 3 months follow up. We studied 30 selected thirty patients with symptomatic mitral stenosis of rheumatic etiology, who were admitted for percutaneous mitral valvuloplasty and another twenty normal disease free subjects, as proved by electrocardiography ECG and Doppler-echocardiography, thirteen were females and seven were males. All patients were subjected to history analysis, clinical examination, ECG analysis, transthoracic echo Doppler study to asses mitral valve area and trans mitral diastolic gradient, transoesophageal echo study to exclude left atrial cavity or appendage thrombi and lastly pulsed TDI to asses right and left ventricular functions one day before and two days after percutaneous mitral valvuloplasty and then repeat at 3 months follow up. Significant increase in mitral valve area, drop of transmitral pressure gradient and increase of left and right venticular ejection fraction two days and 3 months after the procedure [p <0.05]. By TDI all the myocardial velocities significantly increased after PMV but still below the normal values of the control group [p < 0.05]. PMV results in significant improvement of systolic myocardial velocities of right and left ventricles two after and at follow up, but these velocities are still below the normal values

Administration of tetanus toxoid [TT] to pregnant women versus tetanus and reduced diphtheria [Td]: a randomized controlled

We conducted a clinical trial to compare the immunogenicity, reactogenicity and efficacy of Tetanus Toxoid [TT] and the combined Tetanus and reduced Diphtheria [Td] in pregnant women residing four rural communities in Egypt. The study has been designed as a randomized controlled trial. Pregnant women in each of the four villages received either TT or Td randomly. Both TT and Td vaccines are manufactured by the Egyptian Company for Biological Products and Vaccines [VACSERA] in Egypt. A total of 131 pregnant women were enrolled at the time of their antenatal care visit [at the beginning of their fifth gestational month] to one of four health units in Abu Homos district, Beheira Governorate, Egypt. Previously un-immunized women received at random 2 doses of TT or Td eight weeks apart during their pregnancy. Active outpatient follow-up for adverse events was done on the third day after each dose. Local [pain, redness and swelling] or general [fever, malaise and headache or body aches] reactions during the 3-day post-dosing interval served as the primary safety end point. Blood was collected 3 times from each subject to detect antibody level against tetanus and diphtheria by ELISA. The first sample was collected immediately before the first dose, the second before the 2[nd] dose and the third sample one week after delivery. Active surveillance home visits to all study participants were conducted twice. The first home visit was during the first week after delivery and the second one month after labor to report the health status of the mother and the baby. A total of 122 pregnant women received 2 correct doses had inter-dose intervals within the allowable range and provided 3 samples of blood, were included in per protocol analysis [62 in the TT group and 60 in the Td group]. There was no statistically significant inter group difference in the percentage of subject reporting the primary safety endpoint [fever, malaise, body ache, headache] or local reactions at the site of injection as redness and swelling, during the 3-day after each dose. There was a statistically significant greater reporting of pain at injection site in the Td group after dose I and II compared to the TT group. Home visits revealed normal mothers and babies on clinical examination in both groups. However, more babies in the TT group suffered from physiological jaundice. All women in the two groups acquired protective immunity for tetanus, determined as possession of neutralizing antibodies at titre>0.10 IU/ml after completing vaccination. However, the geometric mean titres of tetanus post dose I and II were significantly higher in vaccinees in the TT group [P<0.001]. For diphtheria, post vaccination seroprotection [titre>0.10 lU/ml] was significantly higher in the group received Id than the TT group. Geometric mean Titres of diphtheria post dose II were significantly higher in vaccinees in the Td compared to the other group [P<0.0001]. These finding demonstrared that the use o Td vaccine improves immunogenicity for both tetanus and diphtheria over the use of 'IT vaccine alone and may be recommended to replace TT in immunization of pregnant women.

Detection of occult cor-Pulmonale using dobutamine stress echocardiography in patients with schistosomal hepatic fibrosis

The presence of early diastolic dip of the ventricular septum has been reported to be able accurately diagnose occult cor-pulmonale during cycle ergo meter exercise test in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted to test the ability of dobutamine stress echocardiognaphy [DSE] to detect cases of occult corpulmonale among patients with hepatosplenic schistosomiasis. The study included 25 patients aged 35.6+/=l2.7 years with hepatosplenic schistosomiasis [group 1, 15 males and 10 females] compared to 25 age- and sex-matched patients with COPD [group II]. M-mode echocardiognaphic ventricular septal motion, left ventricular shape [determined by short-axis 2-dimensional echocandiography], and pulmonary artery [PA] acceleration time [determined by pulsed Doppler echocardiognaphy] were measured at rest and during DSE. The ventricular septal motion and PA acceleration time were normal at rest in all patients. In gnoup 1, 22 patients [88%] reported marked downward ventricular septal motion in early diastole during DSE, indicating distortion of left ventricular shape. In group II, only 11 patients [44%] showed the same change during DSE. There is significant decrease in PA acceleration time in patients who showed septal dip in both groups from rest to DSE. It could be concluded that occult cor pulmonale can be diagnosed by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during DSE in patients with hepatosplenic schistosomiasis. This method may be useful in selecting cases for medical treatment for early cor-pulmonale