Noninvasive markers of liver disease in patients with HBeAg negative chronic hepatitis B and normal enzymes

Background/aim: Liver biopsy, traditionally considered to be the reference standard for staging fibrosis, has been challenged over the past decade by the development of noninvasive methodologies. Noninvasive methods, initially studied and validated in patients with chronic hepatitis C, are now used increasingly for patients with hepatitis B. However, the usefulness of these markers in the prediction of liver fibrosis in HBeAg negative patients with normal enzymes still needs to be validated

Patients and methods: Patients with chronic hepatitis B attending the National Liver Institute Biopsy Unit from September 2010 to September 2013 were included in the present study. For patients with persistently normal alanine aminotransferase greater than 40 [69 patients], the following indirect biochemical indices were measured and compared with the biopsy result: aspartate aminotransferase to alanine aminotransferase ratio [AAR], fibrosis index based on the four factors, aspartate aminotransferase to platelet ratio index, AAR to platelet ratio index, fibroindex, and age-platelet index [API]

Results: A total of 50 patients suffered from nonsignificant fibrosis [METAVIR F0-F1] and 19 patients suffered from significant fibrosis. gamma-Globulin [P=0.001] and gamma-glutamyl transferase [P=0.007] were independent predictors of fibrosis. Analysis with receiver operating curve showed that none of the predictors had a powerful diagnostic value. API had the best sensitivity and specificity [sensitivity: 83%; specificity: 58%] for predicting liver fibrosis, followed by fibroindex [sensitivity: 75%; specificity: 54%]. Aspartate aminotransferase to platelet ratio index showed a low precision in identifying significant fibrosis, with an area under the curve of 0.6

Conclusion: None of the tested noninvasive indices could distinguish the significant liver fibrosis effectively. We suggest the use of platelets, gamma-glutamyl transferase and gamma-globulins, API, and fibroindex for monitoring disease severity and predicting prognosis. In suspicious cases, a more validated modality such as FibroScan can be performed

Genotypic detection of enterotoxin producing staphylococcus aureus in food

Staphylococcus aureus is one of the most commonly identified bacteria that cause food poisoning by virtue of its variety of enterotoxins, Nasal and hand carriage of enterotoxigenic Staphylococcus aureus is an important source of staphylococcal food contamination in restaurants, therefore it is important to detect Staphylococcus aureus carriage among foodhandlers to prevent possible food contamination .The objective of the study was to detect prevalence of enterotoxigenic strains of staphylococcus aureus among food handlers in Zagazig City and to evaluate phenotypic [SETRPLA] versus genotypic [multiplex PCR] methods for detection of the staphylococcal enterotoxins. Two hundred and seventy swabs of [nose, hand and axilla] were collected randomly from 90 food workers; 3 swabs from each food worker. The swabs were inoculated on Mannitol Salt agar an incubated aerobically for 24 hours. Any suspected Staphylococcus aureus colonies were systematically identified according to standard methods. Staphylococcus aureus isolates were subjected to SET-RPLA test using SET-RPLA Toxin Detection Kit for phenotypic detection of enterotoxin production and Multiplex-PCR to genetically detect enterotoxigenic strains. Carriage rate among the food handlers was 55.5% representing 50 Staphylococcal aureus isolates from 90 food handler, the proportion of contaminated samples among 270 swabs was 18.5% [50/270]. 38[76%] out of 50 isolates were found to be enterotoxigenic by SET-RPLA and 42 [84%] out of 50 staphylococcal isolates were found to be enterotoxigenic genotypically by multiplex PCR. The number of isolates was significantly higher in nasal swabs than in hand or axillary swabs [?[2] =36.87 and p=0.0000]. Using REPLA, the number of enterotoxin producing organisms was significantly higher in nasal swabs [91.2%] than in hand [38.5%] or axillary swabs [66.6%][?[2] = = 14.48 and p = 0.0007]. Type A enterotoxin was the most common type [48%] followed by type D [18%], then type C [6%] while the least type was type A+B [4%]. It also shows that type A+B was isolated only from nasal swabs [2.9%] and type D was not found in axillary swabs. Using Multiplex PCR, gene type a was the most common type [48%] followed by gene type d [22%] then gene type c [6%] while the least type was genes type a+ b [4%]. It also shows that gene types a+b and b+d were isolated only from nasal swabs [5.9% each]. Compared with multiplex PCR, specificity and positive predictive value of RPLA were 100%, while sensitivity was 90.48% and negative predictive value was 66.67%. This study concluded that nasal and hand carriage of enterotoxigenic S.aureus by food handlers is an important source of staphylococcal food contamination in restaurants and fast food outlets so it is important to detect S.aureus carriage among food handlers to prevent possible food contamination by them resulting in food poisoning.It also concluded that multiplex PCR is reliable and valuable method in detection of enterotoxigenic S.aureus strains and it is more sensitive and specific than SET-RPLA. This study recommended health education of food handlers to decrease contamination of their hands, settings training courses for food handlers to learn them the proper hand washing technique and frequent examination of food handler to find and treat. It also recommends screening food workers to identify staphylococcus aureas carriers and referring them to the appropriate health authorities for decolonization

