protective effect of insulin against isoflurane and sevoflurane induced hepatocellular apoptosis

Several studies deducted that inhalational anesthetics induce apoptosis in human cells. Insulin is believed to have an antiapoptotic action so it is widely used as cardioprotective agent against ischemic reperfusion injuries. This study compared the apoptotic effect of inhalational anesthetics and figuring out the antiapoptotic effect of insulin against perioperative induced hepatocellular apoptosis using immune histochemical study of liver biopsy. Eighty [ASA I] patients scheduled for laparoscopic cholecystectomy were randomly allocated into 4 groups [20 patients each]. Two groups were anesthetized using isoflurane and the other two were anesthetized using sevoflurane. The control groups [IC, SC] received normal saline and the insulin groups [II, SI] received glucose, insulin and potassium [GIK] infusion. Infusions were given 2 hours before induction of anesthesia. Liver biopsy was taken before the umbilical port closure. In liver biopsy Caspase 3, 7, 9 and Akt activity were evaluated. Liver function tests were estimated before infusion and one day after surgery. Serum K and blood glucose levels were closely monitored all through the study. The results showed that in the isoflurane groups, the percentage of caspase 3 and 7 positive cases decreased while Akt positive cases increased significantly in II compared to IC respectively [p < 0.05]. In the sevoflurane groups, the percentage of caspase 3 positive cases decreased significantly in SI compared to SC group [p < 0.05]

Children with isolated growth hormone deficiency: Empty sella versus normal sella.

BACKGROUND: Empty sella (ES) may be associated with variable clinical conditions ranging from the occasional discovery of a clinically asymptomatic pouch within the sella turcica to severe intracranial hypertension and rhinorrhea. The need for replacement hormone therapy in ES, as in other syndromes that may cause hypopituitarism, must be assessed for every single hormone, including growth hormone (GH). AIM: To determine whether or not the presence of ES could allow some changes in the GH responses of the isolated growth hormone deficiency (GHD) patients. MATERIALS AND METHODS: We included a cohort of 59 short stature children and adolescents with isolated GHD. According to computed tomography finding, they were classified into 2 groups: Group 1 included 40 children with normal sella and 19 children with ES in Group 2. All patients received recombinant human growth hormone (rhGH) with a standard dose of 20 IU/m2/week. RESULTS: The baseline results were not significantly different for all variables except weight standard deviation was smaller with statistical significant difference (P = 0.02). We identified no significant differences when comparing both groups, except for height standard deviation (HTSD) after the first year of therapy which revealed significant difference in favor of group 1. When comparing pre- and the two post-treatments HTSD results of the studied cases, all showed significant changes after GH therapy. The results of related variables pre-and post-treatment in both the groups showed significant improvement in all variables of the two groups of the study. CONCLUSION: Our study showed a similar stature outcome in the two treatment groups.

Epi- on versus epi- off techniques of corneal collagen cross linking for treatment of keratoconus

Aim of the Work: The aim of this study is to evaluate and compare the epi-on versus the epi-off techniques of corneal collagen cross linking as regards their safety and efficacy for treatment of mild to moderate degree keratoconus

Design: Prospective, non randomized study

Patients and Methods: Thirty eyes in 15 patients [9 males and 6 females] with bilateral mild to moderate degree keratoconus were included in this study. Their mean age +/- SD was 26.2 +/- 3.9 years. Diagnosis of keratoconus was based on clinical evaluation as well as pentacam examination. All patients were subjected to corneal collagen cross linking. According to the technique used, eyes were classified into 2 groups: Group I: Included 15 eyes in 15 patients, where cross linking was performed after removal of the corneal epithelium [Epi-off]. Group II: included the other 15 eyes of the same patients, where cross linking was performed with intact epithelium [Epi-on]. Comparison between the two groups as regards visual outcome, keratometric readings, least corneal thickness, refraction outcome and corneal haze was done

