New Horizons in the Diagnosis of Tuberculosis of the Spine: The Role of Whole Genome Sequencing

Methods@#Tissues from 61 patients undergoing surgery for spinal TB underwent histologic examination, Xpert MTB/RIF Ultra, and culture and sensitivity testing. DNA from the cultured bacteria was sent for WGS. The test bacterial genome was compared to a reference strain of pulmonary TB. @*Results@#Acid-fast bacilli were observed in 9/58 specimens. Meanwhile, histology confirmed TB in all the patients. Bacilli were cultured in 28 patients (48.3%), and the average time to culture was 18.7 days. Xpert MTB/RIF Ultra was positive in 47 patients (85%). WGS was performed in 23 specimens. Overall, 45% of the strains belonged to lineage 2 (East Asian). There was one case of multidrug- resistant TB and two cases of non-tuberculous mycobacteria on WGS. We could not confirm any genomic difference between pulmonary and spinal TB strains. @*Conclusions@#Xpert MTB/RIF Ultra of tissues or pus is the investigation of choice when diagnosing spinal TB. Meanwhile, WGS can diagnose multidrug-resistant TB and non-tuberculous mycobacteria more accurately. No mutations were identified in spinal and pulmonary TB bacteria.

Identification of Planned Stroke Awareness Behavior: A Structural Equation Modeling

@#Introduction: Stroke is one of the most common neurological diseases, often causing death or gross physical impairment or disability. The associated risk factors such as hypertension, high cholesterol, diabetes, heart disease, and smoking should serve as warnings. However, most people are still not aware of these risks. The main aim of this study is to identify stroke awareness behavior using the construct variable from the Theory of Planned Behavior as the predictor (attitude factor, subjective norm factor, perceived behavioral factor, and intention to perform behavior). Methods: A cross-sectional study was conducted on 256 people who have a high risk of stroke at the Poncokusumo Health Center, Malang, Indonesia. The sampling technique used was purposive sampling. The authors used all the construct variables in the Theory of Planned Behavior. The stroke awareness behavior was measured using a questionnaire developed from the National Stroke Awareness Guide, while the attitude factor, subjective norm factor, perceived behavioral factor, and intention were measured using the instruments developed from standard instruments from the Theory of Planned Behavior. Structural Equation Modeling (SEM-PLS) was used to analyse the data. Result: This study found that 68.4% of respondent with high or low intention of preventing a stroke can be predicted by attitude factors, subjective norm factors, and perceived behavioral factors. While 96.1% of good or bad stroke awareness behavior can be predicted by the model used in this study, the rest (3.9%) is explained by other variables outside this research model. Conclusion: The hypothesis testing results showed that all construct variables in the Theory of Planned Behavior can be strong predictors of stroke awareness behavior. All variables in the Theory of Planned Behavior can be powerful predictors of stroke awareness behavior.

Role of Bedside Ultrasonography in Assessment of Diaphragm Function as a Predictor of Success of Weaning in Mechanically Ventilated Patients / 결핵및호흡기질환

Background@#Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. @*Methods@#We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. @*Results@#There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cutoff value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cut-off value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. @*Conclusion@#The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.

[Prevalence of the staturo-ponderal deficit of Northern and Southern Tunisian boys]

Malnutrition is owing to an alimentation regarding quantity and quality food. To examine the different forms of malnutrition among Tunisian boys of the north and south regions, to form an idea about the state of their health and their living conditions. Our empirical investigation was carried out on 1082 northern boys and 1016 southern boys, aged from 10 to 14 years including 1057 non pubescent boys and 1041 prepubescent boys. Age, weight and height were recorded for the entire population according to the norms of the standard World Health Organization and the nutritional status of these young was described by two indices: Height for age and body mass index for age. The classification used to describe the build is the Cachera Rolland, Malnutrition are significantly more pronounced among the southern boys than their counterparts in the North. Particularly, short stature [19.2% vs 14.4%] and underweight [28% vs 22.5 %]. However, the risk of overweight and obesity is more pronounced among the northern boys. However, the comparison between non pubescent and prepubescent boys shows that the prevalence of stunting increases with age. The mechanisms responsible for these inter-individual differences beings regions appear related to living conditions during the first year after birth, particularly, socio-economic status, family size, type of housing, and the education level of parents