Erectile dysfunction medication induced-changes in plasma levels of homocysteine and antioxidant enzyme activities as risk factors for cardiovascular disease

Objective: Drugs for erectile dysfunction [ED] act by vasodilatation. Hyperhomocysteinaemia is an independent risk factor for premature atherosclerosis, venous thrombosis and other cardiovascular diseases in both men and women. In addition, oxidative stress has long been regarded as a key pathophysiological mediator that eventually leads to cardiovascular disease, whereas oxidative stress is alleviated by antioxidant enzymes such as superoxide dismutase [SOD] and catalase. The aim of the present study was to determine the levels of plasma homocysteine and antioxidant enzymes in male rats given ED drugs

Methods: Male rats were given a daily dose of 1.48 mg/kg body weight sildenafil citrate [Viagra], 0.285 mg/kg vardenafil [Levitra] or 0.285 mg/kg tadalafil [Cialis] for 3 weeks, and plasma levels of homocysteine, SOD and catalase were measured; high- and low-density lipoproteins, total cholesterol and triglycerides were also determined

Results: The level of homocysteine was increased by 93% and 67% in plasma of sildenafil- and vardenafil-treated rats, respectively, whereas tadalafil did not change the level significantly. Sildenafil and vardenafil also increased SOD activity by 35% and 46%, respectively; and sildenafil, vardenafil and tadalafil increased the activity of catalase by 33%, 50% and 43%, respectively. A nonsignificant increase in the level of total cholesterol was seen after treatment with all the drugs, and sildenafil, vardenafil and tadalafil increased the levels of high-density lipids by 25%, 41%, and 25%, respectively

Conclusion: The ED medications sildenafil and vardenafil increase the levels of homocysteine and antioxidant enzyme activities. Tadalafil appeared to be safer than the other two drugs, as it did not change the level of homocysteine. Patients taking sildenafil or vardenafil should therefore be advised to take vitamin B12 and folic acid in order to reduce the level of homocysteine, as these vitamins play an important role in biotransformation of homocysteine into methionine

Bacteriological and immunological study in diabetic foot

Background: Diabetes mellitus is increasing rapidly through the world, so the diabetic foot syndrome become more and more important as a major diabetic complication

Objectives: The aim of study was to determine the association between the up-regulation of circulating level ofIL-6 in diabetic patients with foot ulcer compared with diabetic patients without foot ulcer

Subjects and methods: The study included 60 subjects, they were divided into three groups; group I included 20 diabetic patients without foot ulcer syndrome, group II included 20 diabetic patients with diabetic foot ulcer syndrome [DFUS] and group HI included 20 apparently healthy subjects as a control. All subjects were subjected to clinical assessment, routine laboratory investigations and specific investigations including assay of glycosylated haemoglobin, serum IL-6 and bacteriological culture and sensitivity for ulcer

Results: There is no significant difference among the three studied groups regarding the gender, age, duration of the disease and type of treatment. There was significant difference between group I and other groups regarding hypertension [p<0.02]. There was no significant difference between the three studied groups regarding WBC. There was a significant difference between the three studied groups as regards neutrophils and platelets counts f [p=0.009] nd [p=0.03] respectively. There was a highly significant difference between the three studied groups as regards Hb concentration [p<0.001]. There was a highly significant difference [p<0.00l] between group II and both group I and group III as regards ESR [43 +/- 77.2, 13+/-3.9, 11+/-3], random blood sugar [RBS] [319.7+/-47, 238+/-47.8, 92.5+/-10.8], glycosylated haemoglobin [HbAlc] [9.93+/-1.35, 8.83+/-1.4, 4.6+/-0.6], Urea [49.9+/-37, 52.5+/-41, 20.6+/-2.4] and IL-6 [18.9+/-5.6, 4.9+/-2.7, 2,77+/-I].There was positive significant correlations [p<0.001] between IL-6 and levels of RBS [r=0.72], and HbAlc [r=0.62], respectively. Also, a positive significant correlation between IL-6 and neutrophils% [r=0.35, p<0.005] was found The most common isolated microorganisms from foot culture were mixed gram + ve cocci and gram -ve bacilli representing 60% and lonely gram + ve cocci and gram -ve bacilli were 20% respectively. Also, it was found that the most gram +ve organism was Staphylococcus aureus and the most gram -ve organism was E. coll and the most effective antibiotic was Ampicillin-Sulbactam 70% followed by Imipenem 30%

Conclusion: Diabetic patients with foot ulcer were found to have higher IL-6 level than diabetic patients without foot ulcer and they were prone to complications or mortality. This assay could facilitate early and accurate diagnosis and greatly aid timely institution of appropriate treatment

Helicobacter pylori Infection and its response to treatment in diabetic Patients versus non diabetics