Results: No intra operative complications were reported in our study. Re-epithelialization in eyes of group I was reported within a week except three eyes were re- epithelialization was reported after 10,14and 21 days. There was a statistically significance improvement in best corrected visual acuity in both groups [0.36 before versus 0.60 six months after surgery] but the difference between both groups was not significant. As regards refraction, there was reduction in spherical error 6 months after surgery in both groups [-6.14D before,-5.22D 6 months after surgery] as well as cylindrical error [4.87D before 3.79 D 6 month after surgery]. Differences between both groups were statistically not significant.There was increase in the least corneal thickness after surgery [448.6 microns before surgery versus 451.9 microns 6 months after surgery] but statistically the difference was not significant [P=0.75] and the difference between both groups was also not significant. Changes in keratometric readings were statistically not significant, and the difference between both groups was also not significant.Corneal haze was observed one month post operatively in four eyes in group one versus 3 eyes in group II. Persistent haze at the end of follow up was reported in three eyes in group I versus two eyes in group II. The incidence of haze as well as its density was higher in group I than group II with statistical significant difference

Conclusion: Both epi-on and epi-off techniques of corneal collagen cross linking are safe and effective in stabilization or even improvement of mild to moderate degree keratoconus as regards best corrected visual acuity, refraction, keratometric readings, and least corneal thickness. The epi-on technique is easier and more tolerable by the patient with less postoperative corneal haze

Evaluation of the diagnostic value of serum and tissue apoptotoic cytokeratin- 18 in patients with chronic hepatitis C

Hepatitis C virus [HCV] is considered the most common aetiology of chronic liver disease [CLD] in Egypt. The disease severity ranges from mild illness to cirrhosis and hepatocellular carcinoma. A role for apoptosis in liver damage caused by HCV chronic infection has been suggested. Cytokeratin 18 [CK-18] is the major intermediate filament protein in the liver and is a known caspase substrate in hepatocyte apoptosis. Therefore, we analysed the serum and tissue levels of CK-18 in patients with chronic HCV infection to evaluate its role in hepatocyte apoptosis. We also correlated CK-18 expression with the severity of hepatic pathology. This study examined 80 Egyptian patients with liver disease. There were 69 patients with chronic hepatitis C and 11 patients with hepatitis C-induced cirrhotic changes. Fifteen healthy controls were also included in the study. The levels of CK-18 fragment were quantified in paired serum and liver biopsy samples. The serum and tissue CK-18 levels were reduced in chronic HCV patients compared to early cirrhosis patients. This result indicates that serum levels of CK-18 and the hepatic expression of CK-18 might play an important role in disease progression. The serum and tissue levels of CK-18 were significantly increased and directly correlated with inflammation severity, stage of fibrosis, and ALT levels in the chronic HCV group and the cirrhotic liver group. There was no significant difference in viral load between patient cohorts. The serum level and the hepatic expression of CK-18 are related to disease activity and are directly correlated with METAVIR scoring. This result suggests that serum CK-18 levels may be useful for monitoring disease activity in chronic HCV and liver cirrhosis patients

Consumption pattern of nutritional health drinks and energy drinks among university students in Ajman, UAE

To study the preference, awareness, and percentage consumption of health drinks and energy drinks among University students in Ajman, UAE. A cross-sectional study was carried out among 125 Gulf Medical University Students. Self-administered structured questionnaires were used for data collection. Data and statistical analysis was done using SPSS version 11.0. Chi square test was used to detect significant differences between frequencies. It was found that 92% of the students take energy drink while only 8% take health drinks. Among the energy drinkers, 95% preferred the brand 'Red bull' while only 5% preferred 'Effect'. Among the health drinkers takes it regularly at least once a day but energy drinkers take at least 2 cans per day. It was found that 64% of the students start taking health drinks from the age of 3-5 yrs. And more than 92% of students start taking energy drinks from 15yrs onwards. It was also observed that 72% of the students were influenced by advertisements in television and retail outlay. Around 85% of energy drinkers thought that it would enhance their brain development while 10% preferred it due to its taste. 5% thought that it would increase their height. Majority of the students [95%] were ignorant about the high calorie and caffeine content in these energy drinks. From the survey and the data analysis, it was observed that the majority of students preferred energy drinks over health drinks. Students thought that energy drinks can boost their mental energy. One can of an energy drink contain more than 80 mg of caffeine. As a result, energy drinkers may experience adverse effects of overuse like headache, irritability, inability to concentrate, drowsiness, insomnia, etc. It is also important to note that 'Red Bull' had been banned in France for a decade due to health department's concerns about high caffeine and sugar content, glucuronlactone and taurine, an aminoacid the company claims can actively stimulates body metabolism and mental alertness. Therefore, proper health education regarding nutritional benefits as well as adverse effects of energy drinks should be taught to the students at the entry level in the University

