A conventional multiplex PCR for the detection of four common soil-transmitted nematodes in human feces: development and validation

@#Soil-transmitted helminth (STH) infections, mainly caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms, are among the most common intestinal parasites that infect humans. The infections are widely distributed throughout tropical and subtropical countries, including Malaysia, particularly in underprivileged communities. Microscopic and culture techniques have been used as a gold standard for diagnostic techniques. However, these methods yield low sensitivity and specificity, laborious and time-consuming. Therefore, simple, rapid, and accurate alternative methods are needed for the simultaneous detection of STH infections. Although advanced technologies such as real-time multiplex PCR have been established, the use of this technique as a routine diagnostic is limited due to the high cost of the instrument. Therefore, a single-round multiplex conventional PCR assay for rapid detection of four STH species in the fecal sample was developed in this study. To perform the single-round multiplex PCR, each pair of species-specific primers was selected from target genes, including Ancylostoma duodenale (Internal Transcribed Spacer 2; accession No. AJ001594; 156 base pair), Necator americanus (ITS 2; accession No. AJ001599; 225 base pair), Ascaris lumbricoides (Internal Transcribed Spacer 1; accession No. AJ000895; 334 base pair) and Trichuris triciura (partial ITS 1, 5.8s rRNA and partial ITS 2; accession No. AM992981; 518 base pair). The results showed that the newly designed primers could detect the DNA of STH at low concentrations (0.001 ng/μl) with no cross-amplification with other species. This assay enables the differentiation of single infections as well as mixed infections. It could be used as an alternative and is a convenient method for the detection of STHs, especially for the differentiation of N. americanus and A. duodenale.

Oral bacteria detection among children with cancer in a tertiary teaching hospital in Kuala Lumpur, Malaysia

@# This study sought to determine the prevalence of pathogenic and non-pathogenic bacteria in the oral cavities of children with cancer. There were 68 paediatric patients with cancer who were included in this study. Oral swab samples from the dorsum of tongues and mouth floors of these patients were subjected to culture, staining, and molecular methods to detect the bacteria. The overall prevalence of gram-positive and gram-negative bacteria was 79.4% (54/68; 95% CI = 68.4 – 87.3) and 25% (17/68; 95% CI = 16.2 – 36.4), respectively. Streptococcus salivarius and Streptococcus parasanguinis were the predominant pathogenic grampositive bacteria, while Neisseria subflava and Neisseria perflava were the most common pathogenic gram-negative bacteria. The results revealed that the number of bacteria isolates recovered in patients receiving cancer treatment was higher (55.9%) than those who had not received treatment (16.2%). Therefore, more isolated pathogenic bacteria were observed post-therapy (54.4%). Pathogenic organisms can have significant implications on patient health. Awareness of the types of bacteria inhabiting the oral cavity is essential to predict and prevent dental problems, and their associated systemic complications. Findings on the diversity of oral microflora can also provide a better understanding of the aetiology of oral diseases in paediatric patients receiving cancer treatment.

Knowledge, Practices and Attitude of Healthcare Providers about Using Face Mask to Limit the Spread of the Novel Coronavirus Disease

Aim: There is evidence that health care providers have insufficient knowledge and poor practices regarding the use of surgical mask. Therefore, this study aimed to explore the knowledge, practices and attitudeof healthcare providers about using face mask in order to limit the spreading of the novel coronavirus disease.Methodology:This was a cross sectional pilot study included a questionnaire about the knowledge of health care workers regarding the use of surgical face mask to prevent the new COVID-19 spreading and about their practices and the attitude of them regarding the use of surgical face mask to limit the new COVID-19 exposure Results: About 86.21% of health care workers said that the correct way ofusing surgical face maskisWhite side facing in and about 65.52% of them said that N-95 mask is the mask type that actually protect against COVID-19. All of the respondents reported that they wear a mask in public places to protect themselves against COVID-19 and that they wear a mask in hospital premises to protect themselves against COVID-19 (100.00%).Conclusion: The Knowledge, attitude, and practice of health care providers regarding the use of surgical face masks were found to be good but still more knowledge is required about several aspects such as the types of masks, the duration of using masks and the disposal of the masks

Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at chris hani baragwanath academic hospital

