Urothelial carcinoma of the urinary bladder mixed with squamous differentiation or squamous cell carcinoma in areas with schistosomiasis is showing high risk of recurrence and poor survival

In schistosomiasis haematobium areas endemic, bladder cancer is the first cause of malignancy in men and fourth in women. The chronic schistosomiasis would lead to variant histologic patterns which manifest in squamous cell carcinoma [SCC] or squamous differentiation [SqD]. This study evaluated the clinical outcome after radical cystectomy [RC] in patients with urothe-lial carcinoma [UC] mixed with SCC or SqD, Comparison was done with two arms of pure UC and pure SCC, indication for RC was muscle-invasive-disease, and evaluation included recurrence, metastases, and overall survival. The data of patients treated with RC for muscle-invasive-disease, selection was revised for 127 patients with urothelial carcinoma mixed with SCC/SqD, two comparative arms were 100 patients with pure UC, and 100 patients had pure SCC. Follow up was on 8 months, Syears, and 5 years to detect recurrence, metastasis, and overall survival in the three groupsThe results showed that by comparison of disease aggressiveness in the three groups regarding recurrence, metastasis, and overall survival was analysed. Overall survival with mixed tumours was significantly lower than pure UC or SCC, recurrence and metastases were higher in mixed tumour which was an independent factor for poor prognosis and low survival

Production of antigenic recombinant cholera toxin subunit B.

Cholera is a major public health problem confronting developing countries, where outbreaks occur in a regular seasonal pattern and are particularly associated with poverty and poor sanitation. Primer set was designed to flank binding region of cholera toxin subunit B [ctxB] gene that was amplified using PCR. PCR products were purified using gel purification technique. Cholera ctxB gene was cloned into cloning vector. Stop codons contained in the insert were deleted and then the insert was subcloned into pQE expression vector. Cloned vectors were subjected to DNA sequence analysis. Small-scale culture was done for preparative rCTB production and purification. Mice were immunized with purified rCTB to test ability of rCTB to elicit antibody production. Primer set showed the ability to detect and excise ctxb gene successfully form cholera genomic DNA by PCR. After deleting the stop codons, sequence analysis revealed that the insert was in open reading frame with start codon of the vector. Small bacterial cultures revealed the presence of specific band at approximately 12-125 Kda in induced culture. rCTB was able to elicit specific antibody production after animal immunization

Antigenic potential of whole cell-recombinant cholera toxin subunit B [WC-CTB] preparation

Colonisation of the small intestine by V. cholerae, a typical non-invasive pathogen, is an important early step in the pathogenesis of cholera. In the present study, trial to make cholera whole-cell vaccine with addition of recombinant B subunit of cholera toxin [rCTB] was-done. Cholera chB gene was cloned into pQE expression vector. Large-scale culture was done for preparative rCTB production and purification. Commercial CTB from V. cholerae was used for induction of polyclonal anti-CTB antibodies in mice. These polyclonal antibodies were used to test the antigenicity and identity of rCTB. Cholera whole-cell vaccine was prepared by resuspending equal volumes of dead Inaba and Ogawa vaccine strains in PBS. Orochol E Berna was used as control vaccine. Mice were divided into 4 groups [20 mice each]; group 1 [G1]: control unimmunised, group 2 [62]: rCTB immunized, group 3 [G3]: rCTB + killed Inaba and Ogawa immunised, and group 4 [G4]: Orochol immunized. Sera and faeces from all groups were collected and used in evaluation of anti-rCTB antibody levels. The spleens of animals were aseptically removed and used in lymphoproliferative assay. Small bacterial cultures revealed the presence of specific band at approximately 12-12.5 KDa in induced culture. Anti-commercial CTB antibodies were successfully prepared and used in Western blot analysis and verified the presence and antigenicity of rCTB. Large scale production and purification of rCTB resulted in 12.9 mg protein. Both serum and secretory antibody level in mice of G2 was significantly less than in mice of both G3 and G4. G3 was significantly higher than 62, while there was no significant difference between G3 and G4. G4 was significantly higher than G2, while there was no significant difference between G4 and G3. Stimulation index of splenic cells in G 1 was not significantly different from that of G2, while it was significantly lower than GB and G4. SI of G2 was significantly lower than G3 and G4. G3 was significantly higher than G1, G2, and G4. G4 was significantly higher than 01 and 02, but it was significantly lower than G3. The results in this study showed the ability of rCT B to induce immune responses in the presence of cholera bacteria more than if used alone. The inclusion of rCTB in addition to vibrios, increased systemic, intestinal, and cellular responses. Depending on previous studies, adding any new cholera strain which are present or will appear in future is possible. In addition, other vaccines [either killed bacteria or vaccine subunit] can be added to the formula indicated in this study

role of nasopharyngeal continuos positive airway pressure [NP-PAP] in the successful early weaning following extubation in low birth weight infants [LBW] on mechanical ventilation

