An unusual case of primary peritoneal adenocarcinoma

Primary peritoneal adenocarcinoma is sporadic with few cases cited in pre-existing literature. This cancer arises from the peritoneal epithelium lining of the abdomen, which is derived from extra ovarian mesothelium. It generally carries a poor prognosis. The treatment strategies are similar to ovarian serous papillary carcinoma. Report an incidental finding of primary peritoneal adenocarcinoma in a 39-year-old female army personnel, currently undergoing her chemotherapy and thriving. Exploratory laparotomy was done given the incidental finding of a mass on the contrast-enhanced computed tomography scan (CT). The mass was attached to the greater omentum, however, did not invade the mucosa of the transverse colon. Given this, part of greater omentum was removed. The findings of the immunohistochemical studies of the tumour are described within this report. The diagnosis of a primary peritoneal adenocarcinoma, stage II was established as no other primary site were found upon further investigation. The patient was treated with chemotherapy (carboplatin/paclitaxel) which was planned for 6 cycles. Otherwise, the patient had an uneventful postoperative course, is underway her chemotherapy regime and is planned for interim CT study to assess chemotherapy response. To conclude, isolated solitary primary peritoneal adenocarcinoma without peritoneal carcinomatosis, gastrointestinal manifestations and ascites are rare. This case, however, demonstrates the importance of its diagnosis, accurate evaluation and management.

Serum Cytokine Profile in Patients with Chronic Rhinosinusitis with Nasal Polyposis Infected by Aspergillus flavus

BACKGROUND: Fungi, especially Aspergillus flavus, can cause chronic rhinosinusitis with nasal polyposis and modulate host innate immune components. The objective of this study was to examine the serum levels of T helper (Th) cell subset Th1, Th2, and Th17 cytokines and total IgE in patients having chronic rhinosinusitis with nasal polyposis and Aspergillus flavus infection. METHODS: A case-control study including 40 patients with chronic rhinosinusitis with nasal polyposis and 20 healthy controls was conducted. Aspergillus flavus infection was confirmed by standard potassium hydroxide (KOH) testing, culture, and PCR. Serum samples of all patients and controls were analyzed for various cytokines (interleukins [IL]-1β, IL-2, IL-4, IL-6, IL-17, IL-21, IL-27, TGF-β) and total IgE by ELISA. Data from patients with Aspergillus flavus infection and healthy volunteers were compared using the independent t-test and non-parametric Mann-Whitney U test. RESULTS: Aspergillus flavus infection was found in 31 (77.5%) patients with chronic rhinosinusitis with nasal polyposis. IL-1β, IL-17, IL-21, and TGF-β serum levels were significantly higher in these patients than in controls; however, IL-2, IL-4, IL-6, and IL-27 levels were lower. Compared with nine (22.5%) patients without Aspergillus flavus infection, IL-17 level was higher while IL-2 level was lower in patients with Aspergillus flavus infection. Total IgE was significantly higher in patients with Aspergillus flavus infection than in controls. CONCLUSIONS: High levels of IL-17 and its regulatory cytokines in patients with chronic rhinosinusitis with nasal polyposis infected by Aspergillus flavus raise a concern about effective disease management and therapeutic recovery. Surgical removal of the nasal polyp being the chief management option, the choice of post-operative drugs may differ in eosinophilic vs. non-eosinophilic nasal polyposis. The prognosis is likely poor, warranting extended care.

Isolation, identification, characterization and antibiotic sensitivity profile of pathogenic Legionella pneumophila isolates from different water sources