Background. Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications.  Objectives. To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Methods. Frequency of CP measurement was assessed using a prospective chart review, followed by an interventionalcomponent. In the final stage nurses completed a self-administered questionnaire. Results. A total of 304 charts from 61 patients were reviewed. Patientsâ€â„¢ ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of respondents were trained in critical care. Knowledge of current critical care CP monitoring guidelines was reported by 62% of the respondents (n=23/37). Only 53% (20/38) reported routinely measuring CP. Almost all respondents (94%) knew of at least one complication of abnormal CP. Conclusion. Having a basic knowledge of CP measurement, having awareness of the complications of abnormal CP and the availability of national best practice guidelines did not translate into appropriate ICU practice. Research into effective implementation strategies to achieve best practice is needed

Histological Evaluation of Experimentally Induced Critical Size Defect Skin Wounds Using Exosomal Solution of Mesenchymal Stem Cells Derived Microvesicles

BACKGROUND AND OBJECTIVES: The present study investigated whether MSCs derived microvesicles (MVs) or (Exosomes) can exert therapeutic effects on an experimental model of cutaneous injury and explored the underlying involving mechanisms. METHODS AND RESULTS: Three bilateral full thickness circular wounds were created on the back of two groups of dogs using 2-cm dermal punch. The wounds were at least 2.5 cm apart. Saline was subcutaneously injected in 4 places around each wound area in group-I (control), whereas an equal volume of exosomal solution of MSCs derived MVs was similarly injected in group-II. The findings demonstrated that MSCs derived MVs had significantly promoted cutaneous wound healing, collagen synthesis, and vascularization at wound sites. The application of the exosomal solution had not only promoted the generation of newly formed vessels, but also have accelerated their development and maturation leading to a faster healing process. CONCLUSIONS: MSC-Exosomes appeared to be a superior candidate for treating cutaneous wounds than their originator cells, and may represent a promising opportunity to develop a novel cell-free therapy approach that might overcome the obstacles and risks associated with the use of native or engineered stem cells transplantation therapy.

Tachycardia induced cardiomyopathy, case report

Tachyarrhythmia is a one of the well-known causes of dilated cardiomyopathy. The cardiomyopathy is reversible once arrhythmia is controlled. Cardiologists need to be aware of this reversible cause of left ventricular impairment. We report an eight year old girl who presented with severe left ventricular impairment secondary to paroxysmal junctional reciprocating tachycardia. She failed drug therapy, so radiofrequency ablation was successfully done afterwards. Her left ventricular function returned to near normal within the following six months

Saudi guidelines for the diagnosis and management of COPD

The Saudi Thoracic Society [STS] launched the Saudi Initiative for Chronic Airway Diseases [SICAD] to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease [COPD]. This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test [CAT] and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation [<2 in the past year] can be classified as either Class I when they have less symptoms [CAT < 10] or Class II when they have more symptoms [CAT >/= 10]. High-risk COPD patients, as manifested with >/= 2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score >/= 10. The article also discusses the diagnosis and management of acute exacerbations in COPD.

Small Airways Dysfunction in Asthma: Evaluation and Management to Improve Asthma Control

The small airways have been neglected for many years, but interest in the topic has been rekindled with recent advances in measurement techniques to assess this region and also the ability to deliver therapeutics to the distal airways. Current levels of disease control in asthmatic patients remain poor and there are several contributory factors including; poor treatment compliance, heterogeneity of asthma phenotypes and associated comorbidities. However, the proposition that we may not be targeting all the inflammation that is present throughout the whole respiratory tree may also be an important factor. Indeed decades ago, pathologists and physiologists clearly identified the importance of small airways dysfunction in asthmatic patients. With improved inhaler technology to deliver drug to target the whole respiratory tree and more sensitive measures to assess the distal airways, we should certainly give greater consideration to treating the small airway region when seeing our asthmatic patients in clinic. The aim of this review is to address the relevance of small airways dysfunction in the daily clinical management of patients with asthma. In particular the role of small particle aerosols in the management of patients with asthma will be explored.