Background: H. pylori has been recognized as a public health problem worldwide affecting approximately 50% of the world population and more prevalent in developing than the developed countries. It is a common infection in diabetic patients

Aim of the work: The study designed to study the prevalence of H. pylori infection in diabetic patients in comparison with non diabetic patients and the response to treatment ofH. pylori in both groups

Methods: WO patients were enrolled in the study. They were classified into 2 groups: Group [I] 50 patients complaining of dyspepsia with DM, and group [2] 50 non-diabetic patients complaining of dyspepsia. Serum H.pylori IgG antibodies and stools H.pylori antigen were determined for all patients by Gen Way H. pylori IgG ELISA and OneSite H pylori rapid test respectively

Results: H. Pylori stools Ag was positive in 58% of diabetics and 40% of non diabetics with no significant difference [P value 0.085]. Serum H.pylori Ig G were significantly positive in diabetes [52%] compared to non diabetic patients [32%]; P value 0.05. HE Ale was significantly higher in diabetics positive H.pylori cases compared to diabetics negative for H.pylori. Change in the HBAlc blood level before and after H.pylori treatment was highly significant in diabetic cases [P value <0.001]

H.pylori was more resistant to treatment in diabetic patients compared to non diabetics

Conclusion: No significant difference between both diabetics and non diabetics regarding prevalence of H pylori infection. Type 2 diabetic patients showed a significantly lower eradication rate than non diabetic patients. Successful eradication of H pylori infection significant I improve HBAlc

Haematological side effect of Helicobacter pylori eradication

The effect of Helicobacter pylori infection on systemic disorders is not well understood. This study was to evaluate the effect of H. pylori eradication on blood count, differential leucocytic count and RBCs indices. In this study, atotal of 115 H. pylori positive patients underwent eradication triple therapy for one week, with cured 100 patients. Complete blood count, RBCs indices and differential leucocytic count were analyzed before 2 and 12 weeks after eradication for the cured patients. The results showed that two weeks after H. pylori eradication, platelets count significantly increased but total leucocytic counts and neutrophils were significantly reduced. After three months, RBCs count, Hb concentration, MCV and MCHC were significantly increased, but lymphocytic counts was significantly reduced

Portal vein parameters in Egyptian patients with spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis [SBP] is a severe complication of cirrhosis and the role of portal hypertension in the development of SBP has been suggested. This study assessed the portal vein [PV] haemodynamic changes in patients with SBP. The study was conducted on 20 ascitic patients with SBP [GI], 20 ascitic patients without SBP [GII], 20 cirrhotic patients without ascites [GIII] and 20 healthy cross-matched controls [GIV]. All groups were subjected to complete clinical assessment and routine laboratory investigations. Portal vein diameter, velocity and congestion index [CI] were assessed by Doppler ultrasound. The results showed no significant difference between SBP patients and ascitic patients without SBP as regard PV diameter, velocity or CI. Portal vein diameter was significantly wider in patients with SBP [14.9 +/- 2.08 mm] and cirrhotic ascites [14.15 +/- 2.3] than normal persons [10.5 +/- 2.24 mm] or cirrhotic compensated patients [13.15 +/- 1.6mm]. The mean velocity of PV was significantly lower in patients with SBP [10.4 +/- 2.11] and ascites [10.7 +/- 2.22] than normal persons [15.35 +/- 2.08] or cirrhotic compensated patients [14 +/- 2.6], with no significant difference between controls and cirrhotic compensated patients. The CI of PV was significantly higher in patients with SBP [0.1825 +/- 0.036] and ascites [0.1743 +/- 0.051] than controls [0.05 +/- 0.050] or cirrhotic compensated patients [0.0955 +/- 0.091]. Cirrhotic compensated patients showed significantly wider PV [13.15 +/- 1.6] and higher congestion index [0.0955 +/- 0.091] than normal persons [10.55 +/- 2.24 and 0.05 +/- 0.050 respectively]

Serum levels of adiponectin and resistin in obese children: relationship with insulin resistance

Adiponectin and resist in are fat cell-derived hormones, which are thought to be respectively protective and disadvantageous with regard to the development of cardiovascular disease and diabetes mellitus type 2. The aim is to study the relationship between insulin resistance and serum adiponectin and resistin in obese children. A total of 60 obese and 30 nonobese children were enrolled and serum levels of adiponectin and resistin were measured by enzyme immunoassay. Compared with controls, higher insulin resistance by homeostasis model [HOMA-lR] and lower whole body insulin sensitivity index [WBISI] were found in obese children [all p=0.000]. The acliponectin levels in obese children and controls were 3.41 +/- 1.93 and 5.21 +/- 3.1 micro g/L with a significant difference [p=0. 001], while the difference of resistin levels was not significant [p=0.963]. Significant correlations between insulin resistance parameters [HOMA-lR and WBISI] and age, sexual development, body mass index, serum triglyceride, HDL-cholesterol, LDL-cholesterol, alanine aminotransferase, uric acid, or adiponectin levels [all p<0.05] were noted. On the other hand there was no significant correlation between insulin resistance parameters and serum levels of resistin[p>0.05]. In conclusion, These results suggest that adiponectin may play a protective role in obese children through decreasing insulin resistance