Objective To investigate the prevalence, isolation, identification, characterization, antibiotic profile and pathogenicity of Legionellae isolated from various set of waters. Methods A total of 400 water samples were collected from different water sources. Water samples were pretreated using acid treatment followed by concentration and culture on buffered charcoal yeast extract agar. Parameters like ability of Legionella isolates to grow in various pH range, effect of different concentrations of chlorine and effect of different temperature optima were set up. Biochemical tests were performed to separate Legionellae into species. Antibiotic sensitivity tests and test for pathogenicity were also conducted on isolated strains. Results The rates of isolation of Legionella pneumophila (L. pneumophila) in different water sources were found to be 20% (lakes), 10% (ponds), 8% (water-tanks) and 1% (rivers). Most of the isolates could grow in variable pH 6–8 and it could also survive the normal level of chlorination and even at temperature of 42 °C. Isolated species of Legionellae resulted in identification of 5 different species, L. pneumophila being the dominant one. Strains of L. pneumophila were resistant to many antibiotics. Inoculation of Legionellae into intracerebral route of suckling mice revealed that L. pneumophila was the most virulent. Conclusions Serious and fatal L. pneumophila infections may be transmitted through water. Legionella can survive under various conditions in various water sources. L. pneumophila is the important pathogen causing human disease. Great challenge prevails to health care professionals because these Legionellae acquired antibiotic resistance to many routinely prescribed antibiotics.

Histological effect of bisphosphonate, vitamin D and olive oil on glucocorticoid induced osteoporosis [GIO] in albino rat

Background: Previous studies demonstrated that the prevalence of osteoporosis was 4% in women aged 50 to 59 years compared to 44% in women aged 80 years and older. Osteoporosis may be primary or secondary. Glucocorticoid induced osteoporosis [GIO] is considered among the most common causes of secondary osteoporosis. The present study aimed to assess if vitamin D and olive oil could be useful in the treatment of GIO as bisphosphonate

Materials and Methods: Fifty adult female albino rats weighing 180-220 grams and aged 16-19 weeks were divided into five groups [each consists of ten rats]: the control group, osteoporotic group, bisphosphonate group, vitamin D group and olive oil group. The first group served as a negative control group. The other four groups were injected subcutaneously by methyl-prednisolone [0.5 mg/kg/day - three times a week] for 60 days to induce osteoporosis [glucocorticoid induced osteoporosis "GIO"]. One of the four groups served as a positive control group while other three groups were treated with oral bisphosphonate [0.84 mg/kg/day - five days a week], oral Vitamin D3 [0.1 ug/kg/day - five days a week] and oral Olive oil [0.1 ug/kg/day - five times a week] respectively for additional 60 days. At the end of the experiment, the right femur was removed from each rat and examined histologically after staining by hematoxylin and eosin stain as well as Masson's trichrome stain. The stained sections were photographed and analyzed to assess cortical bone thickness, osteocyte number and osteocyte lacunae

Results: By comparing the cortical thickness in all groups we detected a significant difference between bisphosphonate group and the control group, as well as between the GIO group and the control group. We also found a significant decrease in osteocyte number by comparing the GIO group to the control group. There was as a significant difference between vitamin D group and control group when we compared the number of osteocyte lacunae in all groups

Conclusion: GIO affects mainly the cortical bone thickness as well as the osteocyte number. Bisphosphonate is possibly the drug of choice in the treatment of osteoporosis especially by increasing the cortical bone thickness. Although olive oil acts also on increasing cortical bone thickness as well as bisphosphonates but it was less effective. On the other hand, vitamin D increases both; the cortical thickness and the osteocyte number moderately and may be used as a prophylactic agent against osteoporosis

Effects of George Ohsawaone [macrobiotic] on biochemical and haematological parameters other than prothrombin time and activated partial thromboplastin time in rabbits

Objective: To determine the effects of George Ohsawa One [GO1] on sodium, potassium, calcium, hemoglobin and platelet count in rabbits with and without anticoagulated blood

Study Design: Interventional study

Place and Duration of Study: This study was conducted at the Department of Pharmacology, FederalPost Graduate Medical Institute and National Health Research Complex, PMRC, Sheikh Zayed Hospital Complex, Lahore from January 2010 to August2011

Materials and Methods: Forty eight [n=48] male rabbits were included in the study. They were divided into two groups which were further divided into two subgroups each. About 700 grams of GO1 was used in the study

Results: The effect of GO1 on platelet count, hemoglobin, serum sodium, potassium and calcium were found to be insignificant

Conclusion: This work on the effect of GOI is first of its kind on biochemical and hematological parameters other than prothrombin time and activated partial thromboplastin time in rabbits measured quantitatively. Although theuse of herbal products may not be dangerous per se, further research work is required to explore the benefits of GO1 on biochemical and hematological parameters before it can safely be used in humans as an anti-hemorrhagic agent

Medications package inserts’ usefulness to doctors and patients: Sudanese doctors perspective.

