Chemo-typing of Three Egyptian Rosemary Oil for Their Chemical Composition and Anti-oxidant Activity

Aims:To study the chemical composition of volatile oil samples from different place in Egypt (Mansoura, Gamsa and Assuit) and study their antioxidant activity determined by DPPH assay.Study Design: Hydro distillation of volatile oil samples and theirGC/MS analysis and determination of their antioxidant activity by DPPH assay.Place and Duration of Study:Department of Pharmacognosy, Faculty of pharmacy, Mansoura university, Egypt, between June 2015 and November 2017.Methodology:The essential oil was isolated by hydro-distillation for 5 h using a Clevenger-type all-glass apparatus according to the standard procedure of the European pharmacopeia and volatile oils analysis was performed by GC and GC-MS. GC analysis was carried out using Focus-DSQ-ӀI GC/MS instrument (Thermo Scientific, MA, USA) equipped with TR-5 fused silica column (30 m × 0.25 mm, film thickness 0.25 μm).Results: The yield of the essential oils of three rosemary plants growing in Mansoura (RM), Gamsa (RG) and Assiut (RA) were 0.20% v/w, 0.32% v/w and 0.24% v/w, respectively. Their chemical composition was analyzed by GC/MS, RM and RG were found to be α-pinene dominated chemotypes, 32.4% and 29.6%, respectively, meanwhile RA was camphor dominated chemotype (17.2%). Furthermore, their antioxidant activity was determined by DPPH assay. Their IC50 values of essential oils of RM, RG and RA were 8.66 ± 0.7, 8.18 ± 0.5 and 9.74 ± 0.2, respectively.Conclusion:The GC/MS spectral data revealed the considerable difference between the chemical composition of essential oil constituents of RM, RG and RA which lead to different chemotypes. The present results also demonstrate that REO obtained from different areas inEgypt exhibited free radical scavenging activity determined by DPPH assay due to the synergistic effect between their constituents.

Impact of HCV Genome Structure on Responder to Pegylated Interferon Therapy in Egyptian Patients

This study aimed to investigate relationship of the HCV genome structure and treatment with Pegylated Interferonα/Ribavirin (peg-IFNα/RBV) Egyptian patient. Mutations in two sites of HCV genome; the internal ribosome entry site(IRES) and the interferon sensitivity determining region (ISDR) of HCV genotype 4a were studied in details including DNAsequences and mutations detection in response to treatment. Ninety patients, responders and non-responders, to treatmentwith peg-IFN α /RBV were included in this study. IRES and ISDR regions were amplified by RT-PCR using specific designedprimers, and amplified regions were sequenced. The data obtained were aligned with published sequences in GenBank usingBLAST program. Results of this study have revealed that there are different mutations in the studied sequences in both ISDRand IRES regions. The predicted amino acids sequences in the ISDR region showed significant differences ranging from oneup to more than eight mutations in the HCV Genome sequences. Although there was a significant difference betweensequences of HCV RNA isolated from responders and non-responders, these data were not able to give an absolute answerwhether response to interferon therapy is directly/relates to the structure of the HCV genome

Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection

PURPOSE: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). METHODS: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. RESULTS: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. CONCLUSION: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

Pubertal development and gonadotrophic hormones among girls with type 1 diabetes mellitus

Background: As a chronic disease occurring in childhood, type 1 diabetes is a factor potentially affecting the pubertal development, including age at menarche

Aim of study: To investigate the effect of type 1 diabetes on pubertal development among adolescents; and to investigate their gonadotrophic hormonal profile

Subjects and Methods: Nineteen Egyptian girls aged [13.8- 21.6] years were recruited into the study. Assessment of Pubertal development according to Marshall and Tanner [1969] was performed; and age at menarche was evaluated. Auxological assessment [weight, height, and body mass index] were performed. Laboratory investigations were done, including HbAlc levels and Hormone assays [basal and post stimulation levels]: Serum follicle- stimulating hormone [FSH], luteinizing hormone [LH], and LH/ FSH ratio was calculated