Attitudes of cairo university medical students toward smoking: the need for tobacco control programs in medical education

Tobacco smoking rates are increasing in developing countries and so are tobacco-related chronic diseases. Reported figures from the WHO show rates of smoking in Egypt as high as 20% but limited information is available about smoking specifically among physicians and medical students. Final-year medical students of Cairo University were surveyed regarding their tobacco behavior and attitudes using a modified Global Health Professions Student Survey. We approached 220 students by randomly selecting clinical units into which they were assigned and requested completion of the survey. Ever users of some form of tobacco comprised 46.7% of students sampled, current users of cigarettes comprised 17.4%, and current users of water pipe 'sheesha' comprised 17.6%. The vast majority [87.7%] of students believed that smoking is a public health problem in Cairo and supported restriction of tobacco. Yet, only 58.5% stated that they were taught it is important for physicians to provide tobacco education materials to patients. Among ever users of cigarettes, 54.4% believed health professionals do not serve as health role models for patients, and only a small percentage of all students [34.2%] stated that they had received some form of training on smoking cessation in their medical curriculum to be able to instruct patients. A high rate of smoking was revealed among medical students in Cairo. Overall, approximately 23.4% of students were currently smoking cigarettes and/or sheesha, and 46.7% were ever users of some form of tobacc o. A formal antitobacco program for medical students should be incorporated into their medical curriculum to change the attitudes of medical students and overcome the anticipated increase in chronic diseases in Egypt

Effect of general anesthesia compared to regional anesthesia on the apgar score of neonates

Cesarean section [CS] is one of the common operations performed in obstetric practice worldwide; it can be conducted as elective or emergency operation. To assess the effect of different types of anesthesia used during conducting elective cesarean sections [CS] on the health of neonates by using the Apgar score. A prospective study conducted in Royal medical Services hospitals in Jordan between Jan. 2011 and May 2012.All pregnant women planned for elective CS were included in this study. Women of eventful pregnancy or intra uterine fetal growth retardation or malformation were excluded from the study. 161 healthy pregnant women underwent elective CS were included in this study. The patients were divided into 3 groups; the 1st one received general anaesthesia [GA] [group A] and consists of 104 patients, group B consists of patients who received spinal anesthesia [42 patients] and group C consists of patients who received epidural anesthesia [15 patients]. At one minute 62.5% of patients in group A had normal Apgar score while in group B and C about 80% had normal scores. At five minutes 87.5% of patients in group A had normal Apgar score while in group B and C about 93% had normal scores. There was no statically difference between the three groups in regard to Apgar score at 10 minutes. General anesthesia adversely influences the short term outcome of infants born to mothers by elective cesarean section. Regional anesthesia is safe and well tolerated for the mother and the neonate and should be considered when there is a choice during cesarean section

Skin tags, leptin, metabolic syndrome and change of the life style.

Background: Skin tags (STs), are papillomas commonly found in the neck and in the axillae of middle-aged and elderly people. Metabolic syndrome (MS) is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies of different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with MS. Aim: To study the possible relation of skin tags and leptin levels to MS guided by the International Diabetes Federation (IDF) diagnostic criteria. Methods: This study included 80 participants, 40 ST patients and 40 apparently healthy controls. Age, sex, waist circumference (WC), body mass index (BMI), smoking status, fasting glucose level, insulin level and insulin resistance were estimated as well as cholesterol, triglycerides, HDL, criteria of MS, and leptin levels. Results: The univariate analysis showed that WC, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, and leptin levels were significantly higher in ST patients compared to controls (P < 0.001). The multivariate analysis between MS components and ST showed that only high triglyceride levels (OR 1.205/95% CI 1.044-1.391/P = 0.011) and low HDL levels (OR 0.554/95% CI 0.384-0.800/P = 0.002) were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels, showed that high triglyceride levels (OR 0.287/95% CI 0.410-3.56/P = 0.014), and low HDL levels (OR -0.404/95% CI -8.7 to -2.08/P = 0.002) were significant predictors. Conclusion: The results of this study suggested that the presence of both ST and hyperleptinaemia in patients with STs may be associated with high levels of triglycerides and low levels of HDL and this could suggest that changing the life style of patients with ST may have a beneficial role.

Phylogenetic analysis of Biomphalaria tenagophila (Orbigny, 1835) (Mollusca: Gastropoda)

Mitochondrial DNA of Biomphalaria tenagophila, a mollusc intermediate host of Schistosoma mansoni in Brazil, was sequenced and characterised. The genome size found for B. tenagophila was 13,722 bp and contained 13 messenger RNAs, 22 transfer RNAs (tRNA) and two ribosomal RNAs (rRNA). In addition to sequencing, the mitochondrial DNA (mtDNA) genome organization of B. tenagophila was analysed based on its content and localization of both coding and non-coding regions, regions of gene overlap and tRNA nucleotide sequences. Sequences of protein, rRNA 12S and rRNA 16S nucleotides as well as gene organization were compared between B. tenagophila and Biomphalaria glabrata, as the latter is the most important S. mansoni intermediate host in Brazil. Differences between such species were observed regarding rRNA composition. The complete sequence of the B. tenagophila mitochondrial genome was deposited in GenBank (accession EF433576). Furthermore, phylogenetic relationships were estimated among 28 mollusc species, which had their complete mitochondrial genome deposited in GenBank, using the neighbour-joining method, maximum parsimony and maximum likelihood bootstrap. B. tenagophila was positioned at a branch close to B. glabrata and Pulmonata molluscs, collectively comprising a paraphyletic group, contrary to Opistobranchia, which was positioned at a single branch and constituted a monophyletic group.

