Zoonotic brucellosis: an underestimated or misdiagnosed disease in Egypt

Over six months, 329 suggestive consecutive brucellosis human cases were diagnosed in attending the out-patients clinics of Al Azhar and Ain Shams Universities Hospitals and Giza Governorate Farmers. They were 100 females and 229 males with ages ranged between 15-65 years old. A total of 213 [64.75%] were working in dairy farm and/or consumed raw milk, 16 [14.85%] used home slaughtering of sheep, and 100 [30.4%] were working in Giza Government slaughter-house. Clinically and by ELISA-IgM 259 out of 329 the subjects were proven brucellosis patients [77.8%]. Besides, other patients had toxoplasmosis, or Schistosomiasis mansoni or fascioliasis. Double infection was encountered with toxoplasmosis and either schistosomiasis or fascioliasis. The causes of endemic liver parasitosis that may give false-clinical diagnosis were excluded. Signs and symptoms of brucellosis patients were fever [91.5%], chills [84.1%], Myalgia [69.5%], headache [58.2%], fatigue [77.2%], anorexia [54.1%], tachycardia [38.6%], hepato-and/or splenomegaly [46.2%], lymphadenopaqthy [19.6%] lower back abdominal pain [8.8%] and/or constitutive symptoms [13.1%]

Trypanosoma evansi in dromedary camel: with a case report of zoonosis in greater Cairo, Egypt

Trypanosoma evansi [Steel, 1885] Balbiani, is the cause of trypanosomiasis [Surra] which multiples in the blood and body fluids. The incubation period varies from 7-15 days. The mortality rate was up to 20% and fatality rate may reach up to 100% in untreated camels. Three hundred randomly selected camels were 200 males 4-6 years old and 100 females 10-15 years. They were examined clinically and diagnosed by Giemsa stained blood smear, anti-trypanosomiasis-antibodies by ELISA and urine Thymol turbidity test for natural infection with T. evani [Surra]. The results showed that camels were naturally infected with T. evansi as indicated by stained blood film examination and/or ELISA. Infection in males was 6.0% [stained blood smears], 8.0% [ELISA] and 5.0% [urine thymol turbidity test]. In females the infection rate was 9.0%, 24.0% and 12% respectively. By correlation with suggestive clinical manifestations, ELISA proved to be more sensitive and specific [13.3%] than stained blood films [10.0%] and urine Thymol turbidity test [7.3%]. Regarding humans, one out of 30 was positive as indicated by ELISA and stained blood smear but was negative by urine thymol turbidity test. The human case was successfully treated as indicated clinically, parasitologically and serologically. This is the first reported Egyptian human case of trypanosomiasis evansi, a neglected zoonosis

Interleukin [IL]-12, IL-5 and total IgE in hepatosplenic schistosomiasis with or without asthma

There are a number of similarities between protective immune responses against schistosomiasis and asthma. Both are associated with elevated concentrations of IgE and eosinophilia. Chronic schistosomiasis is liked to Th1 like response with involvement of pro-inflammatory cytokines in schistosomal hepatosplenic disease process resulting in low level of IL-S. Meanwhile, association with asthma could modulate the immune response with shift to Th2 side resulting in marked elevation of IL-5 and eosinophilia. This work evaluated the levels of serum IgE, IL-5 and IL-12 in Schistosoma mansoni-infected asthmatic patients. A total of 100 subjects selected from Al-Azhar University's Hospitals were divided into three groups GI: 50 patients with hepatosplenic schistosomiasis associated with asthma. GII: 25 patients with hepatosplenic schistosomiasis without apparent asthma. GIII: 25 patients with neither bilharzial liver cirrhosis nor asthma as control group. All patients were subjected to full history taking and clinical examination, pulmonary function tests, total serum IgE, bilharzial antibody titre, stool and urine examination for parasites, liver function tests and serum IL-5 and IL-12. The results showed very high level of the total serum IgE in GI and GII compared to GIII. There was high significant difference in peripheral blood eosinophil%. GI and GII gave highest levels, IL-5 was elevated in GI, but low GII, IL-12 was high in GII than GI