Background: Written medication information is important for both doctors and patients. In the developing countries, the medication package inserts (PIs) represent the most available and easily accessible source of written medication information. The main objective of the present study was to assess the knowledge, attitude, and practice of Sudanese doctors toward written medication information in the PIs, and its usefulness for both doctors and patients. Methods: Four hundred (n=400) doctors were randomly selected and addressed with an open to answer the questionnaire composed of fifteen questions (n=15). Results: A big majority (95.7%) of the respondents considered the medications’ PIs, which they regularly read (93.2%), as a reliable and useful source of medication information in their prescribing. Only a minority of the respondent doctors (43.6%) used to advise their patients to read the PIs, whereas a majority (62.4%) of respondents believed that patients might find difficulty in understanding written medication information in the PI. The majority (61.3%) of respondent used to rely on pharmacists to provide patients with the needed medication information. The majority of the respondents (82.2%) used to inform their patients about the possible medication side effects. Respondents ranked medications’ dose (79.5%), how to use it (77.3%) and information about side effects (73%) on top of patients’ medication information most needed particulars. Conclusion: Doctors should give more attention to their patients’ medication information specific needs, advice and motivate them to read the PIs before using their medications.

Pharmaceuticals companies’ promotional brochures: do they display reliable and useful medications’ information.

Background: The main objective of this study which was the first of its kind in Sudan was the evaluation of the medication informational contents (section headings) of pharmaceutical companies’ promotional brochures, their possible benefits, reliability and usefulness in the proper and rational use of drugs. Methods: Three hundred and fifty-one (n=351) brochures were collected from randomly selected doctors’ clinics in Khartoum, Sudan. Ninety-two of those brochures were excluded for being either duplicates, reminder brochures, promoting medical devices or cosmetics. The remaining (259), were then screened to match their macro-informational contents (section headings) against same advised in world health organization ethical criteria for medicinal drug promotion. Results: Almost all the screened brochures displayed unbalanced and poorly evidence supported (48.2%) medication information messages, which minimized the risks of the promoted drugs (45.4%), while displaying section headings encouraging more use of the promoted products, in higher frequencies (93.66%).There was significant difference between the frequencies of display of medication information section headings of eight out of nine tested section headings, of a multinational and branded generic brochures (p. value ranged between 0.01 and 0.000). Conclusions: Screened brochures were found to display poorly reliable and unbalanced medication information. Healthcare providers shall, accordingly, seek independent medication information sources, and not solely depend on commercial sources of medication information. Official regulators shall strictly define and mandate medication information contents in printed pharmaceutical promotional materials. Healthcare providers should, also, master the skills of appraising such promotional printed materials if rational medication use is to be achieved.

Ameliorating effects of proglumide on neurobehavioral and biochemical deficits in animal model of status epilepticus

Status epilepticus [SE] is a recurrent generalized convulsion condition and is regarded as a medical emergency with around 50% of the cases occurring in children. Besides neurobehavioral and motor deficits, SE is reportedly associated with imbalance in a number of neurochemicals in several areas of the brain. Furthermore, neuronal hyperactivity and/or excitotoxicity in such brain areas have been associated with excessive generation of free radicals. Proglumide [Pgm] is a known cholecystokinin [CCK] antagonist and any changes in the level of CCK and in the number of CCK receptors has been linked with SE. The present study was designed to investigate the possible neuroprotective effects of Pgm [0, 250, 500 and 750 mg/ml/kg i.p.] on epileptic seizure activities, some neurobehavioral tests, and on some oxidative stress related parameters like lipid peroxides measured as thiobarbituric acid-reactive substance [TBARS] and total glutathione [GSH] in brain [hippocampus and striatum] of young rats that were experimentally induced with SE by lithium [Li] in 3 mEq/ml/kg dose, i.p. followed 20h later by pilocarpine [Pc] in 20 mg/ml/kg dose, s.c.]. Besides significant anti-epileptic effect, Pgm significantly ameliorated SE-induced deterioration in cognitive behavior [in water-maze], motor performance [on rotarod], and biochemical changes in brain. It is concluded from the present study that Pgm has significant neuroprotective effects against SE and this effect may probably be due to its antioxidant activity. Pgm may prove to be a potentially effective antiepileptic drug, however, further studies are needed to ascertain this possibility