Intervention: Girls underwent GnRH- analogue test with triptorelin [0.1 mg] administered subcutaneously

Results: The mean age at menarche [13.24+ 1.25] yrs, among the 17 [89.5%] postmenarcheal T1DM girls, showed no significant difference [P>0.05] from the normal population; but still 2 [10.5%] girls did not achieve menarche until after the study period was terminated. Moreover, there was a highly significant delay [P< 0.01] in their attainment of adult sexual maturity Tanner stage V [B5, PH5]. Only 3 [15.8%] T1DM girls, had achieved optimal metabolic control, at [< 7.5%], while the remaining 16 [84.2%] had a statistically significant insufficient metabolic control [9.93+ 1.96] [P<0.00]. Also it was found that basal and stimulated LH and FSH levels were significantly decreased in T1DM girls [P<0.000]

Conclusion: Type 1 diabetes could affect pubertal development of girls, in the form of delay in their attainment of adult sexual maturity stages, Tanner Breast stage [B5] and Tanner Pubic Hair development [PH5]; however, their age at menarche, is within the range of normal Egyptian girls. The disease could alter their growth development, with a decrease in their height than the normal population. LH and FSH were significantly decreased than normal reference ranges

Chronic diseases and outcome in critically ill elderly admitted to ICU

Background: Elderly patients are a significant and increasing proportion of ICU patients. With advancing age, the comorbidities critically ill elderly patients have substantial mortality. The early recognition of patients at high risk of mortality is needed to plan care in advance and to control healthcare costs

Aim: To find out the relation between chronic diseases and outcome in critically ill elderly admitted to ICU

Study design: A prospective study

Participants: seventy elderly patients aged 60 years and above

Method: This study was performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill elderly patients admitted for 24 hours or more. Each patient was subjected to on admission clinical assessment including detailed history taking, in addition to laboratory investigations

Results: The results of our study showed that ischemic heart disease was the only chronic diseases that had significant statistical effect on mortality in critically ill elderly admitted to ICU with p. value= 0.002

Conclusion: In the current study we found that mortality was associated with history of ischemic heart disease

Cardioprotective and antioxidant effects of oleogum resin "Olibanum" from Bos Boswellia carteri Birdw. (Bursearceae) / 中国天然药物

One of the leading causes of death worldwide is cardiovascular disease, hence searching for a cure is an important endeavor. The totally safe, edible, and inexpensive Boswellia plant exudate, known as olibanum or frankincense, is considered to possess diverse medicinal values in traditional medicine and from recent biological studies. Investigating the cardioprotective and antioxidant activities of olibanum from a Boswellia species, family Bursearaceae, namely Boswellia carteri Birdw. was the aim of this study. Cardioprotective activity was evaluated using a model of myocardial infarction induced by isoprenaline (ISO), while antioxidant activity was tested adopting nitric oxide scavenging (NOS) and azino-bis-3-ethyl benzthiazoline-6-sulfonic acid (ABTS) assays. The results revealed a mild cardioprotective effect and weak antioxidant activity.

Limited excision and primary closure for pilonidal sinus

Pilonidal disease is a common disorder of the sacrococcygeal region. Various techniques have been used but no method provides the ideal treatment. This study was done to establish to what degree pilonidal sinus could be treated with limited excision and primary closure. 39 patients with chronic pilonidal sinus were treated by limited excision and primary closure between July 2005 and January 2008 by the authors at general surgery department Mansoura University Hospital. They were followed up in the early postoperative period and thereafter for 12 to 30 months. One patient had mild seroma, another one developed irregular scar with accepted healing outcome. All patients were discharged from hospital in the 2nd postoperative day. Operative wounds healed in a period ranged from 12-22 days. The postoperative follow-up now ranges from 12 to 30 months, and no recurrences have been recorded so far. Limited excision of Pilonidal Sinus represents a good therapeutic option for treatment of pilonidal sinus This method has the advantages of having a low morbidity, short hospital stay, early return to work, no recurrence and good long-term results