Evaluation of a linear spectral mixture model and vegetation indices (NDVI and EVI) in a study of schistosomiasis mansoni and Biomphalaria glabrata distribution in the state of Minas Gerais, Brazil

This paper analyses the associations between Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) on the prevalence of schistosomiasis and the presence of Biomphalaria glabrata in the state of Minas Gerais (MG), Brazil. Additionally, vegetation, soil and shade fraction images were created using a Linear Spectral Mixture Model (LSMM) from the blue, red and infrared channels of the Moderate Resolution Imaging Spectroradiometer spaceborne sensor and the relationship between these images and the prevalence of schistosomiasis and the presence of B. glabrata was analysed. First, we found a high correlation between the vegetation fraction image and EVI and second, a high correlation between soil fraction image and NDVI. The results also indicate that there was a positive correlation between prevalence and the vegetation fraction image (July 2002), a negative correlation between prevalence and the soil fraction image (July 2002) and a positive correlation between B. glabrata and the shade fraction image (July 2002). This paper demonstrates that the LSMM variables can be used as a substitute for the standard vegetation indices (EVI and NDVI) to determine and delimit risk areas for B. glabrata and schistosomiasis in MG, which can be used to improve the allocation of resources for disease control.

The Estrada Real project and endemic diseases: the case of schistosomiasis, geoprocessing and tourism

Geographical Information System (GIS) is a tool that has recently been applied to better understand spatial disease distributions. Using meteorological, social, sanitation, mollusc distribution data and remote sensing variables, this study aimed to further develop the GIS technology by creating a model for the spatial distribution of schistosomiasis and to apply this model to an area with rural tourism in the Brazilian state of Minas Gerais (MG). The Estrada Real, covering about 1,400 km, is the largest and most important Brazilian tourism project, involving 163 cities in MG with different schistosomiasis prevalence rates. The model with three variables showed a R² = 0.34, with a standard deviation of risk estimated adequate for public health needs. The main variables selected for modelling were summer vegetation, summer minimal temperature and winter minimal temperature. The results confirmed the importance of Remote Sensing data and the valuable contribution of GIS in identifying priority areas for intervention in tourism regions which are endemic to schistosomiasis.

Spatial distribution of Schistosoma mansoni infection before and after chemotherapy with two praziquantel doses in a community of Pernambuco, Brazil

Praziquantel chemotherapy has been the focus of the Schistosomiasis Control Program in Brazil for the past two decades. Nevertheless, information on the impact of selective chemotherapy against Schistosoma mansoni infection under the conditions confronted by the health teams in endemic municipalities remains scarce. This paper compares the spatial pattern of infection before and after treatment with either a 40 mg/kg or 60 mg/kg dose of praziquantel by determining the intensity of spatial cluster among patients at 180 and 360 days after treatment. The spatial-temporal distribution of egg-positive patients was analysed in a Geographic Information System using the kernel smoothing technique. While all patients became egg-negative after 21 days, 17.9 percent and 30.9 percent reverted to an egg-positive condition after 180 and 360 days, respectively. Both the prevalence and intensity of infection after treatment were significantly lower in the 60 mg/kg than in the 40 mg/kg treatment group. The higher intensity of the kernel in the 40 mg/kg group compared to the 60 mg/kg group, at both 180 and 360 days, reflects the higher number of reverted cases in the lower dose group. Auxiliary, preventive measures to control transmission should be integrated with chemotherapy to achieve a more enduring impact.