Peritonsillar Abscess in Northern Nigeria: A 7 Years Review

Background: The aim of this study was to describe the clinico-epidemiologic profile of peritonsillar abscess (PA) seen in our center in northern Nigeria. Methods: This was a to retrospectively review of all patients with PA managed in our hospital over a 7-year period. Case notes were reviewed and information retrieved included biodata and clinical information were entered into an SPSS statistical software version 20.0 and analysed descriptively and result presented in table and figures. Results: A total of 25 patients were seen during the study period age ranged from 2–52 years with a mean age of 25.96 years; 14.1 (SD 2.8). Male to female ratio of ≈ 1.1:1.0. Right side was affected in 60%. The period of presentation of patients with PA varied between 4–12 days with a mean duration of 6.5 days. The presenting complaints in these patients varied from sore throat alone in 4 (16%), fever and sore throat in 17 (68%), others 16%. The duration of hospital stay varied from between 1 to 8 days with mean of 4.2 days; 3.32 days (SD 1.1). All the patients had incision and drainage with no recurrence of symptoms. Conclusion: PA is an Ear, Nose and Throat emergency that is commoner amongst the young adult males and the modality of treatment is still incision and drainage in our setting.

Efficacy of endoscopic ligation for the prevention of variCeIl rebleeding in cirrhotic patients according to hepatocellular function

Variceal rebleeding is a serious complication of cirrhosis, leading to significant morbidity and mortality. The aim of this work is to eva1ua the efficacy of endoscopic variceal ligation in the prevention of variceal rebleeding in cirrhotic patients and to find out the effect of hepatocellular functions on this efficacy. 60 cirrhotic patients were submitted to full history taking and clinical examination, laboratory investigations, abdominal ultrasound, liver biopsy in selected cases, oesophagogastroduodenoscopy for diagnosis of variceal bleeding and to perform variceal banding. Patients were divided into three groups according to their Child's classification: group A [15 patients], B[20 patients] and C[25 patients]. Regarding grading of esophageal varices there were significant changes in first, second, third and fifth sessions as we go from Child's A to Child's C groups, but there were no significant changes in the fourth session. Endoscopic variceal ligation eradicated esophageal varices in 41 cases out of 60 [68.3%], and failed in 19 cases [31.7%]. 14 cases were eradicated in Child's A group [93.33%]; 15 in Child's B group [75%] and 12 in Child's C group [48%]. The recurrence of oesophageal varices after their obliteration was found in 16 cases out of 41[39%]: 2 cases in Childs'A group [14.3%]; 6 cases were in Childs' B group[40.0%] and 8 cases were in Childs' C group[66.6%]. Esophageal variceal rebleeding in studied patients was found in 18 cases [30%] and classified as 2[13.3%], 4 [26.6%] and 12 [48%] for Child's class A, B and C respectively. The mortality in studied patients was 8 [13%] out of 60: 2[10%] cases were in Child's B group and 6 [24%] cases in Child's C group. Six deaths occurred before completion of EVL therapy, 2 deaths after completion of EVL therapy. Four of them died due to liver failure and 3 of them due to massive haematemesis but one of them died from IHD. Endoscopic variceal ligation is an effective method for the prevention of oesophageal variceal rebleeding in patients with better liver function. Child's C cirrhotic patients had a poor response to treatment. These patients showed statistically significant worse eradication rate, greater rebleeding and mortality rates than Child's AandB patients

Clinical and electrophysiological study of peripheral nerve functions in patients with chronic renal failure