Rubber band ligation for 550 patients of symptomatic haemorrhoids out of 2200 patients retrospective study

This retrospective study was conducted to elucidate the results of the treatment for symptomatic haemorrhoids using rubber band ligation [RBL] method. Method: a retrospective study for 550 patients who came to the colorectal unit from June 1998 to June 2006, data was retrieved from archived files. Forty four patients with haemorrhoid had liver cirrhosis.RBL was performed using the Mc Gown applicator on an outpatients basis. The patients were asked to return to out-patient clinic for follow up at 2 week, 1, 6, months and through telephone call every 6 month for 2 years]. After RBL 496 patients [90.18%] were cured with no difference in outcome for first, second or third degree haemorrhoids [P value = 0.31]. symptomatic recurrence was detected in 16.03% after 2 years then repeated RBL or surgery were done for them. A total of 88 patients [16%] had 155 complications from RBL which required no hospitalization. Complications were registered; pain in 10.37%, rectal bleeding in 8.36% and vaso-vagal symptoms in 7.81%. RBL is a safe and successful method for treating symptomatic haemorrhoids, even in cirrhotic patients

Comparative study between biofeedback retraining and botulinum neurotoxin in treatment of anismus patients

Anismus is a significant cause of chronic constipation. This study came to revive the results of biofeedback BFB retraining and botulinum toxin A BTX- A injection in treatment of anismus patients. Forty eight patients with history of constipation underwent anorectal manometry, balloon expulsion, defecography, and electromyography. All patients had a non relaxing puoborectalis muscle. The patients were randomized into 2 groups. Group I patients receive biofeedback, two times per week for one month. Group II patients were injected with BTX- A. Follow up was conducted weekly in the first month then monthly for one year. In BFB training group 3 patients quite before the end of sessions with no improvement, initial improvement was recorded in 12 patients [50%] while long term success was recorded in 6 patients [25%]. In BTX-A group, initial improvement recorded in 17 patients [70.83%] with long term improvement in 8 patients [33.3%] There is a significant difference between BTX-A group and BFB group as regarding the initial success, but this significant difference disappeared at the end of follow up. Biofeedback retraining has therapeutic effect on patients suffering from anismus also, BTX-A injection is successful for temporary treatment of anismus and need repeated injection. Initial improvement is better after BTX-A injection

Trans-perineal VS. trans-rectal repair of rectocele in obstructed defecation: a prospective randomized trial

To evaluate functional outcome of transperineal [TP] versus transrectal [TR] repair of rectocele presented with obstructed defecation. 48 multiparous females with obstructed defecation due to rectocele were randomly allocated into 3 groups: Group A [16 patients]: TP repair with levatorplasty [LP].Group B [16]: TP repair without LP.Group C [16]: TR repair. The study included defecographic assessment, anal manometry / /[Maximum anal resting pressure [MARP], maximum reflex volume [MRV] and urge to defecate volume [UTDV] and functional score [0 -26]. These were done preoperative and 6 months postoperative. Defecography showed significant reduction in size of rectocele in all groups. Constipation improved significantly in the groups of transperineal but not in transrectal repair. We had significant reduction in MARP, UTDV and MRV only in transperineal approach. Functional score was significantly improved in group A [P<0.001] and B [P<0.001] while the improvement was insignificant in group C. LP significantly improved the overall functional score in group A compared to group B and C [P= 0.032] Rectocele repair improves anorectal function by improving the rectal urge sensitivity. TP repair of rectocele is superior to TR repair in both the structural and functional outcome. Levatorplasty improves functional outcome, but should be avoided in young sexually active females

Proximally based versus distally based gluteus muscle flap in treatment of end stage fecal incontinence