Severe hypovitaminosis D is widespread and more common in non-diabetics than diabetics in Saudi adults

To compare the incidence of hypovitaminosis D in subjects, with and without type 2 diabetes mellitus [T2DM], and determine its association to various risk factors. Three hundred and forty-one [177 non-diabetic, and 164 T2DM] Saudi adults were included in this cross-sectional study conducted at the Biomarkers Research Program [BRP] of King Saud University, Riyadh, Kingdom of Saudi Arabia from March to August 2009. Anthropometrics and fasting blood samples were obtained. Fasting glucose [FG] and lipid profiles were determined. Serum 25-hydroxy vitamin D [25[OH]D] and parathyroid hormone [PTH] were quantified using enzyme-linked immunosorbent assay. Severe hypovitaminosis D was defined as serum 25[OH]D with levels <12.5 nmol/l. Age was the most significant predictor of 25[OH]D in both groups, explaining 25% [p=0.0005] and 16% of variances [p=0.0005]. Waist-hip ratio, systolic blood pressure and body mass index were significant predictors of 25[OH]D among non-diabetics after age adjustment, explaining 21% of variance perceived [p=0.039]. Serum PTH levels were higher in non-diabetic men and women. Severe hypovitaminosis D is prevalent in both non-diabetic and diabetic Saudis, but was more common in the young and middle-aged non-diabetics. The study further underscores the need for vitamin D fortification of the Saudi diet, and the promotion of vitamin D supplementation in both groups

Estudo da anomalia de Pelger-Huët em núcleo familiar: [carta ao editor] / Pelger-Huët anomaly study in a family: [letter to the editor]

The Pelger-Huët anomaly is a dominant autosomal disease, characterized by the incomplete segmentation of the granulocytes nucleus without lost of the cellular function. The heterozygotes form of this anomaly is assintomatic and it did not possess physic meant, while the homozygote form is rare and can be lethal, being therefore, important differentiates of other infectious alterations. The pseudo-anomaly can occasionally be observed in cases of granulocitic leukemia, mieloproliferatives Diseases, some infections and after exposition the determined drugs. We evaluate eleven members of a familiar nucleus and, after the blood cells analysis, six of then had presented neutrophils and eosinophils with nuclei characteristic of the heterozygotes form of the Pelger-Huët anomaly. The recognition of this leukocyte anomaly, mainly in patients without infection and presenting great number of not segmented neutrophils, can prevent wrong interpretations of the blood cells count and unnecessary clinical and therapeutically behaviors.

Bio-medical application of coherent X-ray scattering. a review

The article objective is to highlight the importance of the coherent scattering of x-rays photons in order to give prominence to this promising technology which can provide valuable information about the molecular structures of the biological tissues. This information can be exploited in assisting the diagnosis of some diseases in the near future. The soft tissues have well defined scattering patterns that are characteristics for the particular tissue types and tissue status. The crystalline materials such as urinary stones show sharp peak distributions with well defined scattering angles. The semi-crystalline and amorphous materials, such as body tissues gives rise one or more broad peaks. These peaks are due to the molecular interference effect. Two angular regimes have become distinct, wide angle X-ray scattering [WAXS] where the range of measurement is typically 2-120° and small angle X-ray scattering [SAXS] where intensities are measured between 0.001-2° [at the typical wavelengths used]. Due to the reciprocal nature of the relationship between scattering and atomic space, WAXS is used to characterise materials on an atomic scale whereas SAXS is used to examine larger structures such as molecules. The capability of the X-ray coherent scattering to provide the molecular information on the soft tissue has lead many researchers to investigate the possibility of exploiting coherent scattered x-rays as a diagnostics tool

Starting the program of basic and advanced, cardiac and trauma life support, will improve the emergency medical service in Iraq

In Iraq the emergency medical service has many problems. One of them is insufficient education and training of health care workers. The aim of our study was to assess the knowledge of basic and advanced cardiac and trauma life support among doctors in Medical City Teaching Hospital and to assess the value of these programs in improving the emergency medical knowledge of our doctors. This study was conducted in Medical City Teaching Hospital in Baghdad during the period [Jan.-Sep.2006] during which we started our own program of cardiac and trauma life support. 92 doctors who attended this program up until the end of the study were involved in the assessment. A questionnaire and three part questions were given to them, the questionnaire assessed knowledge about important emergency procedures, while the first, second and third part questions assessed knowledge about ACLS, BTLS and ATLS respectively. The same questions were given before giving the lectures and repeated afterwards. The results were evaluated by computer and the chi-squared test was applied. No one gained the pass mark in the ACLS, BTLS and ATLS questions before giving the lectures; after the lectures all participants succeeded in gaining the pass mark for the same questions. This low percentage of correct answers indicates more education and training are an urgent and important need in our country