Using two methods for early extubation, 52 babies, suffering from respiratory distress syndrome, were randomly selected to post- extubation headbox or postextubation nasopharyngeal continuous positive airway pressure [NP-CPAP]. All infants were suffering from respiratory distress and weight less than 2000 g, had a gestational age of less than 36 weeks, and had been weaning from mechanical ventilation within 7 days of life. The criteria for extubation included stable condition, fraction of inspired oxygen [FIO2] of <35%, peak inspiratory pressure [PIP] of <15 cm H2O and ventilator rate of 6/minute. The individual successful extubation rate of post- extubation in the NP-CPAP group and the post-extubation headbox group were 85% [22/27] and 48% [12/25], respectively. There were no significant differences in clinical characteristics between the two groups. Results suggested that application of NP-CPAP to a preset protocol for extubation can achieve a better success rate of early extubation in low birth weight [LBW] infants weaning from mechanical ventilation

Body temperature gradients in childhood shock states

This study was carried out on 30 infants and children [excluding new- borns], suffering from either peripheral circulatory insufficiency states or frank shock who were admitted to the New Children Hospital of Cairo University. The study spotlighted the value of the intimate relationship between peripheral circulatory perfusion and body temperature gradients; the gradient between deep [core] and peripheral [sole/skin] temperature. The more the severity of peripheral circulatory insufficiency, the greater the temperature gradient. The study showed that temperature gradient more than 5C is suspicious of circulatory insufficiency but more than 6C is a sure sign of frank shock which also correlated well to skin temperature of the limbs towards the trunk; the more the peripheral circulatory insufficiency the cooler the skin temperature by hand palpation. Hence, estimation of temperature gradients in shock states is a simple noninvasive, rapid, bed side easily repeatable for the diagnosis and follow up of therapy of shock without the need of invasive techniques as central venous pressure or pulmonary wedge pressure. So, it is recommended to determine the temperature gradient as a routine test in critically ill children especially those prone to develop shock

Minimal acceptable CPAP levels for tracheal extubation in newborn infants

The study showed that PaO2 [arterial oxygen tension] at 2 to 3 cm water [H2O] was nearly the same as observed following extubation, but was significantly lower at ZEEP; there was no significant change in PaCO2 [partial CO2 tension] or arterial pH when CPAP was discontinued or following extubation, hence tracheal extubation of newborn infants at the end of weaning of mechanical ventilation should be done at 2-3 cm H2O and not at ZEEP to prevent the reoccurrence of hypoxemia after extubation, this minimizing oxygen needs after extubation and preventing the hazards of high oxygen concentration

Obstructive uropathy as a cause of renal failure in paediatric care unit in Egypt

Out of 245 infants and children admitted to the Pediatric Intensive Care Unit at the New Cairo University Children's Hospital because of renal failure, 40 [16.3%] cases were identified as having obstructive uropathy. They were 32 males and 8 females ranging in age from 20 days to 13 years which indicates a great delay in recognition of the obstructive uropathy in the majority of cases. Diagnosis of obstructive uropathy, its cause and site was based on sonographic scanning, plain x-ray abdomen, intravenous pyelography [when clinically indicated], ascending cysto-urethrogram, urinalysis and blood chemistry. The different causes of obstruction were: urinary lithiasis [23 cases, 27.5%] posterior urethral valves [6 cases, 15%], bladder neck obstruction [2 cases, 5%], bilateral ureteric stricture [2 cases, 5%], pelviureteric junction obstruction [1 case, 2.5%], narrow ureteric orifices [1 case, 2.5%] and huge hydrocolpos obstructing both ureters [1 case, 2.5%]. Twenty-two [55%] patients were discharged with complete recovery of their renal function, 9 cases [22.5%] were discharged with chronic renal failure and 9 cases [22.5%] died. Our findings stress the importance of obstructive uropathy as a cause of renal failure in pediatric patients and confirm the value of ultrasound as an excellent screening procedure in such patients