Influence of embryo transfer distance on pregnancy rate in ICSI cycles

To investigate the influence of transfer distance to the fundus on pregnancy rate. Retrospective single center study, including 674 consecutive cycles of ICSI done at Adam International Clinic between January 2005 and December 2005. All patients were included and data examined regarding; their age, endometrial thickness at day of HCG, endometrial pattern at day of HCG, number and quality of embryos transferred, difficulty of embryo transfer as reported by the transferor, transfer distance to the fundus as measured by trans abdominal ultrasound and if the ejection of the media inside the inner sheath of the transfer catheter was seen or not. Our data indicate that the actual distance to the fundus did not affect the pregnancy rate. Our data proves that the exact position of embryo deposition from the fundus does not influence pregnancy rate, however the use of trans-abdominal ultrasound can be of help in visualizing the catheter in the more difficult transfer and air bubbles can be documented, also ultrasound guidance adds to the confidence in the procedure by both the physician and the patient

Comparison of sevoflurane and propofol anesthesia on surgical field and recovery characteristics in patients undergoing endoscopic sinus surgery

The endoscopic surgical procedures have been developed specifically for the areas located in the key points of the lateral nasal wall. Small areas of bleeding in the operative field can reduce visibility and considerably impair surgical conditions. This randomized, prospective study was performed to compare propofol and sevoflurane based anesthesia on the surgical field in patients undergoing endoscopic sinus surgery and to compare the recovery characteristics between them. Patients and Methods Forty patients ASA I and II, scheduled for elective endoscopic sinus surgery were randomly divided into two equal groups to receive either propofol or sevoflurane as a maintenance anesthetic. Propofol was the induction agent in both groups. Group 1 received propofolnitrous oxide for maintenance of anesthesia [Propofol group] while group 2 patients received sevoflurane-nitrous oxide [Sevoflurane group]. in this study, the attending otorhinolaryngological surgeon was unaware of the type of anesthesia administered immediately after the operation, the surgeon rated surgical conditions [bleeding from the surgical field] on a visual analogue scale [0-10 cm] and on a verbal rating scale. Also we compare the two groups [15 regards recovery profile [extubation time, command response, orientation time, and time until eligible for discharge]. Blood pressure was not different between the two groups, but heart rate was lower in the intravenous anesthesia group. Surgical conditions were rated to be significantly better during anesthesia with propofol compared with sevoflurane. There were no differences in the recovery character between the two groups. Total intravenous anesthesia with propofol has the advantage of decreased bleeding compared with sevoflurane anesthesia. Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field. Both sevoflurane and propofol have comparable recovery profiles

approach to minimize perioperative hypothermia and its complications

During general anesthesia there is marked decrease in energy expenditure and heat generation, in addition, central thermoregulatory function is impaired Postoperatively, hypothermicpatients are uncomfortable and at risk of developing several hypothermic related complications such as shivering, ischemic cardiac events and decreased resistance to wound infections. We investigated the effect of I V infusion of a balanced mixture of ammo acids in prevention of perioperative hypothermia and its complications. Forty patients undergoing major abdominal surgery were randomly assigned to either an amino acid [a a] group or a control group. Patients in the a. a group received mixture of 19 amino acids I' V at a rate of 100 ml/h given 1h before induction and continuing for 3h after induction. The control group received Ringer's solution. During the perioperative period we recorded heart rate, arterial blood pressure, SO2, end tidal CO2 and rectsl core temperature Plasma norepinephrine was assayed before induction and after surgery On recovery the patients were observed for shivering and were asked about cold feeling. The mean duration of stay in PACU and hospital stay duration were recorded The surgical wounds were evaluated The mean core body temperature at the end of surgery and at the discharge from the PACU were significantly lower in the control group than the a a group The mean heart rate and arterial blood pressure were significantly higher in the control group. The incidence of postoperative shivering and cold feeling was higher in the control group than the a a group. The mean plasma concentration of norepinephrine was significantly higher in the control groupr. The mean duration of stay in the PACU and duration ofthe hospital stay were significantly longer in the control group than the a.a. group. In conclusion it was found that the infusion of amino acids to anesthetized patients will induce thermogenesis preventing perioperative hypothermia and significantly decreases the sympathetically mediated dynamic and hormonal response to hypothermia during recovery from anesthesia It decreases also significantly the postoperative shivering and cold feeling of the patient. Amino acid infusion enhances also recovery and shortens the hospital stay