To study the prevalence and the patterns of peripheral neuropathy in patients with chronic renal failure. The study was conducted on 40 patients with chronic renal failure [CRF] and 20 healthy subjects of matched age and sex [control group]. Patients were divided into 2 groups. Group]: those with chronic renal failure treated conservatively [n=20] and Group II. those with end stage renal disease treated by hemodialysis [n=20]. Patients were selected randomly. The presence of polyneuropathy and its severity was assessed in all participants hi clinical, neurological examination and the following electro-physiological methods: 1] motor nerve conduction of the median, ulnar, tibial and peroneal nerves, 2] sensory nerve conduction studies of the sural, ulnar and radial nerves 3] F-wave study of the median, ulnar, tibial and peroneal nerves; and 4] Soleus H-reflex. The prevalence of polyneuropathy in group 1 and group 2 were 60% and 65%, respectively [with no significant difference between them]. Polyneuropathy was evident clinically in 37.5% of CRF patients and subclinical neuropathy [diagnosed only on electrophysiological basis] was found in 25% of GRE patients. Electrophysiological abnormalities suggested that the pathology was mainly axonopathy as there was a significant reduction of the CMAP amplitudes. The pattern of uremic neuropathy was axonal, affecting sensory fibers more than motor ones. It seemed that the most sensitive tests in detecting uremic neuropathy would be the H reflex, sural sensory nerve conduction, the peroneal and tibial F wave studies and the median, peroneal and tibial motor conduction studies

Assessment of psychoneurological and intellectual function in beta-thalassemia patients in Ismailia city

Over the years, several reports have demonstrated involvement of the nervous system in beta- thalassemic patients. Neurological complications have been attributed to various factors such as chronic hypoxia, bone marrow expansion, iron overload, and desferrioxamine neurotoxicity. In most cases, neurological involvement is subclinical and can only be detected during neurophysiological evaluation. About 80% of thalassemic children had psychosocial problems. To Assess the psychoneurological and intellectual function in patients with Beta-Thalassemia in Ismailia City. 26 [3 thalassemic major children attending the outpatient hematological pediatric clinic of Suez Canal university hospital. A group of 26 normal children, matched for age and gender were included as a control group. Assessment included history taking; psychosocial assessment was done by asking the parent to fill Child Behavior Checklist, Anxiety scale for children, Child Depression Inventory. Patients underwent neurophysiologic evaluation consisting of brainstem auditory, visual and somatosensory evoked potential examination [BAEP, VEP, SEP] as well as motor and sensory nerve conduction velocity studies [MCV, SCV]. Additionally, the verbal, performance and total IQ were assessed using the Weschler Intelligence Scale for Children [WISC- III]. The incidence of abnormal BAEP, VEP, SEP and NCVs was 0, 7.7, 3.84 and 30.76%, respectively. The prevalence of abnormal total IQ score was considerably high [38.46%], not correlating, however, to any of the parameters assessed [age, sex, ferritin level, BAEP, VEP, SEP, NCV]

Quality of life after total knee arthroplasty

The utilization rates of elective total knee arthroplasties [TKAs] are steadily increasing with an aging population. Measuring the health-related QoL [HRQoL] has been increasingly acknowledged as a means of measuring knee replacement outcomes. To assess the quality of life in patient-reported outcomes at 6 months post-operatively following total knee replacement. A prospective observational study was carried out using the function subscale of a disease-specific measure the Western Ontario and McMaster Universities [WOMAC] Osteoarthritis Index and a generic health status measure the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]. Independent variables examined included demographic variables [e.g., age, sex, BMI], medical variables [e.g., diagnosis, number of co-morbid conditions, ambulatory status], and knee range of motion. Six months after intervention, patients again were re-evaluated by the same questionnaires. During the duration of the study [16 months], 37 patients were included in this study, three patients refused to rejoin the post-operative evaluation. The mean age was 64 years and 57% of the patients were females. Multivariate analysis, in which the pre-operative and postoperative scores were analyzed showed a significant improvement in both WOMAC but a lesser improvement in SF-36 results, 68.5 [SD +/- I6.2] and28.8 [SD +/- 12.3] respectively. The impact of total knee arthroplasty on patients' quality of life is well noticed in the study as the procedure improves functional outcomes in uncomplicated patients