Expression of CycIooxygenase-2[COX-2] and Interleukin-8 [IL-8] in H. pylori gastritis; a study on diagnostic methods and pathological effects of h. pylori infection in dyspeptic patients

Background H. pylori infection causes diverse clinical outcomes, including dyspepsia, peptic ulceration, gastric carcinoma and mucosa associated lymphoid tissue [MALT] lymphoma. Up-remulation of COX-2 has been observed in H. pylori gastritis in response to inflammatory cytokines. IL-8 is a major activator for neutrophils which contribute to mucosal damage in H. pylori infected patients. A wide-spread use of non-invasive simple diagnostic method is indicated for diagnosis and follow-up of H. pylori infection

Aims: Assessment of COX-2 and IL-8 immuno-express.ion in gastric mucosa in correlations to H. pylori infection in patients suffering from dyspepsia and evaluation of different available diagnostic modalities for detection of H. pylori infection in Sohag city, Egypt

Methods: The study included 62 patients complaining of dyspepsia. Stool samples were examined for detection of H. pylori stool antigen [HpSA] using enzyme immunoassay [ElA]. Antral endoscopical biopsies were taken for culture, and histopathological evaluation using Giemsa stain. Immunohistochemical expressions of IL-8 and COX-2 in tissue sections were evaluated

Results: H. pylori infection was detected in 42/62 [67.7%] of patients with dyspepsia by using the gold standard method [culture and Giemsa stain]. The diagnostic accuracy of HpSA was 83.8% which made it a good non-invasive alternative for detection ofH. pylori infection in our community. COX-2 was expressed in 90.5% ofH. pylori positive and in 55% of H. pylori negative cases [P < 0.003]. IL-8 was expressed in 83.3% ofH. pylori positive and in 50% ofH. pylori negative cases [P < 0.003]

Conclusions: Wherever endoscopy is not indicated, HpSA EIA is a non invasive, rapid, easily performed, reliable method for diagnosis ofH. pylori infection. H. pylori infection causes enhancement of COX-2 and IL-8, and this may have a role in the progression of gastritis to more advanced lesions?

Growth response of Egyptian children with idiopathic short stature during four years of growth hormone therapy.

BACKGROUND: Multiple factors affect the growth response to recombinant human growth hormone (rhGH) in children with idiopathic short stature (ISS). AIM: To evaluate the growth responses of children with ISS treated with rhGH, aiming to identify the predictors of growth response. MATERIALS AND METHODS: We studied 120 cases, 90 males (75%), with a mean age of 13.8±2.7 years and 30 females (25%), with a mean age of 12.3±2.5 years. All patients received rhGH with a standard dose of 20 IU/m2/week. The calculated dose per week was divided into six days and given subcutaneous at night. RESULTS: A significant positive trend was detected in the delta changes of all anthropometric data. For the first year, the growth response was positively correlated to CA and BA delay and negatively correlated to height, weight and IGF-1 SDSs. For the second year, the growth response was correlated positively to first year growth velocity, BA, triceps skin fold thickness SDS and deviation from target height, and negatively correlated to weight, IGFBP3 SDS and target height SDS. For the third year, the growth response was positively correlated to five variables namely target height, 2nd year growth velocity, IGF-1 SDS, weight SDS and triceps skin fold thickness SDS. For the fourth year, growth response was positively correlated to 2nd and 3rd year growth velocity, BA, deviation from target height and weight/ height SDS. CONCLUSION: Our study showed multiplicity of predictors that is responsible for response in ISS children treated with rhGH, and BA was an important predictor.

