Allolobophora caliginosa coelomic fluid ameliorates gentamicin-induced hepatorenal toxicity in rats

Objective: To explore the efficacy of earthworm's coelomic fluid against gentamicin-induced hepatic and renal toxicity in rats. Methods: The animals were divided randomly into three groups (n= 6 per group): control, gentamicin, and Allolobophora caliginosa coelomic fluid-treated groups. Toxicity was established after injection of gentamicin daily for 8 days at a dose of 100 mg/kg. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total proteins, albumin, creatinine, urea, uric acid, malondialdehyde, glutathione, catalase and histopathology of tissues were investigated in the study. Results: Allolobophora caliginosa coelomic fluid significantly decreased urea, creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and malondialdehyde levels while significantly increasing levels of total proteins, albumin, glutathione and catalase. The histopathological investigation showed partial restoration of renal and hepatic architecture. Conclusions: This study shows the potency of Allolobophora caliginosa coelomic fluid in improving the biochemical and histopathological changes induced by gentamicin in the liver and kidney of the rats.

Assessment of remineralization potential of Theobromine and Sodium Fluoride gels on Artificial Caries like lesions / Avaliação do potencial de remineralização de géis de teobromina e fluoreto de sódio em lesões de cárie artificial

Objective: To compare the remineralization potential of theobromine and sodium fluoride gels on artificial caries like lesion. Materials and Methods: Forty longitudinal halves of human mandibular premolars were equally divided into 4 groups of 10 samples each: control group (C), samples were stored in distilled water during the experiment period. The remaining 30 specimens were subjected to demineralization protocol to create caries like lesions. samples were immersed for three days in a demineralization solution (pH 5.0) containing 0.2% carbopol and 0.1% lactic acid saturated with calcium phosphate tribasic. The samples were subdivided into 3 equal groups according to the treatment applied during the pH cycle. Demineralization group "D": no treatment applied. Group "F" treated with 2000 mg/liter sodium fluoride gel. Group "T" treated with 200 mg/liter theobromine gel. The specimens of the two studies groups were subjected to Demineralization- Remineralization PH Cycle Protocol for 5 days (Alternating four steps: 1: Treatment material, fluoride or theobromine ˜= 3 minutes. 2: Demineralizing solution 3 hours. 3: treatment material ˜= 3 minutes. 4: Remineralizing solution till the next cycle). The samples were investigated by scanning electron microscope (SEM) and energy dispersive x-ray analysis (EDXA). Results: The enamel of the demineralization group was porous with artificial caries like changes exposing the subsurface enamel rods with severe rod core defects. Theobromine gel and fluoride gel groups showed marked improvement in the surface characteristics in the enamel in both groups. Theobromine gel group showed more observable enamel surface improvement than the fluoride gel group. EDXA revealed that the calcium-phosphorus ratio displayed a descending order: (C > T > F > D). The differences between the two tested groups were not statistically significant. Conclusion: Theobromine gel had more effective remineralizing potential than fluoride gel as a result of its effect in improving the enamel surface characteristics of human teeth. (AU)