Synthesis, anticancer activity and structure-activity relationship of some anticancer agents based on Cyclopenta [b] thiophene scaffold

Methods for the synthesis of new heterocyclic systems of thieno [3,2-d]- [1,2,3]-triazine derivatives and N-[3- cyano-5,6-dihydro-4H-cyclopenta [b] thiophene derivatives have been developed. The newly synthesized compounds were tested in vitro against human breast carcinoma cell line [MCF-7]. Compounds 7 and 9 have shown the highest activity among the two synthesized series. The results of this study have led to the identification of two lead compounds with good inhibitory activities that can confirm the design of the next generation inhibitors of tyrosine kinase with fewer side effects such as hepatotoxicity and resistance

Percutaneous transthoracic needle aspiration, lavage and instillation of clindamycin-gentamycin in peripheral pyogenic lung abscess

Lung abscess are defined as localized suppurative necrotizing collection occurring within the pulmonary parenchyma. Some authors emphasized image-guided aspiration of lung abscess before antibiotics use in order to identify the pathogen. Antibiotic lavage is currently widely used in the treatment of patients with peritonitis, but not used previously in lung abscesses. Is to asses the role of percutaneous transthoracic needle aspiration, lavage and instillation of clindamycin-gentamycin on the treatment of peripheral pyogenic lung abscess. Twenty-six patients with peripheral pyogenic lung abscess are included in this study and classified into two groups. Group I received systemic empirical antibiotic, remod-ulated after the result of sputum culture and sensitivity. While group II underwent ultrasound guided percutaneous transthoracic needle aspiration, lavage and local instillation of antibiotics [clindamycin-gentamycin] associated with receiving systemic empirical parentral antibiotics, that were remodulated after the result of aspiration culture and sensitivity. Chest X-ray and chest ultrasound were done pre, post and after intervention by one week and before discharge. There was a statistically significant difference between group I and II as regard duration of systemic antibiotic use, duration of hospital stay, duration of radiological improvement, and size of abscess after intervention. Moreover complications occurred in group I were higher than in group II. Succeeded patients [according to clinical and radiological improvement of lung abscess] were more obvious among group II than group I. Aspirates culture and sensitivity revealed gram negative bacteria and anaerobic microorganisms, which are sensitive to local instillation of antibiotics [clindamycin-gentamycin]. Percutaneous aspiration of peripheral lung abscess has an accurate determination of the causative organisms inside the abscess. The resolution of the abscesses clinically and radiolog-ically was hastened by needle aspiration, lavage and instillation of clindamycin-gentamycin. Early intervention can improve symptoms, decrease morbidity and complications

A Polymorphism in the Microsomal Triglyceride Transfer Protein Can Predict the Response to Antiviral Therapy in Egyptian Patients with Chronic Hepatitis C Virus Genotype 4 Infection

BACKGROUND/AIMS: A polymorphism in the microsomal triglyceride transfer protein (MTP) is associated with hepatic fibrosis, and carriers showed higher levels of steatosis, higher levels of hepatitis C virus (HCV) RNA and advanced fibrosis. The aim of this study was to study MTP expression pattern in HCV patients and impact of the MTP polymorphism on the response to antiviral therapy. METHODS: One hundred consecutive naive HCV genotype 4 patients were recruited to receive antiviral therapy, and 40 control subjects were also recruited. Demographic, laboratory, and histopathology data were collected. DNA was isolated, and the samples were subjected to polymerase chain reaction analysis and genotyping for MTP by restriction fragment length polymorphism analysis. RESULTS: Patients and controls were age- and sex-matched (male/female, 56/44, age, 39.2+/-7.8 years for patients with HCV; male/female, 18/22, age, 38.1+/-8.1 years for controls). MTP single nucleotide polymorphisms (SNPs) (GG, GT, TT) and alleles (G, T) in the patients versus the controls were 70%, 21%, 9% & 80.5%, 19.5% versus 10%, 87.5%, 2.5% & 53.8%, 46.3%, respectively (p=0.0001). The sustained viral response (SVR) of the patients was 60%. SNPs in MTP genotypes (GG, GT, and TT) and alleles (G and T) in the responders and nonresponders were 71.7%, 25%, 3.3% & 84.2%, 15.8% versus 67.5%, 15%, 17.5% & 75%, 25% (p=0.038 and p=0.109, respectively). A multivariate analysis showed that the GT genotype was an independent predictor of SVR (area under the curve 90% and p=0.0001). CONCLUSIONS: MTP could be a new predictor for SVR to antiviral therapy in patients with HCV genotype 4 infection.