Efficacy of technical nursing concern on prevention and management of pressure ulcers

This study aims to evaluate the efficacy of technical nursing concern on prevention and management of pressure ulcers. A quasi-experimental design was used in the conduction of this study as a research methodology. The study was conducted in the following units [oncology, intensive care, orthopedic, neurological and bum at children hospital, Ain Shams Hospital, El-Demerdash Hospital, El-Mataria Hospital and New Children Hospital. A purposive sample included 100 pediatric nurses, 80 medical-surgical nurses, 75 child aged from 6-18 years plus 50 adult patients without pressure ulcers at admission and 50 child plus 50 adult patients having ulcers from the aforementioned settings. Different tools were used for data collection [pre/post tests]; 1] Self-administered questionnaire to assess nurses' knowledge, 2] An observation checklist to assess nurses' practice, 3] The Braden scale for predicting risk of pressure ulcers; 4] Pressure ulcers assessment scale and 5] Pressure ulcers healing scale. The study revealed that there were highly statistically significant differences between knowledge and practice of nurses in different settings about pressure ulcers [prevention and management] in pre/ post tests. Increasing technical nursing concern through educational program had a positive effect on prevention and management of pressure ulcers. The educational programs and workshops about pressure ulcers [prevention and management] are needed. Further studies are needed to shed light on non-traditional methods of pressure ulcers management

Comparative study of 1540-nm non-ablative fractional erbium laser versus 2940-nm ablative erbium: YAG laser in resurfacing of post-acne scarring

Atrophic post-acne scarring remains a therapeutically challenging problem despite various currently available technologies. Although ablative laser skin resurfacing is an effective treatment for post-acne scarring, however the long downtime and post-treatment complications are common. Non-ablative fractional laser is a novel concept of cutaneous resurfacing based on microthermal zones heating for collagen remodeling without burning the epidermis. The objective of this study is to compare between 1540-nm non-ablative fractional erbium laser versus 2940-nm ablative erbium: YAG laser in resurfacing of post-acne scarring as regard efficacy, tolerability and side effects. A total of thirty patients [skin phenotypes III to V] with facial post-acne scarring were divided into two equal groups who received either 2-3 sessions of ablative erbium: YAG laser or 6-9 sessions of non-ablative fractional erbium laser with 3 months follow up. Assessment of the clinical improvement of the scars and development of any complications were done in addition to the degree of subjective satisfaction. In our series, the overall average clinical improvement was 76% and 75% among the ablative and fractional groups respectively while, the incidence of post-treatment sequelae and complications was higher and of longer duration in the ablative laser group. Both techniques have near similar post-acne scarring resurfacing capacity, however, treatment with ablative erbium laser has the advantages of predictable clinical improvement within shorter time but with longer downtime and increased risk of side effects namely oozing, crustation and hyper-pigmentation especially in the dark skin types and its limited use during winter. On the other hand, the fractional laser efficacy was not as impressive as issued by others in addition to the long treatment course. Meanwhile, it has the advantages of minimal downtime and fewer side effects with short term adverse sequelae even in dark skin types with its safe use all over the year

Polyacrylamide hydrogel as a long-lasting and permanent soft tissue filler, 4 years experience

Soft tissues augmentation has been tried for decades and many materials were used including biological and artificial fillers. Many synthetic injectable augmentation fillers were used but unfortunately, none of them was ideal. Polyacrylamide gel [PAAG] is a group of non-absorbable, long-lasting, non allergic, malleable and relatively cheap soft tissue fillers that have been extensively used in the Europe, Middle East and many countries for more than 10 years with satisfactory augmentation results and few complications on the short-term follow-up duration. In this study, we report more than 4-years experience in using two types of injectable PAAG for facial and body soft tissue augmentation, We used Bio-alcamid for facial augmentation and Esteform for lower limb augmentation. A total of 618 patients were injected with PAAG. Bio-alcamid was used to augment different areas in the face in 571 patients. It was injected into the malar, nasolabial lines, buccal, lateral face, chin and temples, while Esteform was injected in the gluteal areas, thighs and legs in 47 patients. The follow-up period ranged between 15 and 48 months. The early post-procedure [after 2 weeks] augmentation results showed that 96.1% [594 patients] expressed satisfaction but the later aesthetic results and satisfaction were decreased over the follow-up time. Among our series, 73 patients [11.8%] required more than one session of injection either for more augmentation [52 patients = 8.4%] or touch up to correct asymmetry or irregularities [21 patients =3.4%]. The overall incidence of the reported complications was 6.6%, where 41 patients had developed delayed adverse reactions at or near the injection sites. 7 out of these 41 patients developed multiple complications along the follow-up period. Nodularity, infection, migration, induration and disfigurement represented the most common reported complications and were treated with either surgical or conservative treatment. PAAG is long lasting filler that gives high rate of early satisfaction but with several delayed adverse effects. It is not safe, especially in the face, and needs certain precautions to minimize its related complications. These complications usually occur months or even years after injection and are difficult to treat, which is why the best way to minimize complications is to avoid these types of fillers