Objetivo: Comparar o potencial de remineralização dos géis de teobromina e fluoreto de sódio em lesões de cáries artificiais. Materiais e Métodos: Quarenta metades longitudinais de pré-molares inferiores humanos foram igualmente divididas em 4 grupos de 10 amostras cada: grupo controle (C), as amostras foram armazenadas em água destilada durante o período do experimento. As 30 amostras restantes foram submetidas ao protocolo de desmineralização paracriar lesões artificiais de cárie. As amostras foram imersas por três dias em uma solução de desmineralização (pH 5,0) contendo 0,2% de carbopol e 0,1% de ácido lático saturado com fosfato de cálcio tribásico. As amostras foram subdivididas em 3 grupos iguais, de acordo com o tratamento aplicado durante o ciclo do pH. Grupo de desmineralização "D": nenhum tratamento aplicado. Grupo "F" tratado com 2000 mg / litro de fluoreto de sódio em gel. Grupo & quot;T &q uot; tratado com 200 mg / litro de gel de teobromina. As amostras dos dois grupos de estudo foram submetidas ao protocolo de ciclo de desmineralização - remineralização por 5 dias (quatro etapas alternativas: 1: material de tratamento, flúor ou teobromina ˜= 3 minutos. 2: solução desmineralizante 3 horas. 3: material de tratamento ˜= 3 minutos 4: Solução de remineralização até o próximo ciclo). As amostras foram investigadas por microscopia eletrônica de varredura(MEV) e análise de raios-x dispersivos de energia (EDXA). Resultados: O esmalte do grupo de desmineralização era poroso, com cáries artificiais, como alterações que expunham as hastes de esmalte do subsolo com graves defeitos no núcleo da haste. Os grupos gel de teobromina e flúor apresentaram melhora acentuada nas características da superfície do esmalte nos dois grupos. O grupo gel de teobromina mostrou uma melhoria na superfície do esmalte mais observável do que o grupo gel de fluoreto. A EDXA revelou que a razão cálcio-fósforo exibia uma ordem decrescente: (C> T> F> D). As diferenças entre os dois grupos testados não foram estatisticamente significantes. Conclusão: O gel de teobromina teve um potencial remineralizante mais eficaz que o gel de flúor como resultado de seu efeito na melhoria das características da superfície do esmalte dos dentes humanos. (AU)

Comparison between clinical and biochemical versus interleukin 28b as a predictive factor of virological response to direct antiviral drugs without interferone in treatment of hepatitis c virus patients

Introduction: for SNP, the CC is associated with a higher SVR after DAAs/RBV therapy while, the genotype TT is a risk factor for non-response

Aim of the work: this study aimed to assess the value of SNP [rs8o99917] as a predictor of SVR

Methodology: this study was a retrospective controlled study and was performed on a total number of 15o patients who were treated by DAAs/RBV for 12 weeks and SNP was done for the all the patients. Results: CC genotype was more prevalent in SVR group than CT and TT genotypes

Conclusion: determination of SNP before starting antiviral therapy may serve as a good response predictor

Detection of Helicobacter pylori vacA, cagA and iceA1 virulence genes associated with gastric diseases in Egyptian patients

Background: Helicobactor pylori [H. pylori] virulence markers would be useful to predict peptic ulcer disease [PUD] or gastric cancer

Aim: In Egypt, since inadequate data are present regarding H. pylori virulence-related genes in different age group patients with gastro-duodenal diseases, it becomes crucial to study the clinical status of cagA, vacA and iceA1 genotypes of H. pylori strains recovered from patients with dyspepsia

Subjects and methods: The study included 113 dyspeptic patients who were exposed to upper gastrointestinal endoscopic examination. Four antral biopsies were obtained from each patient for the analysis of H. pylori infection by rapid urease test and detection of 16S rRNA

Results: Sixty [53.1%] patients were confirmed to be infected with H. pylori. Upon endoscopy, gastritis was revealed in 27 patients [45%] and10 patients [16.7%] had PUD. Of the 60 H. pylori strains, 39 [65%] had at least one virulence gene. Six different genotypic forms were recognized; vacA [9/60], iceA1 [1/60], vacA/cagA [7/60], vacA/iceA1 [13/60], vacA/cagA/iceA1 [8/60] only one of cagA/iceA type and we could not detect cagA. The overall vacA, iceA1and cagA genes identified were 61.6%, 38.8%, 26.6% respectively, by PCR-based molecular testing. The vacA gene status was highly significant related to gastritis patient [P ? 0.036]. The vacA s1m1 and s2m2 alleles were significantly found in 50% of H. pylori infected patients with PUD and with gastritis 57.1% respectively [P

Conclusion: In conclusion, the main genotype combinations in the studied Egyptian patients were; vacAs2m2/iceA1, vacAs1m1/cagA, mostly associated with gastritis, and vacAs1/cagA/icA, mainly in PUD. The less virulent [s2, s2m2] H. pylori genotypes were found in patients aged over 43 years

Use of acupuncture in the management of attention deficit hyperactivity disorder

Background: Our aim was to evaluate the effectiveness of acupuncture therapy as complementary medicine tool in the management of children with Attention Deficit Hyperactivity Disorder