To compare proximally based versus distally based gluteus maximus muscle flap transposition in patients with end stage fecal incontinence. Between August 2005 and August 2007, this prospective randomized study was performed on twenty patients with an end stage anal incontinence. They were sixteen men and four women with an age ranging from 7 to 31 years. A proximally based gluteus maximus flap [group III] was carried out in ten patients while, a distally based flap [group I] was done in the other ten. Patients were followed up for 6 - 18 months both subjectively and objectively with evaluation of their incontinence score, anorectal manometry, saline enema test and magnetic resonance imaging [MRI]. Overall, 6/10 patients [60%] in group I and 8/10 patients [80%] in group II were clinically improved with down staging of their incontinence scores from C3 to 0 [P 0.003 and 0.0001 respectively]. This was confirmed by the significant changes in anorectal manometry and saline enema test. MRI done one month postoperatively showed disruption in three patients. Proximally based gluteoplasty appears to be an excellent encirclement procedure that restores voluntary squeeze pressure as well as rectal sensation when compared with unilateral distally based gluteoplasty

Comparative study between botulinium toxin injection and partial division of puborectalis for treating anismus

To compare the results of partial division of puborectalis [PDPR] versus local botulinium toxin [BTX-A] injection in treating patients with anismus. This prospective randomized study included 30 male patients with a mean age 38.93 +/- 12.39 years and a mean duration of 5.80 +/- 3.96 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into: Group [I]: included 15 patients injected with BTX-A, and Group [II]: included 15 patients who underwent bilateral PDPR. Follow up was conducted for one year. Both BTX-A and PDPR significantly reduced the preoperative constipation scores. The initial and long term success rates were 86.7% and 40% in BTX-A group versus 100% and 66.6% in PDPR group. Recurrence was observed in 7 patients [53.8%] and 5 patients [33.4%] following BTX-A and PDPR respectively. Minor incontinence had occurred in 2 patients [13.3%] following PDPR. BTX-A injection seems to be successful for temporary treatment of anismus. However, PDPR has been found to be a promising method for treatment of anismus with a relatively lower morbidity in relation to its higher success rate

Comparative study between open vs closed methods of partial division of puborectalis in treating patients with anismus

To revive the results of partial division of the puborectalis and to compare the efficacy of open and a newly designed closed method in treatment of anismus. This prospective randomized study included 30 patients. They were 29 males and one female, with a mean age 42.30 +/- 13.01 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into: Group [I]: included 15 patients who underwent bilateral open division of the puborectalis and group [II]: included 15 patients who underwent bilateral closed method. Follow up was conducted for about one year. Improvement was considered when patients returned to their normal habits. Both open and closed methods significantly reduced the preoperative constipation scores. There was 100% initial success. Long term success existed only in 66.6% and 53.3% in group [I] and [II] respectively with no significant difference between the two methods [chi 2:0.556-P: 0.456]. Recurrence was observed in 5 and 7 patients following open and closed methods respectively. Minor degrees of incontinence were confronted in 13.3% in each group with no significant difference. Bilateral partial; division of puborectalis was found to be an effective method in treatment of anismus. Moreover, closed method seems to be simple and attractive

Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study

Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy [LC] feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy [OC] versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group [55 patients] and LC group [55 patients]. There was no operative mortatity. In LC group 4[7.33%] patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group [96.13+17.35m vs. 76.13+15.12] P<0.05, associated with significantly higher intraoperative bleeding in OC group [P<0.01], necessitatating blood transfusions to 7 [12.72%] patients in OC group. The time to resume diet was 18.36+8.18h in LC group which significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group [6+1.74 days vs. 1.87+1.11 days] P<0.01 with low postoperative morbidity. LC in cirrhotic is still complicated and highly difficult which associates with significant morbidity compared with that pf patients without cirrhosis. However, it offers lower morbidity, shorter operative time, early resume dieting with less need for blood transfusion and reducing hospital stay than OC.