efficacy of Hepatitis B Vaccine among previously vaccinated Egyptian children

Hepatitis B virus [HBV] infection is a serious global health problem, with 2 billion persons infected worldwide, and 350 million suffering from chronic HBV infection. Vaccination by hepatitis B [HB] vaccine has been implemented in the Egyptian Extended Program for Immunization since 1995. This work aimed to evaluate the efficacy of hepatitis B vaccine to previously vaccinated children after 5 years from vaccination, to study the effect of vaccine dose response [0.25ml/dose vs. 0.5ml/dose] as well as to study children's response to a booster dose. This study was carried out on 315 neonates immediately after birth, 173 out of them received 0.50 ml/dose of Engerix-B vaccine and the remaining 142 children received 0.25 ml/dose of the same vaccine. All studied children received vaccine at birth and later on at one month and at six months of age. After 5 years, these children were subjected to several investigations including qualitative and quantitative determination of antibodies to hepatitis B surface antigen [anti-HBs], qualitative determination of hepatitis B surface antigen [HBsAg], hepatitis B core antibodies [anti-HBc, IgG], hepatitis Be antigen [HBeAg], hepatitis Be antibodies [anti-HBe], antibodies to hepatitis C virus as well as antibodies to hepatitis D virus. After 5 years of vaccination 30 children retained anti-HBs seropositivity [9.5%] with anti-HBs titers >/= 10 mlU/mL while the other 285 children [90.5%] lost protective anti-HBs titers [non-immunized]. Eighty seven of the non-immunized children received 0.50 ml of the vaccine as a booster dose to detect their response. After 45 days from this booster dose they were retested for anti-HBs. Initially 30 of these children received 0.25 ml of the vaccine and the other 57 children received 0.50 ml in infancy. The results revealed that 44 [50.6%] children were converted to anti-HBs seropositive while the other 43 [49.4%] children remained anti-HBs seronegative, i.e., non-immunized. The titers of anti-HBs varied greatly in the converted group. Therefore, 90.5% of the vaccinated children showed non-detectable levels of anti-HBs after 5 years, and about 50% of them are in need of more than one booster dose. It could be concluded that our findings mandate an action towards providing booster dose/s to our children at the age of 5 years or earlier. Non responders may respond to a booster dose double the dose of the vaccine or respond to repeated booster doses. Vaccine dose, inspite of being effective in the primary response to the vaccine, no significant difference of children's response was observed towards the two used doses, they lost protective antibodies after 5 years of vaccination

Psychosocial problems and EEG findings in children with end stage renal failure

Psychosocial disturbances are most commonly encountered problems in children with chronic renal failure and end stage renal disease but little is known about the prevalence in Egypt. The present study aimed to assess the psychosocial functioning level and EEG findings in children with chronic renal failure whether on conservative therapy or undergoing chronic dialysis. Fifty four patients with end-stage renal disease were divided into three groups: Group I: twelve patients on regular hemodialysis three times weekly. Group II: twelve patients on continuous intermittent peritoneal dialysis [CIPD]. Group III: thirty patients with CRF on conservative treatment [CTr]. The patients and controls [13 children] were assessed for psychosocial problems including depression [Children's Depression Inventory], anxiety [Children Manifest Anxiety Scale], phobia [Phobic scale for children], behavioral disturbances, and intelligence [IQ]. Also EEG was done for patients with CNS manifestations. Psychiatric diagnosis on axis I according to DSM-IV showed that HD group had more prevalent major depression compared to other CRF groups. As regard social difficulties, no significant differences were detected statistically between CRF group and control group but HD group was more significantly complaining from social difficulties than CTr and control groups. The depression was more common in HD and PD groups than CTr group with no statistically significant difference. Severe anxiety symptoms were more common among HD patients with high significant difference than CTr and control. Differences between the studied groups as regard phobic scale revealed that phobia was significantly more common among HD, CTr and CRF groups in relation to control group. The patients on HD had more fear of illness than those on PD or CTr with no statistically significant difference but a highly significant difference was found between CRF groups and control. Behavioral disturbances were more common in HD and PD groups than controls with statistically significant difference in between [p=0.05]. Nocturnal enuresis [NE] of primary type was more prevalent in HD and PD groups than CTr group with significant difference in between. Also NE was more prevalent in CRF groups than control with significant difference between HD and PD groups and controls. Statistically significant correlation [border line] was detected between NE and age of onset with higher rate of primary NE among children with early age at onset of the illness [<6y]. The highest mean of IQ was found in the control group with significant difference between it and CRF group [p<0.001]. The IQ was negatively correlated with duration of the disease [p<0.01], and age of onset of CRF [p<0.001]. The school leavers and failure were more common among RD and PD groups than conservative group [p<0.01] and control [p<0.001]. Differences between studied groups as regard global assessment score showed that HD group had lower score than other CRF groups with no significant difference but a significant difference was found between CRF groups and controls [p<0.001]. EEG findings revealed generalized slow wave activity in EEG [generalized low voltage] in all patients whether on hemodialysis [11 patients] or on conservative treatment [14 patients]. Activity of Beta and Alpha waves are mostly poor with generalized Theta and Delta waves. Psychosocial disturbances are commonly encountered problems in children with end stage renal disease. Depression was more common among HD and PD patients. High rates of phobia on phobic scales, phobia of illness, severe anxiety and behavioral disturbances were found among CRF groups. Multiaxial assessment showed significant differences in psychiatric diagnosis, educational difficulties and global function with higher rate in CRF children. Nocturnal enuresis was significantly higher among CRF children and correlated with the age at onset of illness and social difficulties. Thus proper medical support and rehabilitation programs to guard against psychiatric troubles, their causes, and their sequalae are recommended including transporting vehicles, hospital based educational programs, summer camps, peer socialization, and others