Biodegradable ocular inserts for sustained delivery of brimonidime tartrate: preparation and in vitro/ in vivo evaluation

As the bioavailability of therapeutic agents from eye drops is usually limited due to corneal barrier functions and effective eye protective mechanisms, the current study aims to enhance ocular bioavailability of brimonidine, a potent antiglucoma drug, through the preparation of ocular inserts. Solvent casting technique was employed to prepare the inserts using polyvinylpyrrolidone K90 [PVP K-90] as film forming polymer blended with different viscosity grades of bioadhesive polymers, namely hydroxypropylmethycellulose, carbopol, sodium alginate and chitosan. The ocular inserts prepared were evaluated for various physicochemical parameters, swelling behavior and in vitro release patterns. Sodium alginate based ocular inserts revealed the most sustainment in drug release [99% at 6 hr], so it was selected for further modifications via coating it, on one side or dual sides, using hydrophobic film composed of either ethylcellulose or Eudragit RSPO. The in vitro release results obtained for the modified ocular inserts revealed that ethylcellulose is superior to Eudragit RSPO in terms of brimonidine release sustainment effect. Ocular inserts composed of 7% PVP-K 90, 1.5% low molecular weight sodium alginate with or without ethylcellulose coat were able to sustain the in vitro release of brimonidine. Their therapeutic efficacy regarding intraocular pressure [IOP] lowering effect when inserted in albino rabbits' eyes showed superior sustainment effect compared to that of brimonidine solution. Furthermore, due to both the mucoadhesive property and the drug sustainment effect, the one side coated ocular insert showed more IOP lowering effect compared to the non-coated or dual side coated counterpart

Bone age is the best predictor of growth response to recombinant human growth hormone in Turner’s syndrome.

BACKGROUND AND OBJECTIVES: Recombinant human growth hormone (rhGH) is approved for use in children with Turner’s syndrome (TS) in most industrialized countries and is recommended in the recently issued guidelines. We determined the growth responses of girls who are treated with rhGH for TS, with an aim to identify the predictors of growth response. MATERIALS AND METHODS: Fifty-six prepubertal girls with TS, documented by peripheral blood karyotype, were enrolled. All the patients received biosynthetic growth hormone therapy with a standard dose of 30 IU/m2/week. The calculated dose per week was divided for 6 days and given subcutaneously at night. RESULTS: This study showed that rhGH therapy provides satisfactory auxological results. Bone age delay is to be considered as a predictive factor which may negatively influence the effect of rhGH therapy on final height. The growth velocity in the preceding year is the most important predictor of rhGH therapy response. CONCLUSION: These observations help us to guide rhGH prescription, to reduce the risks and costs.

Evaluation of tuberculin skin test and serological tests for the detection of tuberculesis in chronic hemodialysis patients

Background: The risk of Tuberculosis reactivation in Hemodialysis [HD] patients is increased. Tuberculin skin test [TST] is not usually helpful in detecting tuberculosis [TB] infection because of the anergic reaction and the inability to differentiate latent from eradicated TB infection. In this study we evaluated TST and serum Lipoarabinomannan [anti-LAM] antibody detection for the diagnosis of TB in a dialysis population. In addition, the percentage of positivity to purified protein derivatives [PPD] immunoglobulins IgG and IgM in serum was also evaluated

Methods: A total of 80 HD patients were screened using TST [Mantoux method], anti-LAM test [MycoDot Mossman diagnostic] and immunoglobulin IgG and IgM to PPD. In addition 40 healthy volunteers never treated for TB were included as controls. Test Results were compared with clinical and radiological findings

Results: A total of 80 patients and 40 controls were evaluated by TST, MycoDot and PPD ELISA tests. They were 56 [70%] males and 24 [30%] females TST was positive in 20 [25%] of the patients and in 12 [30%] of the controls. Anti-LAM was positive in 32 [40%] of the patients and in 4 [10%] of the controls. Significant correlation was found between TST and both anti-LAM and IgM PPD ELISA tests in the patients group while highly significant difference was found between the patients and controls groups as regards anti-LAM antibody test. A significant correlation was found between anti-LAM test and the pulmonary symptoms, while no significant relationship was found between the test and the other clinical or radiological findings