Combined radiofrequency ablation [RFA] and percutaneous acetic acid injection [PAI] versus radiofrequency ablation alone for treatment of hepatocellular carcinoma [HCC]

Hepatocellular carcinoma [HCC] is one of the most commonly occurring solid tumors worldwide. Percutaneous acetic-acid injection [PAI] and radiofrequency ablation are options for treatment. The aim is to compare the efficacy and safety of combined radiofrequency and acetic acid injection versus radiofrequency alone for ablation of HCC. This study was conducted on 40 patients having HCC. Group 1 [20 patients] was subjected to radiofrequency ablation preceded by intra-tumoral acetic acid injection [RFA+AA]. Group 2 [20 patients was subjected to RFA alone. The procedure was successful in 18 [90%] patients of group 1 and in 15 [75%] of group 2. RFA+ AA are most effective than RFA alone as acetic acid injection may enhance the ablation induced by RFA

experience of burn injueies

To study the demographical data of burn patients. This study was carried out in department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 years were included. Total 77 males and 65 females fulfilled the criteria. The mean age in males was 32.2 years and 24.4 years in females. Male to female ratio was 1: 1.18 respectively. Burns were common during winter season [42.2%] In 6% patients, suicidal burns were noted. 15% patients were homicidal cases. 79% patients had the burns accidentally. Stove burst [22%] was the major mechanism in females whereas in males, 18% had the direct flame injury. Kitchen [27%] was the commonest place in females. Housewives [35%] were most frequently affected. More married males [39%] were burnt as compared to 18% of the unmarried females. Inhalational injury was present in 23% patients. Males had average burns of 27.4% TBSA and females had 39.5% TBSA involvement. 18% of the deaths were among the males and 16% in females. Prevention is always the rule to be safe from burns but once it occurs, immediate and proper care should be given with aggressive treatment to minimize the post burn problems

Low contrast visual acuity and glare susceptibility with different types of intraocular lenses

Assessment of quality of vision namely low contrast visual acuity and glare susceptibility with different types of intraocular lenses [IOLs] recently introduced in our market. The quality of vision with low contrast early treatment diabetic retinopathy study [ETDRS] visual acuity charts as well as glare susceptibility ratio [GSR] in levels of luminance for day light [Photopic] conditions. Best corrected visual acuity [BCVA] and tests for quality of vision were performed in cross-sectional pattern four weeks postoperative. The inclusion criteria were uneventful phacoemulsification IOL implantation in the bag. Eyes with significant posterior capsule opacification [PCO] and eyes with other associated ocular pathology were not included. Four classes of IOL materials were included; polymetylemetacrylate [PMMA], hydrophilic acrylic, second generation silicon and three designs of hydrophobic acrylic IOLs. Seventy eyes were included in the study with 10 eyes implanted by each group of IOL and 10 control eyes. The mean BCVA in 100% and 25% contrast targets was not statistically significant in different groups. In 100% contrast targets, the mean BCVA was 0.91 in PMMA, 0.87 in hydrophilic acrylic, 0.9 in Acrysof MA, 0.92 in Acrysof SA, 0.91 in califlex and 1.1 in the control group. 25% contrast targets, the mean BCVA was 0.72 in PMMA, 0.61 in hydrophilic acrylic, 0.65 in Acrysof MA, 0.69 in Acrysof SA, 0.65 in Sensar, 0.7 in Clariflex and 0.8 in control group. However in lower contrast steps [12.5% and 6%] only Acrysof SA and Clarifiex groups had mean BCVA [0.55 and 0.61 respectively in 12.5% contrast and 0.41 and 0.52 respectively in 6% contrast]. These were not significantly different from control group. The mean GSR in Acrysof SA group was 1.0 in 100% contrast, 1.09 in 25% contrast, 1.1 in 12.5% contrast and 1.2 in 6% contrast. The mean GSR in Clarifiex group was 0.92 in 100% contrast, 0.69 in 25%, contrast, 0.95 in 12.5% contrast and 1.0 in 6% contrast. These results were not significantly different from control group mean GSR [0.92 in 100% contrast, 0.89 in 25% and 12.5% contrast and 0.81 in 6% contrast]. Only hydrophobic acrylic IOL [Acrysof SA] and second generation silicon IOL [Clariflex] with high refractive index [RI] and protected edge designs had mean BCVA not significantly different from control group in all low contrast steps [25%, 12.5% and 6%]. Hydrophobic acrylic with non protected edge design [Acrysof MA] and those with relatively higher water content [Sensar AR[40]e] had mean BCVA that was significantly different from control in 12.5% and 6% contrast steps. Also the Acrysof SA and Clariflex besides Sensar AR[40]e had mean GSR that was not significantly different from control group and was stable with decreasing contrast steps. The small optic PMMA IOL had intermediate performance. The hydrophilic acrylic with square non protected edge had the lowest performance