Phenotype and genotype of some clinical group B streptococcus isolates resistant to erythromycin in Egypt

The aim of the study was to determine susceptibility of group B streptococci [GBS] to commonly used antibiotics and to determine the phenotype of macrolide resistance correlating it with the genotype. 220 group B streptococcus strains were subjected to antibiotic sensitivity disc diffusion method to penicillin, ampicillin, ceftriaxone, tetracyclines, erythromycin [E] and clindamycin [CD]. Erythromycin resistance phenotype was done by double disc diffusion test. Erythromycin resistance mefA, ermB, and ermTR genes were determined using multiplex PCR. The results revealed that all strains were sensitive to penicillin, ceftriaxone and ampcillin. 161 [73%], 38 [17%] and 24 [11%] strains were resistant to tetracyclines, erythromycin and clindamycin respectively. 15 [39.5%] were resistant to E alone [M phenotype]. M phenotype strains were associated with mefA gene. 23 [60.5%] isolates were resistant to both E and clindamycin [CD]. 9 [23.7%] strains were inducibly resistant to clindamycin [iMLSB] and all had ermTR gene.. 14 [36.8%] were constitutively resistant to clindamycin [cMLSB]. cMLSB strains have different genotypes. 7 strains were ermB genotype. 4 strains were ermTR genotype. 2 strains had both ermB and ermTR genes while only one strain had both ermB and mefA genes. Only 1 strain was resistant to clindamycin but sensitive to E. MefA was detected in 16 [42%] E resistant strains. ErmTR was also detected in 16 [42%] E resistant strains. ErmB was detected in 10 [26%] E resistant strains. 31[82%] E resistant strains contain single resistance gene while 7[18%] resistant strains contain more than one resistance gene. The study findings conclude that GBS isolates remain uniformly susceptible to penicillin and ampicillin but he erythromycin resistance has reached substantial level. The study recommends that testing of susceptibility to erythromycin and clindamycin by double disc diffusion method should be performed in individual cases when considered as alternatives for prophylaxis and treatment of GBS infection or colonization because strains with inducible MLSB cannot be detected with the conventional disc diffusion method

Slime forming staphylococcus epidermidis isolated from orthopedic prosthesis infections and its sensitivity to antibiotics

Staphylococcus epidermidis [S.epidermidis] is a frequent cause of infections of indwelling medical devices especially those with orthopedic implants. S.epidermidis grows on medical devices as an adherent biofilm consisting of cells enmeshed in a sticky, extracelluar slime that is firmly attached to the underlying surface. The slim matrix makes S.epidermidis biofilm highly resistant to antibiotics and host defenses and nearly impossible to eradicate. The aim of the study is to determine importance of slime formation in S. epidermidis orthopedic prosthesis infections and to investigate if slime formation has an effect on its antibiotics sensitivity. 80 coagulase negative staphylococcus strains [CoNS] were isolated from 200 tissue specimens of patients with orthopedic prothesis infections. Out of these 80 CoNS, 52 [65%] strains were S.epidermidis. Isolated S. epidermidis were plated on Congo red agar and subjected to PCR to detect icaA and icaD genes to identify and confirm slime producing strains respectively. All biofilm producing strains were subjected to MIC and MBEC using Calgary Biofilm Device[CBD]. 36 [69%] S. epidermidis strains were slime [biofilm] producers and 16 [31%]strains were non slime [non biofilm] producers by CRA, while by PCR 39[75%] strains of S. epidermidis were biofilm producers and 13 [25%] strains were non biofilm producers. The results also revealed that the minimal biofilm eradication concentrations [MBECs] were higher than the corresponding conventionally determined MICs for all antibiotics tested. MIC 50 and MBEC 50 for vancomycin, were 2 micro g/ml versus 8 micro g/ml, gentamycin, 1 micro g/ml versus 32 micro g/ml, oxacillin, 4 micro g/ml versus 16 micro g/ml, erythromycin, 8 micro g/ml versus 64 micro g/ml, ciprofloxacin, 0.5 micro g/ml versus 2 micro g/ml and cephalothin 4 micro g/ml versus 16 micro g/ml. MIC90 and MBEC90 for vancomycin were 4 micro g/ml versus16 micro g/ml, gentamycin, 16 micro g/ml versus 128 micro g/ml, oxacillin, 8 micro g/ml versus 128 micro g/ml, erythromycin, 16 micro g/ml versus 128 micro g/ml, ciprofloxacin, 4 micro g/ml versus 8 micro g/ml and cephalothin 32 micro g/ml and 128 micro g/ml. The results of the present study confirm that ica genes can be considered a virulence marker in the pathogenesis of implant associated orthopedic infection by S. epidermidis. This study also demonstrates marked differences between the results of susceptibility testing performed according to standard NCCLS guidelines and testing based on biofilm susceptibility testing