Conclusion: Serodiagnostic testing may be useful in detecting TB infection in HD patients. MycoDot test is relatively simple and inexpensive and combination of serological tests may increase the effectiveness of serodiagnosis. More researches on a larger scale are needed in addition to a longitudinal study to assess the association of positive tests and the subsequent risk of TB reactivation in those patients

Study of islet cell autoantibodies in serum of siblings of type 1 diabetics

Type 1 diabetes is an autoimmune disease that accounts for approximately 15% of the diabetic population. The pathogenesis of Type 1 diabetes could be divided into six stages. Stage I is genetic susceptibility which requires the presence of a triggering event [stage Il] that initiate the development of autoimmunity [stage Ill] which is characterized by lymphocytic infiltration of the islet cells and production of anti-islet autoantibodies e.g. islet cell cytoplasmic autoantibodies [ICCA], insulin autoantibodies [IAA], glutamic acid decarboxylase autoantibodies [GADA], and autoantibodies against irisulinoma-associated-2 autoantigen [IA-2A]. In stage IV, there is progressive loss of insulin secretion despite normal blood glucose level. Stage V develops when overt diabetes is first recognized. In stage VI, there is complete beta cell destruction. Since the clinical onset of Type 1 diabetes does not occur until 80-90% of the insulin-producing pancreatic beta cells have been destroyed, this prediabetic stage may last for a long time during which the immunologic disease markers are present and measurable. The present study aimed to determine the prevalence of the islet cell autoantibodies in siblings of type I diabetics for the presence of islet autoantibodies in an attempt to allow the opportunity for prediction and/or the prevention the clinical onset of the disease. 108 healthy siblings of Type 1 diabetic children [group I] and 100 healthy control subjects [group II] of matched age and sex were enrolled in the present study. IAA, GADA, and IA-2A autoantibodies were assayed in serum of all subjects by radioimmunoassay. Eight of the control subjects had autoantibodies in their sera which were of the IAA type only. In siblings of Type 1 diabetic children, the prevalence of GADA seropositivity showed the highest percentage [25%], followed by IAA [14.81%], then IA-2A [2.78%]. There was significant association between the brotherhood to Type 1 diabetic children and the presence of GADA alone [i.e. no concomitance with any other autoantibody], total GADA [GADA alone and in combination with other autoantibodies], and GADA+IAA [P=0.000, 0.000, and 0.018 respectively]. IAA+GADA+IA-2A or for IAA+lA-2A combinations were not detected in sera of siblings of Type 1 diabetic children. None of the siblings of Type 1 diabetics had lA-2A autoantibodies alone in the serum. From the present results it could be concluded that some degree of islet cell autoimmunity might develop in siblings of type 1 diabetic children as evidenced by the significant association between the presence of GADA or GADA+IAA and the brotherhood to type 1 diabetics. The present results also revealed that GADA is the most frequent autoantibody in serum of siblings of type 1 diabetics. They also showed that the presence of GADA per se conferred the highest significant association with the brotherhood to Type I diabetic children. However, a larger prospective study is recommended to ascertain the importance of the assay of these immunologic markers for the prediction and possible prevention of type 1 diabetes in individuals at risk e.g. sibling, parents, and offspring of Type 1 diabetics

Predictors of obstructive sleep apnea in snorers.

Snoring is a commong problem that poses a high risk for obstructive sleep apnea [OSA]. We studied the contribution of risk factors for OSA in snorers for full-night polysomnography [PSG]. A questionnaire was administered to subjects referred for PSG in the period from April 2002 to March 2005. There were 191 [84%] snorers identified by 227 PSG studies. They had a mean age of 48.1 +/- 9.8 years, [age range, 23-73 years] and 78.5% were males. OSA as indicated by a respiratory disturbance index [RDI] of>5 events/hour was seen in 126 [66%] subjects. In males, 72.7% had OSA, with a mean RDI of 43.0 +/- 26 events/hour, versus 41.5% [corrected] with OSA in females with a mean RDI of 27.8 +/- 26.5 events/hour [P<0.001]. The OSA group had a higher mean Epworth Sleepiness Scale [ESS] [P<0.001], a larger mean neck circumference [P<0.01], an increased mean age [P<0.050], and more witnessed apneas [P<0.001] but not choking [P=0.096]. The mean increase in body mass index was linked to OSA only in females [P<0.05] but not in the overall study [P=0.507]. Multivariate analysis showed that ESS, male gender, and a history of witnessed apneas were associated with OSA, while controlling for obesity, large neck circumference, age, and history of choking. In screening snorers for PSG, male gender, ESS and a history of witnessed apneas were the most important predictors of OSA, but other factors should be considered in referring snorers for PSG. In males, obesity did not contribute to the risk of OSA in our study population