Histological and biochemical evaluation of the effects of some antioxidants on aged testes

Different studies have demonstrated that aging clearly affects male fertility which may be attributed to the androgen deficiency. Reactive oxygen species play a central role in the pathophysiology in the aged-related decrease in male fertility. Some antioxidants have ameliorative effects on different aged organs. The present study aimed to evaluate the effects of some antioxidants on aged testes. Ten adult and fifty aged male albino rats [Rattus albus] were divided into six groups. Group I [control adult], Group II [control aged], Group III [Vitamin E-treated aged], Group IV [Vitamin C-treated aged], Group V [Zinc sulphate-treated aged], Group VI [Vitamin E-, Vitamin C-and Zinc Sulphate-treated aged]. Vitamin E, Vitamin C and Zinc were administrated in doses 2.52 mg, 3.15 mg and 0.693 mg, respectively. Histological and ultrastructural evaluation of the testes were examined as well as Follicle stimulating hormone [FSH], Luteinizing hormone [LH], total and free testosterone levels in the serum were measured. Counting the number of litters per animal and the teratogenic effects was noticed. Giving zinc alone or combined with other antioxidants gave better ameliorative effects on the testicular structure and hormonal levels in the serum. No teratogenic effects of the aged animals`offspring were noticed

Anti-mullerian and androgens hormones in women with polycystic ovary syndrome undergoing IVF/ICSI

Despite its frequency, the polycystic ovary syndrome [PCOS] is still a difficult diagnosis in endocrinology, gynecology, and reproductive medicine. The Rotterdam consensus conference proposed to include the ultrasonographic follicle count as a new diagnostic criterion. Unfortunately, its assessment does not offer sufficient reliability worldwide. To explore the possible roles of altered circulating androgens and anti-mullerian hormone among PCOS women regarding their body mass index and their outcomes after IVF. In this cross sectional study, 195 women with PCO were included, they were divided according to their body mass index [BMI <27 kg/m[2]] as obese PCOS [n=91] and overweight PCOS [BMI >/= 27 kg/m[2]] [n=104]. Serum levels of androgens [dehydroepiandrosterone sulfate [DHEAS], testosterone and androstenedione [A4]], and anti-mullerian hormone [AMH] were assessed and compared with the endocrine profile and cycles outcomes. AMH, A4, FSH, and TSH concentrations were significantly higher in obese than in overweight women [p<0.001]. Contrary, LH: FSH ratio values, E[2], PRL and DAHE-S levels were significantly lower in obese than in overweight women [p<0.0001]. Total oocyte retrieved, mature and fertilized oocyte were significantly higher in obese than in overweight women. Among pregnant obese PCOS women both AMH and A4 were significantly increased and DAHE-S was significantly decreased compared to pregnant overweight PCOS women. Obese PCOS women have a higher chance of getting pregnant over those categorized as overweight PCOS. Also, androgens and AMH levels recommended to be considered in IVF attributes among obese and overweight PCOS women

Efficacy of ozone therapy in management of patients with internal derangement of temporomandibular joint

Internal derangements are the most frequent articular causes of temporomandibular joint dysfunction, which involve progressive slipping or displacement of the articular disc. Temporomandibular joint arthrocentesis is considered successful treatment inn TMJ internal derangements. The aim of the study was to evaluate the efficacy of ozone application in arthrocentesis of temporomandibular joints with internal derangement. Thirty patients were evaluated in this study and were presented with limited movement and pain in the TMJ. They were divided randomly into two groups: group I, subjected to arthrocentesis using saline solution and group II, subjected to arthrocentesis using ozonized water. Pain levels were significantly decreased in both groups however the significant decrease in group II was reported at post-operative, after first month and one year. Maximal mouth opening for all patient in both groups were improved and the significant increase was reported in group II after first month, six months and one year postoperatively. Clinical efficacy of arthrocentesis with ozone in the temporomandibular joint internal derangements, and efficacy of ozonized water as a clinically applicable form of ozone in ozone therapy for the temporomandibular joint

