Zoonotic cutaneous leishmaniasis: reservoir host and insect vector in north Sinai, Egypt

Cutaneous leishmaniasis [ZCL] is a protozoan disease well documented not only in Egypt, but in nearly all the East Mediterranean Countries. Sinai Peninsula was a sparsely populated area where sporadic cases of ZCL were reported with the reconstruction of Sinai and people coming in and out, it was indicated to study the status of ZCL in North Sinai Governorate, the reservoir host[s] and insect vector[s] in Sinai. In the present study, the six species of rodents were trapped from areas or nearby areas where human ZCL cases were detected. Rodents [50] were Mus musculus [10], Rattus r. alexandrinus [18], R. norvegicus [2], Gerbillus gerbillus [4], G. pyramidum [12] and Jaculus jaculus [4]. The rodents were examined clinically for any skin lesion or even nodule, particularly in head and tail. One G. pyramiduim had natural infection with L. major as indicated by smears and culture, but typing was not done. The spot light surveys for Phlebotomus were carried out by the sticky paper traps and the CDC light traps in four main centers; Al Hassanah, Nakhil, Al Arish, and Bir Al-Abd. A total of 1320 sandflies were identified. They were P. papatasi [1150] and P. sergenti [170] in a ratio of 7:1. A total of three isolates of zymodeme London 70 undistinguished from the formerly obtained human and rodent isolates were enzymatically identified in P. papatasi

Acute viral hepatitis in Egyptian pregnant women; natural history

Seventy-three pregnant women with acute hepatitis were selected for this study. All cases were subjected to history taking, obstetric status, clinical and abdominal ultrasonography examinations. Out of these cases, 61 patients agreed to participate in this study. The commonest symptoms and signs were jaundice, urine darkness, anorexia, abdominal pain, fever, diarrhea, hepatomegaly and splenomegaly. Fulminant hepatitis was found in seven cases. Serum bilirubin and transaminases were about 3-5 fold above the normal level. Two deaths, three were still birth and five premature labor were the mean complications and the normal labor was 82.2%. A benign clinical course was given in 88.7% and the mortality rate was 3.2%. There was no specific clinical course indicated to a specific virus infection. Pregnancy did not aggravate the course of acute viral hepatitis, but the viral hepatitis could complicate the pregnancy course

Evaluation of antibodies to 60s ribosomal phosphoproteins in systemic lupus erythematosus

Despite their recognition in systemic lupus erythematosus [SLE] patients more than 30 years ago, the prevalence and disease associations of anti-ribosomal P[anti-P] antibodies are controversial. We attempted in this study to evaluate the prevalence, the clinical significance and the pathogenesity of anti-ribosomal antibodies in SLE patients. Our study included 82 patients with SLE [71 females and 11 males] with age ranging from 17 to 50 years [27.6 +/- 9.2] in addition to twenty age and sex matched healthy individuals as a control group. Routine investigations, together with urine microscopy, 24-hour urinary protein quantitation, creatinine clearance, liver function tests and serum C3 level were performed. Renal biopsy was performed for most patients with lupus nephritis. Brain Computed tomography [C.T], Electroencephalogram [EEG] and Magnetic Resonance Immaging [MRI] were done for patients with neuropsychiatric lupus. The clinical activity of the disease was assessed by the SLE disease activity index [SLEDAI] after full clinical examination including rheumatological examination. Immunologic investigations included: 1] determination of anti-P antibodies by an enzyme linked immunosorbent assay [ELISA] method using a highly purified COOH terminal 22 amino acid peptide as an antigen. 2] indirect immunofluoresent technique for the detection of antideoxy ribonucleic acid [dsDNA], anti-smooth muscle antibodies [ASA] and anti-mitochondrial antibodies [AMA]. 3] ELISA methods for the detection of anticardiolipin antibodies [ACA] IgG and IgM, hepatitis C virus antibodies [HCV] IgG and hepatitis B surface antigen [HBsAg]. Anti-P antibodies were positive in 22/82 [26.8%] of patients with SLE and in none of the normal control subjects. Accordingly we classified our patients into two groups: Group I with positive anti-P antibodies [22 patients] and group II with negative anti-P antibodies [60 patients]. Hepatitis [which could be attributed to SLE and not to other causes since they were negative for ASA, AMA, HCV and HBV] was reported in 21/82 [25.6%] of our SLE patients. Fifteen of them were from the anti-P positive group [15/22, 68.1%] and 6 were from the anti-P negative group [6/60,10%]. This difference was statistically highly significant [p<0.001]. Regarding the incidence of lupus nephritis, it was [18/22, 81.8%] in the anti-P positive group, while in the anti-P negative group it was [24/60, 40%], the difference was statistically significant [p<0.001]. There was no statistically significant difference between anti-P positive and anti-P negative patients with regard to the presence of anti-ds DNA antibodies. Lupus psychosis was reported in 12/22 [54.5%] of anti-P positive patients [group I] and in 6/60 [10%] of anti-P negative patients [group 11], the difference was statistically highly significant [p<0.001]. The level of ACA in the sera of our patients was correlated significantly with the level of anti-P antibodies [r = 0.573 and p<0.001 for IgG ACA and r = 0.773 and p<0.001 for IgM ACA]. Clinical observations revealed that the presence of anti-P antibodies was significantly correlated with disease severity determined by systemic lupus erythematosus disease activity index [SLEDAI]. The SLEDAI score was significantly elevated with a mean of 26.9 +/- 2.6 in anti-P positive patients [group I] and a mean of 17.2 +/- 1.6 in the anti-P negative patients [group II] [p<0.001]. The level of C3 was significantly reduced in anti-P positive patients when compared with anti-P negative patients [p<0.001]. We concluded that, although anti-P antibodies were present in a small percentage of SLE patients, yet they were significantly associated with more aggressive disease, with increased incidence of hepatic, renal and central nervous system [CNS] involvements. Thus, the determination of anti-P antibodies may be one of the useful prognostic tools in identifying a subset of SLE patients with more severe disease associations and early major organe affections, that necessitate close clinical observations and frequent follow up visits. Large scale prospective study can better illuminate the relationship of anti-P antibodies to clinical disease expression, especially hepatitis and CNS involvement

Importance and clinical significance of serum sialic acid and lactate dehydrogenase determination in cervical cancer patients

In an attempt to establish a blood-based biochemical index for diagnosis of cervical cancer patients, serum levels of total sialic acid [TSA] and lactate dehydrogenase [LDH], were estimated. Serum concentrations of the markers in 30 untreated cervical cancer patients were compared with the levels of the biomarkers in 20 healthy, ages matched female individuals with the same socio-economic status as controls. Cancer cervix patients were divided into 2 groups; group [A], early disease [stages I and II] n=18, and group [B] advanced disease [stages III and IV] n=12. The levels of all markers were found to be significantly higher [P<0.001] in untreated cervical cancer patients versus to the control group. TSA was found to be the most sensitive [86.6%] marker for diagnosis of cervical cancer. Combined use of the markers revealed higher sensitivity [93.3%]. In comparison between advanced [stages III and IV] and early [I and II malignant disease, the markers showed higher levels in advanced disease, but this increase was found to be insignificant [P<0.05]. These results suggest that combined evaluation of these markers is helpful for diagnosis of cervical carcinoma patients in conjunction with the studies of cervical smear and other conventional diagnostic methods