Assessment of T helper 1 and T helper 2 cytokines and their correlations with viral load in HCV patients co-infected with S. mansoni

The aim of this study was to investigate the effect of infection with S. mansoni on the balance between Th-1 and Th-2 cytokines in patients with chronic hepatitis C virus [HCV] infection and to show the relations between these two groups of cytokines to the degrees of viral load in these patients. 44 individuals were classified into 4 groups: group I of control subjects [n=10], group II of patients with S. mansoni mono-infection [n=9], group III of patients with chronic HCV mono-infection [n=13] and group IV of patients with both S. mansoni and HCV co-infection [n=12]. For individuals of all studied groups, interferon-gamma and IL-2 [cytokines of Th-1 cells] and IL-4 and IL-10 [cytokines of Th-2 cells] were measured. Viral load was measured for patients of group III [HCV mono-infection] and group IV [co-infected patients]. The results showed that Th-1 cytokines [IFN-gamma and IL-2] were significantly higher in HCV mono-infection patients and significantly lower in patients co-infected with HCV and S. mansoni compared to normal subjects group. In S. mansoni mono-infection group, IFN-gamma was decreased while IL-2 was normal compared to normal control group. Th-2 cytokines [IL-4 and IL-10] were significantly higher in the three patients groups compared to the control group but the degree of increase of IL-4 showed no significant difference between S. mansoni mono-infection patients and HCV mono-infection patients while the degree of increase of IL-10 was higher in S. mansoni mono-infection patients compared to HCV monoinfection patients. The degree of increase of both IL-4 and IL-10 was significantly higher in the coinfection patients compared to the HCV mono-infection patients. Viral load was significantly higher in the co-infected group compared to HCV mono-infection group and in both groups, the viral load was positively correlated with Th-2 cytokines and negatively correlated with Th-1 cytokines [except IL-2 in the group of HCV mono-infection patients]. In conclusion, these results suggest that HCV patients co-infected with S. mansoni suffer from strong activation of Th-2 cells and so increase of Th-2 cytokines that suppress Th-1 cells and related cytokines which is the type of immune response needed in face of HCV. This Th-1/Th-2 imbalance allows more viral replication and higher viral load in these patients compared to HCV patients who are not co-infected with S. mansoni and this may give an explanation to the rapid hepatic deterioration of these co-infected patients

Rapid diagnosis and characterization of diarrheagenic Escherichia coli in Egyptian children using multiplex PCR

Escherichia coli [E.coli] is the most important etiologic agent of childhood diarrhea and represents a major public health problem in developing countries. Aim of this work was to investigate the role of diarrheagenic E.coli in Egyptian children below 5 years age using multiplex PCR and to evaluate multiplex PCR in rapid diagnosis of enteric infections caused by diarrheagenic E.coli strains. Rectal swabs were taken from 83 children under 5 years age with diarrhea and 33 age-matched controls. All E.coli isolates were O serotyped using E.coli O polyvalent and monovalent antisera and subjected to multiplex PCR assay with specific primers, eae primer of eaeA [gene of intimin of EHEC and EPEC], primer bfpA of bfpA [structural gene for the bundle-forming pilus of EPEC], primers VT1 and VT2 of vt1 and vt2 genes [genes of shiga toxins 1 and 2 of EHEC respectively], primer LT of eltB [gene of labile toxin of ETEC], primer ST for estA [gene of stable toxin of ETEC], primer SHIG of ial [invasion-associated locus of the invasion plasmid found in EIEC] and primer EA of pCVD [the nucleotide sequence of the EcoRIPstI DNA fragment of pCVD432 of EAEC]. The study revealed that diarrheagenic E.coli strains were significantly isolated from patients more than control using multiplex PCR. Out of 70 E.coli strains isolated from patients, 17[24.3%] isolates were proved to be diarrheagenic by multiplex PCR where 53 [75.7%] isolates were non diarrheagenic. Out of 30 E.coli isolates recovered from control group, 1 [3.3%] isolate was proved to be diarrheagenic by multiplex PCR where 29 [96.7%] isolates were non diarrheagenic[Chi-square=18.5 and p