Methods: We performed the study on 50 ADHD patients of any subtype, with EEG and TIQ were done to all patients before the start of acupuncture therapy to exclude epilepsy and mental retardation, Conners Rating Scale was done to all patients before and after acupuncture therapy. Patients were divided into two groups, group [I]: received acupuncture therapy with pharmacotherapy, group [II]: received acupuncture therapy only. The two groups were compared as regard the hyperactivity, impulsivity, and inattention parameters on Conners Rating Scale

Results: Treatment efficacy of acupuncture therapy for ADHD patients using Conner's parent questioner was 88% of the studied group who showed improvement with variable degrees while 12% of the studied group, showed no improvement, all patients below 8 years show improvement [100%], while >8 years [70%] with [p value< 0.001 HS], acupuncture was more effective in the hyperactive /impulsive subtype, the 12 patients showed improvement [100%], followed by combined type 26 patients, with improved 22 [84%], then the inattentive type 12 patients, with improved 10 [83%] with [P value< 0.05 S.]

Conclusion: This cross sectional interventional study provides a scientific evidence for the efficacy of acupuncture therapy in the management of children with Attention Deficit Hyperactivity Disorder. Acupuncture therapy improves the core symptoms of ADHD which are hyperactivity, impulsivity and inattention with efficacy rate up to 88%. Acupuncture therapy provides a successful complementary medicine tool in the management of children with ADHD with a high success rate and safe method free from side effects

Serum procalcitonin in Egyptian patients with acute meningitis and a negative direct cerebrospinal fluid examination

To reduce the morbidity and mortality related to bacterial meningitis, it is important to discriminate bacterial meningitis from aseptic meningitis during the acute phase of the disease, when the clinical symptoms are often similar. To test the reliability of serum procalcitonin [PCT] to discriminate bacterial meningitis from aseptic meningitis in patients who have a negative direct cerebrospinal fluid [CSF] examination, and to evaluate the role of serum PCT to assess treatment efficacy compared with the total leukocyte count [TLC], erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]. Forty patients with suspected acute meningitis and negative gram stains were included, and ten healthy persons were included as controls. According to the clinical examination and the CSF cytochemical analysis and cultures, the patients were divided into bacterial and aseptic groups. The measurements of serum PCT, ESR, CRP and TLC were performed. Patients in the bacterial group had a higher value of serum PCT at admission and at 3 days post-treatment than those in the aseptic group, with a highly significant difference between them. Serum PCT and, to a lesser extent, TLC had prognostic value in patients with acute meningitis, and PCT is more useful because it can be frequently measured for the diagnosis and follow-up of bacterial meningitis.

Protective and Anti-Pathology Effects of Sm Fructose-1,6-Bisphosphate Aldolase-Based DNA Vaccine against Schistosoma mansoni by Changing Route of Injection

This study aimed to evaluate the efficacy of fructose-1,6-bis phosphate aldolase (SMALDO) DNA vaccination against Schistosoma mansoni infection using different routes of injection. The SMALDO has been cloned into the eukaryotic expression vector pcDNA3.1/V5-His TOPO-TA and was used in injecting Swiss albino mice intramuscularly (IM), subcutaneously (SC), or intraperitoneally (IP) (50 microg/mouse). Mice vaccinated with non-recombinant pcDNA3.1 served as controls. Each group was immunized 4 times at weeks 0, 2, 4, and 6. Two weeks after the last booster dose, all mice groups were infected with 80 S. mansoni cercariae via tail immersion. At week 8 post-infection, animals were sacrificed for assessment of parasitological and histopathological parameters. High anti-SMALDO IgG antibody titers were detected in sera of all vaccinated groups (P<0.01) compared to the control group. Both the IP and SC vaccination routes resulted in a significant reduction in worm burden (46.2% and 28.9%, respectively, P<0.01). This was accompanied by a significant reduction in hepatic and intestinal egg counts (41.7% and 40.2%, respectively, P<0.01) in the IP group only. The number of dead eggs was significantly increased in both IP and IM groups (P<0.01). IP vaccination recorded the highest significant reduction in granuloma number and diameter (54.7% and 29.2%, respectively, P<0.01) and significant increase in dead miracidia (P<0.01). In conclusion, changing the injection route of SMALDO DNA vaccination significantly influenced the efficacy of vaccination. SMALDO DNA vaccination via IP route could be a promising protective and anti-pathology vaccine candidate against S. mansoni infection.