Anti-cyclic citrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis

Anti-cyclic citrullinated peptide [CCP] antibody has recently been used in the classification of rheumatoid arthritis [RA]. This antibody is more specific than rheumatoid factor [RF] for the diagnosis of RA. The study objectives were to determine the sensitivity, specificity, positive and negative predictive values of anti-CCP in RA diagnosis. Eighty RA patients and 80 non-RA individuals were included in the study. Blood was collected from both arms of study subjects and tested for anti-CCP and RF antibodies. Relevant clinical information and laboratory profiles of the RA patients were evaluated using patients' medical records and Integrated Laboratory Management System [ILMS], respectively. The sensitivity and specificity of anti-CCP were 35% and 100% respectively. The positive and negative predictive values were 100% and 61%, respectively. Positive anti-CCP was found significantly associated with multiple joint pain [p < 0.001] and hand's joints pain [p=0.01], symmetrical joints involvement [p=0.015] and high CRP value [p < 0.001]. Anti-CCP was also found to have positive association with RF [p < 0.001]. Anti-CCP is highly specific for the diagnosis of RA. High positive predictive value should be taken into consideration for effective treatment

effect of a combined high-intensity plyometric and speed training program on the running and jumping ability of male handball players

The aim of this study was to investigate the effect of a combined program including sprint repetitions and drop jump training in the same session on male handball players. Twenty-two male handball players aged more than 20 years were assigned into 2 groups: experimental group [n=11] and control group [n=11]. Selection was based on variables "axis" and "lines", goalkeepers were not included. The experimental group was subjected to 2 testing periods [test and retest] separated by 12 weeks of an additional combined plyometric and running speed training program. The control group performed the usual handball training. The testing period comprised, at the first day, a medical checking, anthropometric measurements and an incremental exercise test called yo-yo intermittent recovery test. 2 days later, participants performed the Repeated Sprint Ability test [RSA], and performed the Jumping Performance using 3 different events: Squat jump [SJ], Countermovement jump without [CMJ] and with arms [CMJA], and Drop jump [DJ]. At the end of the training period, participants performed again the repeated sprint ability test, and the jumping performance. The conventional combined program improved the explosive force ability of handball players in CMJ [P=0.01], CMJA [P=0.01] and DJR [P=0.03]. The change was 2.78, 2.42 and 2.62% respectively. No significant changes were noted in performances of the experimental group at the squat jump test and the drop jump with the left leg test. The training intervention also improved the running speed ability of the experimental group [P=0.003]. No statistical differences were observed between lines or axes. Additional combined training program between sprint repetition and vertical jump in the same training session positively influence the jumping ability and the sprint ability of handball players

Influence of morphological characteristics on physical and physiological performances of Tunisian elite male handball players

The purpose of this study was to describe the body structure and morphological characteristics of Tunisian elite handball players, and to determine the effect of these variables on functional and physical performance levels. A sample of 42 male handball players [mean age 21, 98 +/- 3, 24 years training duration 12 years] of international level was submitted to a test battery comprising morphological, physical and physiological assessments. Tests were yo-yo intermittent recovery test, squat jump test, countermovement jump test, vertical-jump test, and Repeated sprint Ability. Measures for assessment of anthropometric characteristics were age, size, weight, body mass index, Body fat, Fatty mass, and thin mass. Weight was negatively correlated to the squat jump, and the countermovement jump performance. Age, weight, and body composition measures [fat and thin body mass] were additionally negatively related to the maximal oxygen uptake, and to the maximal velocity obtained in the Yo-Yo recovery test. No relationship was found between seize, body mass index, body fat and the physical abilities considered. Concerning the effects of physical characteristics on the functional performances, we can note a positive relationship between squat lump, countermovement jump, and the yo-yo recovery test performance. No relationship was found between vertical jump, repeated sprint ability, and the physiological performances. Study results point to the existence of strong correlation between morphological and physical characteristic with functional characteristic. In handball, it is possible to have a reliable estimate of anthropometric measurements, physic and physiological performances

population-based study of the epidemiology and clinical features of adults with acute myeloid leukemia in algeria: report on behalf of the algerian acute leukemia study group