Study of measles iGg antibody levels and some immunological abnormalities in autistic children

Autism is generally considered to be a multi-factorial disorder. Causally speaking, immune, neuro-chemical, environmental such as viral infections mainly measles and genetic susceptibility factors have been implicated. Currently, the etiology of autism is still unknown, and although there are treatments for some of the behavioral abnormalities, there is no cure. Autoimmunity has a strong prospect for finding a cause and treatment of autism today. The aim of the present work was to study measles antibodies and some immunological parameters in autistic children in a trial to pave the way to new optimistic interventions both diagnostic and therapeutic. Thirty-nine children were included in this study allocated into 2 groups. Group I [autistic children] consisted of 19 children [17 males and 2 females], aged 2-7.75 years, diagnosed as autistic by CARS. Group II [control children] consisted of 20 healthy children [17 males and 3 females] aged 2-8 years. All children were subjected to detailed history and thorough clinical examination [to confirm diagnosis and exclude other neurodevelopmental illnesses]. Total serum protein, serum albumin, serum protein electrophoresis immunoglobulins and ANA were measured for all children. CD[4] and CD[8] subsets of T-lymphocytes were phenotyped by whole blood flow-cytometry to get CD[4]/CD[8] ratios. Measles IgG antibody levels were measured for all children by indirect enzyme-immunoassay. Autistic criteria were detected late [in the second year of age] among all our autistic children. Some autistic children [4 children] showed autistic regression after MMR vaccination. Family history of autism and other autoimmune diseases was found in a small number of our autistic families [2 and 4 respectively]. Autistic children had significantly higher TSP, serum albumin, gamma globulin, and IgG levels than control children, while their alpha1, alpha2 and beta globulins, IgA and IgM were not significantly different. About one third [36.84%] of our autistic children were positive for ANA with the mean of ANA titers significantly higher in the autistic children compared to controls. CD4+ lymphocytes were significantly reduced, while CD8+ lymphocytes were normal or slightly decreased, resulting in a significantly lowered CD4/CD8 ratio among our autistic children compared to normal controls. The mean serum levels of measles IgG antibodies were significantly higher among autistic children as compared to non autistic control children

Conclusion: the hyperimmune response to measles virus and the immunological abnormalities may play a role in the pathophysiology of autism. Depending on the nature of the immune abnormality, the goal of therapy should be to normalize or reconstitute the immune response instead of inducing immune suppression or stimulation. It is recommended to start immediately a wide, well controlled research project to explore the importance of autoimmunity and other immunological abnormalities in early diagnosis, prevention and treatment of autism

Management of splenic trauma in children

To study the possibility of conservative management of splenic injuries in children with isolated and non-severe lesions. Patients and The records of 39 pediatric patients [<18 y] with splenic injures from blunt trauma were reviewed in this retrospective study which covered 6 years. We identified 3 groups: Group I: [n = 17] operative group in unstable or polytraumatized children. Group II: [n = 7] delayed operative group in children with associated injuries. Group III: [n = 15] absence of associated injuries. Conservative management. There was no statistical difference between group II and III concerning length of hospitalization and volumes of transfused blood. In these groups, volume transfused seemed to correlate with associated lesions These data confirm that the majority of children with blunt splenic injury can be successfully treated without surgery. In cases of instability, multiple associated lesions, or suspected intestinal disruption confirmed by peritoneal lavage, early operation must be recommended