effects of different nutritional supplements on experimentally induced osteoporosis in male albino rats: a scanning electron microscopic study

Osteoporosis is one of the major health problems afflicting our modern world, especially disuse osteoporosis. Reduction of mechanical stresses on bone could lead to osteoporosis. To study the role of Ca and vitamins D and K on the prevention of immobilization osteoporosis. The study included 30 adult male albino rats, They were divided into three groups. Group I [the control group] and group II were immobilized by casting their right lower limb for 4 weeks. Group III [the immobilization group that concomitantly received a dietary supplement] was further subdivided into four subgroups; subgroup IIIa was given Ca citrate, subgroup IIIb was given vitamin D [alfacalcidol], subgroup IIIc was given Ca and vitamin D, and subgroup IIId was given vitamin K during the same period of immobilization. The distal ends of the femur of the immobilized limb were taken, processed, and examined using scanning electron microscopy. Morphometric studies were carried out. The results showed significant thinning of both compact and cancellous bone on immobilization. Multiple cavities and cracks and widening of the Haversian canal were detected in the compact bone. Thin irregular spike-like bone traveculae and fracture were also seen in the cancellous bone trabeculae. Administration of either Ca [subgroup IIIa] or vitamin D [subgroup IIIb] with immobilization did not improve most of the previous results. Combined administration of both Ca and vitamin D [subgroup IIIc] improved cortical bone thickness but not the thickness of cancellous bone. Administration of vitamin K [subgroup IIId] with immobilization resulted in extensive branching and anastomosing bone trabeculae in the metaphysic. For the period of this experiment, vitamin K proved to be more effective as a protective agent compared with combined Ca and vitamin D administration in cases of immobilization osteoporosis

Detection of ascitic fluid infections in patients with liver cirrhosis and ascites

Ascitic fluid infections [AFIs] are the frequent complications of advanced liver disease. Bacterial translocation is considered a key step in the pathogenesis of gut-derived bacterial infections; mainly spontaneous bacterial peritonitis [SBP] in cirrhotic patients. Bacterial DNA [bactDNA] in ascitic fluid and serum has been suggested as a surrogate marker for bacterial translocation. We attempted at the isolation and identification of bacteria in ascitic fluid in cirrhotic patients and the assessment of polymerase chain reaction [PCR] in ascitic fluid and serum. Fifty cirrhotic patients having ascites with no signs of infection were included. Ascitic fluid cultures were obtained from patients. Ascitic fluid and serum were subjected to DNA extraction and PCR for the universal amplification of a region of the 16S ribosomal RNA [16S rRNA] gene to detect bactDNA. Bacteria were isolated from 9 [18%] of the ascitic fluid samples, and were mainly Gram-positive bacteria. BactDNA was detected simultaneously in the ascitic fluid and serum of 17 [34%] patients and in the ascitic fluid of only 2 patients. In a single patient with positive ascitic fluid culture no bactDNA was detected in ascitic fluid or serum. By considering AFIs as a positive ascitic fluid culture and/or the presence of bactDNA in the ascitic fluid and/or serum, ascitic fluid culture could detect 9 out of 20 patients with AFIs [45%], PCR of ascitic fluid could detect 19 out of 20 [95%] while PCR of serum could detect 17 out of 20 [85%]. In 10 patients with culture negative non-neutrocytic ascites [CNNNA] bactDNA could be detected in serum and ascitic fluid. AFI can be caused by Gram positive as well as Gram negative organisms. A substantial percentage of cases with CNNNA show bactDNA in serum and ascitic fluid. PCR of ascitic fluid should, therefore, be used in the diagnostic workup of suspected cases of ascitic fluid infections

Macroinvasive papillary thyroid carcinoma presenting as internal jugular vein tumor thrombus

