study of genital tract ecosystem in some gynecologic disorders

Introduction: The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understand the aetiology of these diseases. In addition, microorganisms possibly those associated with bacterial vaginosis may inhabit the uterine cavity [bacteria endometrialis] where they are responsible for some common gynecological and obstetric enigmas. The aim of the present work was to study vaginal and uterine ecosystem in some gynecologic disorders aiming at reconsidering the place of appropriate antibiotic regimens

Subjects and Methods: The present study was conducted on 100 patients admitted to Obstetrics and Gynecology Department, Ain Shams University Hospital. Their ages ranged from 36-60 years and they were all indicated for hysterectomy. Informed consent was obtained from each patient. They were subjected to history taking, general and local examinations and vaginal PH measurement before taking the specimens. The specimens included three swabs taken from cervical os and the posterior fornix of vagina immediately before the operation and three endometrial swabs taken immediately after hysterectomy and incising the uterine wall using full aseptic technique. Swabs were used for preparation of direct Gram stained smear, Isolation of aerobic and anaerobic bacteria. Results in the present study showed that metrorrhgia and uterine fibromyomas were the most common indications for hysterectomy and Lactobacilli were the most commonly isolated organism, followed by coagulase negative Staph, Diphtheroids, Peptococci, anaerobic Gram -ve bacilli and Gardnerella vaginalis [G Vaginalis]. However, there was no statistically significant association between any of the isolated organisms and the indications for hysterectomy. In premenopausal patients, Lactobacilli were the most commonly isolated organism while coagulase negative Staph was the most commonly isolated organism from postmenopausal patients. With exception of Lactobacilli, the difference between premenopausal and postmenopausal women regarding isolated organisms was statistically none significant. Organisms were isolated from the uterine cavity in 11 patients and the most commonly isolated organisms were G vaginalis and Staph aureus. Each organism was isolated from four cases, anaerobic Gram -ve bacilli was isolated from two cases and Peptococci was isolated only in one case. It could be concluded that presence of bacteria in the endometrial cavity could be implicated as a significant previously unrecognized; cause of obstetrics and gynecologic diseases, as in recent years, an unexpected infectious aetiology has been found for a variety of clinical conditions. Thus, the place of appropriate antibiotic regimens would need careful consideration. However, further studies are needed to confirm these results

effect of assertive training techniques on improving coping skills of nurses in psychiatric set up

Psychiatric mental health nurses are confronted with the daily responsibility of assessing, intervening and evaluating client responses to stress and client interactions. They need to identify the meaning of their own stress and develop strategies that increase personal and professional growth. Some nurses may have learned to express their needs honestly to use anger constructively, to improve personal and work relation ships and to build self-confidence through assertive behavior. But others still struggle with being assertive, perhaps because they don't believe they have the right to be assertive, they are anxious about asserting themselves or they don't know how to be assertive Learning assertive techniques are considered as tools for coping skills with a variety of life stressors. Increasing assertive behavior becomes an expression of person's feelings. So the aim of this study was to assess the effects of assertive training techniques on coping skills of nurses working in psychiatric setup. The study was conducted on nurses at Tanta Mental Health Hospital, Ministry of Health [n=58]. Data were collected using four tools, Assessment of Coping Skill inventory, Assertiveness inventory, 5 selected situations, 5 selected clinical situations used only as a post-test. The study showed that a significant change was found in level of assertiveness responses and coping responses of the studied nurses before and after training. The assertiveness training affect on coping level of the nurses significantly as the coping level of nurses has improved after the training. This revealed that the assertiveness training helped nurses to communicate and to be more tolerant to their patients in different situations

Cognitive profile self poisoning suicide atttempters

Worldwide, deliberate self-poisoning is recognized as a major public health problem with a significant morbidity. In the recent years, there has been growing interest in the contribution of cognitive factors to the etiology of suicidal behaviors. The aim of this study was to determine cognitive profile of self- poisoning suicide attempters. The study was conducted at Alexandria Poison Center in the Main University Hospital. The subjects of the study comprised 200 suicide attempters. Battery of psychometric tests that are; Suicide Intention Scale[SIS], Hopelessness Scale [HS], Negative Automatic Thought Questionnaire [NATQ], and General Locus of control [GLO] were used to collect the data through conducting the interview method on an individual basis. Results of the present study revealed that suicide attempters who had high intention to die were having more hopelessness, helplessness, low self-esteem and external locus of control than those who had not. However, only feelings of hopelessness, helplessness and death orientation were independent cognitive predictors of high suicidal intention