In Algeria, the incidence of hematologic malignancies has been difficult to estimate for many years. Today, many hematological centers, including 14 university hospitals, have been developed in the entire north and have useful epidemiological data pertinent to acute myeloid leukemia [AML]. We studied the incidence of AML and its subtypes, age distribution, geographic distribution and trends in the rate of diagnosis over the last 5 years in Algeria. Secondary goals were to study trends of referral of AML cases from various regions to specific centers to assess the needs for health infrastructure and change of current practices. Retrospective analysis of nationwide survey of all adult cases of AML [>16 years] diagnosed between 1 January 2006 and 31 December 2010. A survey form was distributed to all departments of hematology at the 15 participating centers. The 1426 cases of AML diagnosed during the study period represented an annual incidence of 0.91/100 000 persons with a male to female [M/F] ratio of 1:16 and a median age of 45 years [range, 16-82 years]. Nationally, 20% of cases AML were diagnosed in the whole western region of the country, 47% in the central and 33% in the east. There was a trend of continuous increase in the rate with age and in the rate of diagnosis over the last 5 years. The most common subtype was M2, followed by M4 and M5. An overall increase in the number of AML patients diagnosed nationwide over the last five years indicates a need for additional health care resources including curative and therapy-intense strategies, such as stem cell transplant facilities to optimize outcome. The relatively younger age of patients compared to the Western countries may be due to the demographic composition of our population

Relationship between HCV infection and Insulin resistance in non-obese non-diabetic patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide. There is growing evidence as regard to the association between hepatitis C virus [HCV] infection and type 2 diabetes mellitus. However, the mutual link and related virological implication have not been fully clarified. Insulin resistance [IR] plays a primary role in the development of type 2 DM. This is supported by the results of prospective longitudinal studies showing that IR is the best predictor of the development of type 2 DM, preceding its onset by 10-20 years. To assess the correlation between HCV morbidity and Insulin resistance [IR] detected by HOMA test in none diabetic none obese HCV patients. The study participants were subcategorized into two groups,Group [I]: included 867 healthy subjects [negative HCV RNA] as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile, glucose profile and HOMA test. This study revealed higher insulin resistance in the HCV study group than the control group

Detection of visceral adiposity by ultrasonography and its relation to insulin resistance in HCV patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide, Ultrasonography is a simple non-invasive method for detection of visceral fat, which is directly, correlated with insulin resistance [IR] as well as development of type 2 diabetes mellitus. To assess the validity of detection of visceral adipose tissue area with Ultrasonography and its correlation with IR in HCV patients. The study participants were subcategorized into two groups, Group [I]: included 867 healthy subjects with negative [HCV] RNA as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile and glucose profile. This study revealed that Ultrasonography is a simple, non-invasive, safe method in detection of visceral adiposity, which is correlated significantly with IR in chronic HCV patients

Evaluation of routine biochemical indices and alpha-fetoprotein versus histology in chronic hepatitis C patients

This study was conducted to investigate the value of routine biochemical indices and alpha -fetoprotein in the evaluation of liver fibrosis in chronic hepatitis C patients. One hundred and sixty two chronic hepatitis C patients were recruited for antiviral therapy in a national centre in Egypt. Patients were 127 males and 35 females with a mean age of 38.4 years. Patients were evaluated with laboratory tests needed to decide eligibility for antiviral therapy. Indices were calculated from aspartate to alanine aminotransferase ratio index [AARI], AST/platelet count for APRI, age/platelets index [API] and alpha -fetoprotein. Metavir score was used to stage fibrosis. Receiver Operator Characteristic curves was used. Prevalence of significant fibrosis [F2-4] was 86 patients [53%]; 10 patients [6.1%] were cirrhotics. In patients with significant fibrosis AARI had sensitivity rate [80%], specificity [30%] and AUC value [0.594]. APRI, API and AFP had a better specificity than AARI [54%, 76% and 55%, respectively], with a lower sensitivity [68%, 61% and 62%] and AUC [0.644, 0.699 and 0.613, respectively]. Combining non-invasive indices with alpha-fetoprotein, the specificity did not improve, though sensitivity increased. age/platelets count index [API] had highest sensitivity [100%] with specificity [59%] and AUC = 0.832 for prediction of liver cirrhosis, whereas APRI showed higher specificity [65%] but lower sensitivity rates [70%] and AUC = 0.644. API is useful in discriminating patients with significant fibrosis, showing the best in this study in predicting cirrhosis. Adding AFP to AARI, APRI or API showed no value in increasing prediction of significant fibrosis