Papillary thyroid carcinoma with massive invasion into the great veins of the neck and mediastinum has rarely been reported and is thought to have a poor prognosis. But multimodal therapeutic approach comprising of surgery, radioiodine and external beam radiotherapy may give best results for patients in whom thyroid cancer is occluding the great veins. Here we report successful management of a case of papillary thyroid carcinoma with extensive invasion into the left internal jugular vein

Comparative study on the effect of vitamin K versus combined Ca and vitamin D administration on the prevention of experimentally-induced osteoporosis in adult male albino rats

Immobilization is one of the important causes of osteoporosis especially after cast application and in the elderly people who might be bedridden or suffering from joint diseases. To compare between the effects of vitamin K and the combined use of Ca and vitamin D on the prevention of experimentally-induced osteoporosis of the femur. This study included 24 adult male albino rats. They were divided into four groups: group 1 [control group], group 2 [immobilization group that were immobilized by casting of their right lower limb for 4 weeks], group 3 [immobilization group that concomitantly received 0.0009 mg/g body weight of vitamin K daily during the casting period], and group 4 [that was given Ca [0.09 mg/g body weight daily] and vitamin D [0.5 micro g/kg alfacalcidol daily] during the casting period]. At the end of the experiment, the distal end of the femur of the immobilized limb was taken, processed, and examined by different histological techniques. A morphometric study was conducted to measure cancellous bone thickness, osteoid thickness, osteoid surface percentage, and the eroded surface percentage. The data were statistically analyzed. It was observed that immobilization caused marked thinning of the cancellous bone trabeculae. Erosion cavities were frequently seen in both compact and cancellous bones. Increased mean eroded surface percentage and decreased mean osteoid thickness and mean osteoid surface percentage were also noticed with immobilization when compared with the control group. Concomitant administration of vitamin K with casting resulted in significant improvement of most of the above-mentioned bone parameters. With combined administration of Ca and vitamin D with immobilization, erosion cavities were still seen in a few areas. Decreased mean cancellous bone thickness was also noticed when compared with groups 1 and 3. According to the results of this experiment, vitamin K proved to be more effective, as a protective agent, than combined Ca and vitamin D administration in cases of immobilization osteoporosis. Level of evidence Level three in vitro [prospective case-control study in vitro]

effects of transformational and transactional leadership style on job satisfaction

Effective leadership plays an important role in the growth and better performance of the organization. Understanding factors that influence job satisfaction is keys to enhancing morale within the profession and creating a secure future to support the demands of the aging population. Nurse' managers are in an outstanding position to influence job satisfaction of nurses. By examining the relationship of perceived leadership styles of nurse managers and job satisfaction of staff nurses, the nursing profession can begin to establish positive, mutually beneficial relationships leading to efficiency, productivity, and job satisfaction. A total of 120 staff nurses [n=120] working in all inpatient unit were chosen and data was collected using two questionnaire "The Multifactor Leadership Questionnaire [M.L.Q.]" and "Job Satisfaction Questionnaire". The results revealed significant difference between head nurses leadership style and nurses job satisfaction. Nurses who perceived head nurses as transactional leaders [TA], who were satisfied more with extrinsic factors. In relation to intrinsic job satisfaction factors, nurses who perceived head nurses as TF leaders revealed with recognition for achievement, the work itself and responsibility and work hours, but for extrinsic job satisfaction factors serealed with supervision and job security. On the other hand, nurses who perceived head nurses as TA leaders were satisfied with intrinsic factors as sense of achievement, except the work itself and responsibility and for extrinsic factor they were Satisfied with Interpersonal relationship. No significant difference was found between their demographic characteristics except nurses' age among nurses who perceived head nurses as transactional leaders. Managerial implications are presented based upon these results

Helicobacter pylori cag pathogenicity island genes among dyspeptic patients with chronic gastritis