Multifrequency tympanometry in rheumatoid arthritis patients

To assess the value of the multifrequency tympanometry [MFT] in rheumatoid arthritis [RA] patients. 56 patients with RA, and 54 well-matched controls. MFT was used to measure admittance, conductance, susceptance and phase angle at different probe frequencies and resonant frequency. The RA group had a mild sensouneural hearing loss [SNHL] in the high frequencies with an average of 26.52 dBHL at 4kHz and 34.55dBHL at 8kHz which suggests inner ear affection. However, there was no statistically significant difference between the two groups as regards the air conduction pure tone average. Our RA group showed a higher mean resonant frequency [1038Hz +/- 251.18] than the control group [927.78Hz +/- 126.14] and this difference was statistically significant [p<0.05]. This suggests increased middle ear stiffness in RA, through a chronic inflammation that may involve the incudo-malleolar and/or incudo-stapedial diarthroidal joints. There was a correlation between resonant frequency and different disease parameters: The positivity of the rheumatoid factor, mean grade of disease activity, drug therapy and the presence of extra-articular manifestations. There was a direct correlation between resonant frequency and Erythrocyte sedimentation rate, rheumatoid factor, articular index and morning stiffness; and there was an inverse correlation between resonant frequency and grip strength of the patients. However, there was no correlation between resonant frequency and age of the patient, age of onset nor duration of the disease. MFT is more sensitive than single-frequency tympanometry to detect small changes in the mechanics of the tympano-ossicular chain in RA patients which can be used for the staging of RA, in addition to the traditional rheumatological parameters

Transmission dynamics of Giardia lamblia in a cohort of rural school children

A longitudinal study that included 6 surveys was done on 264 children attending a rural primary school in Gharbia Governorate, Egypt to study the transmission of the protozoan Giardia lamblia. The surveys were done every two months from September 2001 to July 2002. On each survey, three stool samples were collected from each participating child over one week period, and all three samples were pooled and examined using formol ether concentration technique. At the end of the study period, weight and height were recorded and anaemic status was estimated. Results revealed that G. lamblia prevalence ranged between 20.5% in May and 26.5% in November with no observed seasonality. By the end of the study period, 83.7% of the children had at least one positive G. lamblia stool examination. Loss and reinfection rates were 77% and 40.9%, respectively. The high susceptibility may be due to the ubiquity of the parasite in the environment and the antigenic variation of the organism that leads to evasion of the immune response. Transmission pathways appear to be person to person as indicated by repeated infection in 50% of children with bad personal hygiene, and in those having a high crowding index. Environmental role is indicated by higher detection times among those who used stored water for drinking. Neither anaemia nor under nutrition was associated with the infection. An integrated program should be implemented blending nutritional interventions and phytotherapeutic agents with health education to minimize symptomatology and clear the parasite, without significant side effects

probability distribution of attendance to hospital emergency units for school students in Alexandria

The present work is a retrospective study designed to examine the assumption that emergency arrivals at the Sporting Students' Hospital in Alexandria follow a Poisson distribution. Data about all arrivals at the emergency room [ER] for the year, 2000 [43076 arrivals] was extracted from the records of the emergency department and classified by age, sex, school, reason for visit, date and time of visit. Data analysis revealed that 12.9% of the total arrivals indicated hospital admission either to the inpatient units [12.5%] or the ICU [0.4%]. Goodness of fit test showed that admissions to the ICU fit the Poisson distribution but those admitted to the inpatient units did not follow the assumed distribution. However the latter group did not fit exactly the normal distribution which indicated that deviance from the Poisson is due to the large mean non-elective admissions [14.74% per day]. Hence the Poisson assumption is not excluded as the inpatient emergency admissions are still randomly distributed and independent. Univariate and multivariate Poisson regression of the daily emergency admissions gave another clue to the goodness of fit of emergency admissions to the Poisson process. Regression analysis showed significantly higher log[e] number of emergency admissions among the age group 12 or more, male students, medical conditions in contrast to injuries, governmental schools, and at 04:00-11:59 pm in contrast to midnight to 07:59 am. Results of the present study indicated the random nature of demand for emergency admission which affects use of bed stock. A prospective study of these admissions on daily basis is needed

cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt

Chronic liver diseases are disastrous to health. Many factors are associated with their prevalence, hence endemicity. These are mainly infectious, parasitic and toxic. A survey was conducted in a village south to Cairo. Large industries concerned with iron and steel industry, metals smelting, cement manufacturing and electric station were located north to the village. A systematic random sample of houses was selected. All individuals inside the houses were invited to share in the study. Sample size was 84 individuals. Hepatitis markers were done [HBsAg and anti-HCV antibodies]. The levels of some heavy metals were assessed; which were lead, mercury, arsenic, aluminum, manganese, nickel, chromium and cadmium. Levels of some trace elements were assessed. These were copper, iron, selenium and zinc. Aflatoxin B1 was assessed in serum. Assessment of schistosomal circulating antigen and antibodies was carried out. Abdominal ultrasonograghy was done to assess liver condition. Univariate logistic regression analysis was done to assess the association between studied variables and HBsAg or anti-HCV sero-positive subjects. The association between studied variables and bilharzial or fatty liver, diagnosed by ultrasonography, were also assessed. The univariate logistic regression analysis revealed odds ratios at the following results. For HBsAg sero positive subjects, aflatoxin B1, lead, chromium and schistosomal antigen and antibodies were higher than negative ones where odds ratios were; 6.2, 1.6, 1.6, 1.6 and 1.7, respectively. None of the variables showed statistically significant difference. For anti-HCV antibodies sero-positive subjects, aflatoxin Bi and chromium had the highest odds ratios among the studied variables, [odds ratios were 2.5 and 2.4, respectively]. Bilharzial liver showed higher significant positivity of anti-HCV antibodies and insignificant decreased level of zinc than negative ones [odds ratios were 7.2 and 4.5, respectively]. Fatty liver cases showed higher statistically significant positivity of anti-HCV antibodies and chromium than negative ones. Odds ratios were 8.0 and 7.1, respectively. Statistically significant lower level of aflatoxin B1 was shown in fatty liver than normal liver subjects. Multivariate logistic regression analysis for fatty liver showed that only anti-HCV antibodies sero-positivity had statistically significant odds ratio in comparison to chromium level and aflatoxin B1. It is concluded that some heavy metals, and Aflatoxin B1 had a definite association with liver diseases in the area under study. Having anti-HCV antibodies had a relation with fatty liver and with bilharzial liver more than having HBsAg. It is recommended that environmental management to factories nearby the village is urgently needed to decrease exposure to heavy metals. Prevention of hepatitis infection and aflatoxin exposure through different means is also recommended, other wise health care authorities would be confronted with unusual cases of HCC in the nearby future

Geographic information systems [GIS] analysis of under five mortality in Alexandria

The aim of this study is to analyze under five mortality in Alexandria using GIS. A retrospective study is conducted to collect recorded data about under-5 deaths and live births from 1996 to 2001 from Health Information Center and CAPMAS in Alexandria. Data used include sociodemographic and environmental conditions in Alexandria sub-districts digitized maps of Alexandria districts and sub-districts [scale 1:50, 0000]. The spatial analysis of the geographical database revealed that there is regional variations of U5MR. GIS overlay analysis indicates that there is no association between low sociodemographic and environmental indicators and deaths caused by perinatal conditions and congenital malformations. The cause of death most associated with low sociodemographic and environmental indicators are found to be ARI and external causes of mortality. This is quietly evident in Amria and Borg Al Arab sub-districts