Interleukin-1 receptor antagonist among chronic renal failure pediatric patients with and without hemodialysis

During hemodialysis [HD], human blood leucocytes in circulation are exposed to several extraneous challenges, thus stimulated to secrete many inflammatory cytokines and its inhibitors as inter-leukin-1 and interieukin-1 receptor antagonist [IL-Ira]. The aim of this study was to investigate difference in the level of IL-IRa synthesis by peripheral blood mononuclear cells [PBMC] between CRF patients under conservative treatment and CRF patients under hemodialysis, and if this cytokine-specific inhibitory protein of PBMC can be used as a marker of dialysis related morbidity. The study included 44 subjects divided into 3 groups: [A] control group, [B] Chronic renal failure[CRF] under conservative treatment, [C] CRF under HD. Peripheral blood mononuclear cells [PBMC] were separated by ficoll-Hypaque. Spontaneous and Phytohemagglutinin [PHA] stimulated total IL-1Ra synthesis [cell-associated and secreted] by cultured PBMC was measured using EL-ISA method. The results of the study revealed that there were significant spontaneous total IL-IRa synthesis by PBMC in dialysis patients [group C] 2812 +/- 836 and in patients with conservative treatment [group B] 1791.2 +/- 252 compared to control group [group A] 940 +/- 227.8 [P value <0.001]. There were significant spontaneous total IL-IRa synthesis by PBMC in dialysis patients [group C] 2812 +/- 836 compared to patients with conservative treatment [group B] 1791.2 +/- 252 [P value <0.001]. There were significant PHA stimulated total IL-IRa synthesis by PBMC in dialysis patients [group C] 34041 +/- 8906 and in patients with conservative treatment [group B] 8565 +/- 1244 compared to control group [group A] 2980 +/- 608 [P value <0.001]. There were significant PHA stimulated total IL-IRa synthesis by PBMC in dialysis patients [group C] 34041 +/- 8906 compared to patients with conservative treatment [group B] 8565 +/- 1244 [P value <0.001]. There was positive correlation between PHA stimulated total synthesis of ILIRa and spontaneous total synthesis of ILIRa by PBMC in the 3 groups [P value <0.001]. There was significant correlation between IL-IRa [spontaneous and stimulated] with blood pressure, urea and creatinine level [P value <0.001]. This study concluded that PBMC of CRF patients synthesize significant level of IL-IRa compared to PBMC of healthy subjects. Also, PBMC of CRF patients on HD synthesize significant level of IL-IRa compared to PBMC of CRF under conservative treatment. Lastly, IL-IRa synthesis by PBMC of CRF patients was correlated with blood urea, serum creatinine and blood pressure level

Anatomical sites of radial nerve compression

This study was designed to determine the anatomical sites of radial nerve compression, and consisted of 30 upper limb specimens dissected to expose the radial nerve throughout its course through the arm and forearm and was photographed. The radial nerve was found to be crossed at least at one site in each specimen, it was found crossed by muscle bundles in the radial tunnel in 12 specimens [40%] and as it pierces the supinator muscle in another 12 specimens, [40%] and was found crossed by vascular elements in 7 specimens [23.33%], in 5 specimens as it traverses the radial tunnel and in 2 specimens at the cubital fossa. Crossing fibrous bands were reported in 7 specimens [23.33%] in the radial tunnel, extending between the brachialis and brachioradialis muscles. We can conclude that radial nerve is crossed at various sites throughout its course through the arm and forearm, however, the commonest site being in the front of the lateral intermuscular septum [at the radial tunnel] and the commonest crossing element is the muscular bundles

study of HLA type II [DRB] by PCR in Egyptian rheumatoid arthritis patients

To assess the relationship between HLA-DRB1 and rheumatoid arthritis in Egyptian patients, 40 subjects ere examined; 26 were rheumatoid arthritis patients and 14 were normal persons. The patients were further subdivided into groups according to the Mean Grades of the Disease Activity. All patients and the controls were subjected to ESR estimation by Westgren's method, Rheumatoid factor testing and HLA-DRB1 typing by PCR. The DNA was extracted from whole blood. Exon 2 was amplified and checked by gel electrophoresis. For HLA-DRB1 allele detection, amplification products were subsequently hybridized using typing strips in which 37 sequence specific DNA probe lines and 2 control lines were fixed. There was a significant association between rheumatoid factor and the grade of disease activity. There was a significant association between HLA-DRB1 broad types *4 and *1 and the susceptibility to rheumatoid arthritis. HLA-DRB1 broad types *4 and *1 had significant higher frequencies in patients than controls. They were 40.4% and 21.2% in patients while were 10.7% and 3.6% in controls. P values were 0.04 and 0.003 respectively for them. HLA-DRB1 *0102 allele had shown a significant increase in group IV rheumatoid arthritis patients with a frequency of 50%. high relative risk, and a P value of 0.014