The cag pathogenicity island [cagPAI] is one of the major virulence determinants of Helicobacter pylori [H. pylori]. Acquiring virulent strains of H. pylori is associated with increased risk for the development of gastric ulcers or cancer. The aim of this study was to determine H. pylori cagPAI genes pattern among dyspeptic Egyptian patients and its correlation with the varying degrees of the associated chronic gastritis. Histopathological examination, urease test and polymerase chain reaction [PCR] assay were performed for gastric antral biopsies obtained from 106 dyspeptic patients undergoing upper endoscopy. DNA extracts from H. pylori positive cases were analyzed for the presence of cagPAI genes cagA, cagE, cagM, tnpA, tnpB and cagT by using PCR assay. Apparently normal gastric mucosa was seen on endoscopy in 30.2% of dyspeptic patients while gastritis was diagnosed in 69.8% with significant difference [p<0.05]. H.pylori was detected in 71.7% of dyspeptic patients. A strong association was observed between H. pylori infection and gastritis patients [p<0.01]. The positivity rate of any of the cagPAI genes were 65.8% of H. pylori positive cases. Analysis of the entire cagPAI genes revealed that both cagA and cagE were the most predominant genes [30.2% , 18.4% respectively]. cagT and tnpB genes were not detected in all H. pylori positive gastric biopsies. The presence of the entire cagPAI genes was more substantiated in gastritis patients than in those with apparently normal mucosa [p<0.05]. The presence of cagA1/2, cagA3/4, cagM and cagE genes were significantly associated with moderate degree of gastritis [p<0.02], while tnpA gene was mostly detected in marked degree of gastritis [p<0.02]. In conclusion, it can be admitted that infection with virulent strain carrying cag PAI genes may be an indication of the risk of progression of gastric mucosal damage in chronic gastritis patients. In such country as Egypt where there is a high prevalence of H. pylori infection, cagPAI genotyping is important for prediction of the clinical outcome in H. pylori related gastritis aiming at eradication of infection before the progression to severe gastroduodenal diseases

Diagnostic relevance of pyuria in haemodialysis patients [renal tuberculosis as an A etiology of sterile pyuria]

This study was designed to assess the significance of pyuria as a marker of urinary tract infections [UTIs] in haemodialysis patients and renal tuberculosis as a common a etiology of sterile pyuria. The study was conducted on 50 patients with end stage renal disease [ESRD] on regular haemodialysis [group I], as well as 10 healthy controls [group II]. Fresh urine samples were cultured, examined microscopically for pyuria and tested by Bayer reagent strips for protein, blood, nitrite and leucocyte esterase [LE]. Gram stain of colonies and their identification to the species level using API 20 E system were performed. Ziehl-Neelson [ZN] staining for acid alcohol fast bacilli and Polymerase chain reaction [PCR] for detection of Mycobacterium tuberculosis [MTB] DNA were performed on 24 hours collected urine samples. All patients had pyuria [>/= 5 WBCs/hpf]. Protein, blood, LE and nitrite were significantly higher in patients than in controls [P value <0.01, <0.01, <0.001 and <0.05 respectively]. A significant correlation was found between patients' symptoms and bacterial growth [p<0.1]. Thirty one patients had sterile pyuria; three out of them [10%] were proved to be tuberculous by ZN or PCR. To conclude, pyuria is a common finding in haemodialysis patients and is proved to be a valuable parameter of UTIs in these patients. In symptomatic patients with sterile pyuria, renal tuberculosis should be excluded by ZN staining and/or PCR. In asymptomatic patients, periodic urine culture should be performed to confirm presence or absence of UTIs

Performance characteristics of different assays for detection of CMV infections in patients with cancer bladder

Recent epidemiological studies have implicated Cytomegalovirus [CMV] infection in the etiology of cancer bladder. The present study was designed to estimate the performance characteristics of different assays, used for identification of CMV infection in schistosomal patients. The study was conducted on sixty cancer bladder patients; thirty five with schistosomiasis [group I] and twenty five without [group II], and twenty control subjects were included [group III]. PCR technique for detection of CMV DNA was performed on bladder tissue, serum, buffy coat and urine. ELISA for detection of IgG and IgM in sera and Antigenemia test and electron miscroscopic studies [EMS] on buffy coat were performed. CMV DNA was significantly detected in group I versus group II by PCR on bladder tissue, buffy coat, and serum respectively. None of the urine samples were positive for CMV DNA. The results of different assays were evaluated in relation to PCR results on tissue biopsies. Antigenemia test showed significant difference between group I versus group II. The EMS was found to increase the sensitivity of PCR on bladder tissue. Both PCR on serum and antigenemia test showed similar sensitivity of 56%, but a specificity of 100% and 81% respectively. In conclusion, the significant association of CMV infection with cancer bladder in Egyptian patients, suggest that the virus may be implicated in the development of such malignant transformation especially in cases with schistosomal affection. Both pp65 antigenemia assay and PCR on serum are two major assays available for diagnosis and monitoring of CMV infections. The EMS could increase the sensitivity and accuracy of PCR on bladder tissue and on buffy coat. Further investigation on a larger number of patients are required in immunodeficient schistosomal cancer bladder patients in order to clarify the role played by CMV in bladder cancer