Time-series analysis of under five mortality in Alexandria

The aim of this study is to analyze levels, trend and seasonal patterns of under-5 mortality in Alexandria. In order to fulfill this aim, a retrospective study is conducted to collect recorded data about under-5 deaths and live births from 1996 to 2001 from Health Information Center and CAPMAS in Alexandria. Causes of death are categorized using the ICD-10. Several trend equations were tried to select the best fit trend equation. Seasonality is tested using the 12-month moving average method. The predicted value for under-5 mortality rates for the year 2002 is calculated using the best-fit trend equation and the seasonal index and compared to the actual levels to test the validity of the prediction models. The study revealed a significant downward trend of U5MR PNMR and CMR while the NMR does not show significant decrease over the study period. The peak seasonal index of U5MR is in December followed by summer months, those of NMR and CMR are in summer and PNMR is mainly in winter. Maximum index of U5MR due to ARI is in winter while rates related to congenital malformations are in autumn while deaths due to perinatal conditions are mainly in May and June, and external causes of injury are mainly in summer. Though the picture is promising special emphasis is still needed for ARI, congenital anomalies and perinatal conditions

Nutritional status of children in squatter and urban areas in Alexandria, Egypt

Normal individuals have their own growth potential, which is genetically determined. However, variations in the growth are due to interactions between these potential and environmental factors such as nutrition and/or chronic diseases. The objective of the study was to compare the nutritional status of squatter and urban children less than two years in relation to their feeding practices. Methodology: Through a cross-sectional approach, 1000 healthy children [<2 years] from a squatter and urban area in Alexandria-Egypt were submitted to weight and length measurements. Mothers were interviewed about demographic characteristics, socioeconomic data, and the current feeding practices using the 24-hours recall method. Stepwise multiple logistic regression analysis was performed with stunting, wasting, and underweight as dependent variables. There is a statistically significant difference between squatter and urban children in the prevalence of wasting [4.2% and 1.4% respectively] and underweight [11.3% and 2.4% respectively], whereas the prevalence of stunting was insignificantly higher among squatter children compared to urban children [21.7% and 16% respectively]. Nutritional status was generally better among exclusively breast-fed infants and those breast-fed for 23 months. Beside squatter residence, poor nutritional status was strongly associated with older child's age, male sex and being a child of non-working mothers. Conclusion and recommendations: Better nutritional status was encountered among urban children compared to squatter ones. Measures that enables children to live in environment that favor achievement of their growth potentials were recommended

Clinical and microbiological study on bloody diarrhea in children

Bloody diarrhea has been noticed to occur with increasing incidence In our locality. Detection of the causes will help in patient evaluation and proper treatment. The aim of this work was to elucidate the etiology of bloody diarrhea, the clinical and epidemiological profile and the use of third generation cephalosporin in the management of both acute and persistent diarrhea. The study involved 100 infants and children [74 males and 26 females] suffering from bloody diarrhea, aged 1-48 months and 20 apparently healthy controls of matching age and sex. Stool samples were investigated for infectious causes of diarrhea by culturing on appropriate media. All cases were subjected to complete clinical examination and blood picture. Eighty-five percent [85%] of cases were proved to have infectious bloody diarrhea, 6.1% of them were associated with Entameba histolytica. Non infectious cases were 5% allergic, 6% surgical and 4% bleeding tendency. Increased incidence of bloody diarrhea was found more in bottle and mixed fed children and in infants aged <1 year and in infants weaned before 6 months. Twenty cases had protein energy malnutrition [FEM], 67% were anemic and 63% had leukocytosis. stool culture revealed 41.1% E. coli [31 EHCH], 31.7% Salmonella, 14.1% Shigelia and 9% Campylobacter species. No single case of Clostridium difficiie was detected in our series. The frequency of improvement in cases who received 3rd generation cephalosporin [cefotaxime] was 97.5% versus 75% in cases who did not receive it. Campylobacter cases did not improve by the use of 3rd generation cephalosporin but improved by erythromycin

Conclusion: The problem of bloody diarrhea in our locality is mostly infectious mainly by E. coli and Salmonella species. Most of cases of bloody diarrhea improved on cephalosporin. However Campylobacter infection could be considered if the case did not respond to this type of treatment and the use of erythromycin is helpful in such cases. Prevention of infection is the most important challenge to avoid complication by encouraging breast feeding and considering vaccinations against the most prevalent organisms