Effect of helicobacter pylori eradication on ulcer healing and recurrence after simple closure of perforated duodenal ulcer

Helicobacter pylori [H.Pylori] plays a fundamental role in the causation of duodenal ulcer. This study was conducted to elucidate the prevalence of H.Pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H.Pylori prevent ulcer recurrence following simple repair of the perforation. Eighty three patients admitted with perforated duodenal ulcer, only seventy seven patients treated with simple closure included in our study. Sixty five patients [84.4%] who had H.Pylori infection were randomly divided into triple therapy group [34 patients] and alone group [31patients]. Follow up endoscopy was performed at 8 w, 16 w and 1 year to show the ulcer healing and determine H.Pylori. The eradication of H.Pylori was significantly higher in triple therapy group than omeprazole alone group [at 8 weeks 91.2% vs. 22.6% respectively]. Initial healing of ulcer was significantly better in eradication group and after one year the difference in ulcer recurrence between the two groups was statistically significant [2[6.1%] in eradication group vs. 8 [29.6%] in omeprazole alone group P=0.001]. H.Pylori was present at a high ratio in patients with duodenal ulcer perforation. Eradication of H.Pylori after simple closure of a perforated duodenal ulcer reduces the incidence of recurrence ulcer

Isolation of aeromonas species from diarrheal patients in Ismailia Governorate

In order to know the prevalence of Aeromonas species as a causative agent of diarrhea in Ismailia, three hundred and fifty stool samples and rectal swabs were collected from infants and children under the age of 5 years visiting El Kilo 11 Clinic suffering from acute diarrhea in the period from May 2004 to September 2004. Stool samples were collected from control group of fifty healthy infants and children of matched age and sex. It was found that 29 diarrheal samples were positive for Aeromonas species with prevalence of 8.28%. None of control samples were positive for Aeromonas. In most cases it was found that the infection is water or food borne. Aeromonas strains show high degree of antibiotic susceptibility

Early oral feeding versus delayed oral feeding in patients undergoing intestinal resection

Aim: This study was conducted to evaluate early oral feeding versus delayed feeding after intestinal resection

Methods: In the period from June 2005 to September 2006 this study included 240 patients who underwent intestinal resection either elective or emergency, they were randomized into two groups. Group [A] included 120 patients with early oral feeding and group [B] with delayed oral feeding. Patients were followed lip for a period of 3-12 months

Results: Twenty four [20%] patients in group [A] had leakage versus 28 [23.3%] in [B], [p0.531]. Sixteen [13.3%] patients were explored in group [A] versus 18 [15%] in [B], [p= 0.711]. In group [A] 15 [12.5%] patients had local complications versus 14 [11.3%] in [B], this was not of statistical significance. Hospital stay was significantly shorter in group A than [B] with mean stay of [2.5 + 1.7] versus [9.93 + 2.60] days respectively. General complications were less frequent in group [A] versus [B] with more patient satisfaction and early return to work, but readmissions were more frequent among group [A] [5 versus 2]. Regarding mortality 9 [7.5%] patients died in group [A] versus 8 [6.6%] in [B], [p= 0.333]

Conclusion: Early oral feeding after intestinal resection is well tolerated and safe with better outcome

Evolution of colorectal cancer in schistosomiasis

Aim: To define the clinico-pathologic character of schistosomiasis mansoni associated colorectal cancer [S.CRC] and the possible carcinogenic relation of Schistosoma mansoni [S.M]

Methods: This study included 176 patients with colorectal cancer associated with S.M. Their clinical database and surgical pathology sheets were documented with the detection of S.M on stool analysis, serologic tests, pathologic associated lesions and tumor P53 protein expression using immuno-cytochemical assay

Results: Sixty eight patients [40%] with S.CRC were below 40 years with male predominance [1.8 - 1], distal CRC predominance in 109 patients [62%], mucinous type in 58 patients [33%], higher grades II, III in patients [79%], with significant angio-invasion in 50 patients [30%], lymph vessels invasion in 50 patients [35%] and perineural invasion in 17 patients [10%], associates with poor immune response in 8 patients [5%], preceded with schistosomal lesions especially in patients with schistosomal colitis >/= 10 years, associates with TP53 in 114 cases [65%] and presented at advanced stages in 99 cases [56%] with only hepatic metastasis in 28 cases [90%]

Conclusion: S.CRC is a special clinical entity that has all pathologic pattern, bad biologic behavior and the SM is implicated in SCRC progression