Human papilloma virus DNA and p53 protein expression among Egyptian patients with urinary bladder cancer in relation to schistosomiasis and clinicopathologic outcome

Several studies have demonstrated an association between human papilloma virus [HPV] infection and urological malignancies. Inactivation of p53 tumor suppressor gene is a common genetic change in human cancers. Since proper understanding of the natural history of bladder cancer and significant prognostic factors is critical for management of this disease, we aimed to study the role of HPV16, 18 types and p53 protein expression among 72 Egyptian patients with bladder cancer in relation to schistosomiasis and clinicopathological parameters. Polymerase Chain Reaction assay [PCR] was used for detection and typing of HPV-DNA in bladder tissue biopsies where as p53 protein over expression was detected by immunohistochemistry. Results revealed that 36.1% of bladder tumors were schistosomiasis-associated, while 69.4% and 78.6% were significantly related to transitional cell carcinoma [TCC] and low grade tumor respectively. HPV16, 18 DNA types were detected in 41.7%, the majority of which [66.6%] was of type-16. p53 protein expression and its coexistence with HPV DNA-types was detected in 66.7% and 38.9% of tumors respectively. Although p53 protein expression had no statistically significant relation to schistosomiasis, the presence of HPV DNA or its coexistence with p53 showed statistically significant relation. In pre-malignant lesions, positive HPV DNA incorporation and p53 expression were detected in 20% and 12.5% respectively. Fair correlation was recorded between the presence of HPV DNA-types and p53 expression [kappa coefficient = 0.421]. Significant marked expression of p53 was detected in 92.9% of HPV DNA positive cases. There was no significant association between tumor recurrence and HPV DNA positivity. It is worth mentioning that marked expression of p53 was significantly associated with recurrent tumors [85.7%]. In conclusion, both HPV infection and p53 protein expression could contribute to schistosomal bladder carcinogenesis in an independent way. Over expression of p53 could play a role as an indication for high risk HPV infection or for tumor recurrence tendency. We suggest screening of patients with schistosomiasis for high risk HPV-16 and HPV-18, as they will need more strict treatment modalities and follow up besides, monitoring of their response to therapy. Further data are needed to study the relation between HPV and the reduction in cancer-specific survival, which is the ultimate goal of screening

Inducible nitric oxide synthase expression in helicobacter pylori CagA+ strains infections

Increased expression of inducible nitric oxide synthase [iNOS] has been observed in patients with chronic inflammatory diseases of the gastrointestinal tract leading to sustained production of nitric oxide [NO] which may induce DNA damage. Since Helicobacter pylori [H. pylori] infection produces a state of chronic immunostimmulation in the gastric epithelium and a causal relationship between H. pylori CagA+ strains infection and gastric cancer has been suggested, therefore, our aim was to evaluate the significance of iNOS expression in gastric lesions induced by H. pylori CagA+ strains with correlation to the encountered endoscopic and pathological diagnoses. Eighty four dyspeptic patients underwent endoscopic examination. Four antral gastric biopsies were obtained for detection of H. pylori by histopathological assessment [Giemsa staining], urease test and gene expression of H. pylori using PCR assay. Immunohistochemical staining for iNOS expression and quantitative detection of anti-CagA antibodies were performed. It was found that H. pylori infection was detected in 64.3%, CagA seropositivity in 54.8% and iNOS expression in 61.9%. Anti-CagA antibodies seropositivity and iNOS immunoexpression were significantly related to H. pylori infection. The positive rates of iNOS immunostaining increased with the lesion progression from chronic superficial gastritis to chronic atrophic gastritis to intestinal metaplasia [45.2%, 87.5% and 92.8% respectively]. Positive immunostaining rates of iNOS correlated significantly with H.pylori Cag A seropositivity with respect to both endoscopic and pathologic diagnoses. In conclusion, CagA+ H. pylori strains are associated with enhanced immunoexpression of iNOS in H. pylori-related gastric diseases, therefore they might contribute as risk cofactors that conduces to gastric carcinogenesis. Given the high prevalence of H. pylori gastric diseases and frequent performance level of endoscopic gastric examinations among Egyptian patients, prompt identification of gastric infections caused by H. pylori harboring Cag A virulence factor is necessary for the early eradication of infection before the development of pre-neoplastic lesions

SEN virus infection in Egyptian chronic hepatitis C and haemodialysis patients

SEN virus [SENV] has been tentatively linked to transfusion-associated non A-E hepatitis. The aim of the present study was to determine the prevalence of SENV among Egyptian patients with HCV-related chronic liver disease [CLD] and haemodialysis [HD] patients and to assess the clinical effect of SENV infection on coexistent hepatitis C either in the severity or the probability of developing hepatocellular carcinoma [HCC]. Polymerase chain reaction [PCR] was used to detect SENV-D and SENV-H DNA in serum samples of 74 HCV-related CLD patients, 45 uraemic patients on maintenance HD and 28 healthy controls. SENV DNA was detected in 13.5%, 11.1%, and 7.1% of CLD, HD patients and healthy controls respectively with no significant differences between patients and control group. No statistically significant differences were demonstrated between SENV infected and non infected CLD or haemodialysis patients regarding the clinical and biochemical parameters. SENV infection was significantly higher in CLD patients with HCC [33.3%] than without [8.5%] [p<0.05]. In conclusion, SENV does not seem to be a common infection in Egyptian patients. It has no apparent influence on the severity of co-existent HCV related CLD but it could be a risk factor for developing HCC in these patients. Further studies are needed to define the aetiopathogenic role of SENV infection in HCC development

case of amniotic fluid embolism successfully resuscitated

We reported a case of 38 years old woman who is presented for elective cesarean section [CS] with previous history of 3CS. After induction of anaesthesia, CS was started and immediately after delivery of baby, patient developed hypotension, cyanosis and cardiac arrest. Cardiopulmonary resuscitation measures started and patient responded after 3 attempts. During resuscitation patient started to bleed and diagnosed as disseminated intravascular coagulopathy [DIC]. Resuscitation was performed by appropriate blood products and inotropes was given. After haemodynamic stabilization and abdominal closure patient was transformed to ICU and IPPV was done. Acute respiratory distress syndrome [ARDs] was evident radiologically, clinically and by ABGs. Ventilator parameters were adjusted and patients weaned on the 4th ICU day at that time neurological evaluation revealed right sided hemiplegia and aphasia. Physiotherapy started and patient showed improvement and walked before discharge from hospital

Rupture of splenic artery aneurysm during labor: a case report of maternal and fetal survival

To report a case of splenic artery aneurysm that ruptured during labor with both maternal and fetal survival. Clinical Presentation and Intervention: A 33-year-old primigravida at 42 weeks of gestation was admitted to Adan Hospital for induction of labor. Three days after induction, the patient suddenly collapsed and was found to be hypotensive. Abruptio placentae was mistakenly diagnosed, despite the absence of vaginal bleeding, and the patient was immediately taken to the operating room for emergency cesarean section. A female infant was delivered without any evidence of abruptio placentae but with 2,000 ml blood noted in the abdominal cavity. A vertical midline incision was performed and a ruptured splenic artery aneurysm was found. Proximal ligation of the splenic artery was performed followed by splenectomy. Both mother and newborn did well and were discharged on the 7th postoperative day. This case illustrates the need to consider ruptured splenic artery aneurysm as part of differential diagnosis of hemoperitoneum in pregnant women. Immediate surgical intervention is needed to ensure survival of both mother and fetus.