Expression of toll-like receptors 2 and 4 in periodontal diseases

Background: Periodontitis is an inflammatory disease affecting the connective tissue surrounding the teeth leading to tooth loss. Pathogens associated with periodontitis interact with Toll-like receptors [TLRs] to induce cytokines causing and aggravating disease. Members of TLR family recognize conserved microbial structures, such as bacterial lipopolysaccharides[LPS], and activate signaling pathways that result in immune responses against microbial infections

The aim of the present study was to determine the level of tissue expression of TLR-2 and TLR-4 in healthy gingiva, chronic gingivitis and chronic periodontitis and find out their role in these different infections

Subjects and Methods: 28 subjects between the ages of 25-45 were recruited. All subjects were able and willing to participate in the study and gave their informed consent to study participation 28 Gingival tissue specimens were obtained from 28 subjects during periodontal surgical therapy who were divided into three groups: Group 1: Ten patients suffering from chronic gingivitis. Group 2: Ten patients suffering from chronic periodontitis. Group 3: Eight control samples from healthy individuals who haveundergone orthodontic treatment. Gingival tissues were collected on phosphate buffered saline. Total RNA isolation was done, then cDNA synthesis and PCR were done in a single step using Prime RT- PCR Premix. Data are presented as mean +/- standard deviation. Comparison between groups was done using students [t] test

Results: The present study showed that both TLR 2 and 4 were expressed in controls, and that the expression of TLR-2 and TLR-4 were statistically significantly elevated in tissue samples from patients with chronic gingivitis and chronic periodontitis compared to controls. TLR-2 expression in controls and chronic gingivitis patients was increased compared to TLR-4 but the increase was not statistically significant. Whereas, TLR-4 was statistically significantly increased in chronic periodontitis compared to TLR-2. Also, TLR-4 was statistically significantly increased in chronic periodontitis compared to chronic gingivitis

Conclusion: It could be concluded that TLR 2 and 4 have a role in the pathogenesis of periodontal diseases however the present study is only a step that needs further studies to fully understand the expression of TLRs in different stages of gingivitis and periodontitis

Fas expression on peripheral blood t lymphocytes in systemic lupus erythematosus [SLE]: relation to disease activity and lupus nephritis

Introduction: Systemic lupus erythematosus [SLE] is an autoantigen driven T cell dependent autoimmune disease. Lupus nephritis is one of the most serious complications in SLE, occurring in up to 60% of the patients. SLE patients show increased apoptosis of peripheral blood mononuclear cells [PBMCs], especially T lymphocytes and decreased resistance of activated T cells to apoptosis. Fas, also known as APO-1 or CD95, is a cell surface protein that triggers apoptotic cell death with characteristic cytoplasmic and nuclear condensation and DNA fragmentation. The aim of this work was to evaluate Fas expression [as an apoptotic marker] on peripheral blood T lymphocytes in SLE patients in relation to disease activity and lupus nephritis

Subjects and methods: Thirty-five SLE patients and 15 normal controls were studied. Disease activity was assessed by SLAM score and patients were divided according to: a] disease activity [mildly active group with SLAM score <6, moderately active group from 6-12 and severely active group >12], b] the clinical presentation including the presence or absence of either lung, cardiac, neurological affection or nephritis as well as regard, c] WHO classes of lupus nephritis. Laboratory investigations included CBC, ESR, serum creatinine, urine examination, 24 hours urinary proteins, ANA and Anti-dsDNA, flowcytometric analysis of percentage of Fas expression [CD95+] on peripheral blood T lymphocytes [CD3+] and percutaneous renal biopsy in indicated patients with evidence of nephritis

Results: Percentage of CD3+CD95+ cells from SLE patients was statistically significantly increased compared to healthy controls [p<0.05]. Comparative study among the patients according to SLAM score was statistically significant [p<0.05] using ANOVA test with the highest percentage of apoptotic T lymphocytes in severely active group. When comparing each group with the control one, results showed statistically significant more apoptotic T cells in severely active SLE patients compared with controls. However, although the apoptotic T cells were increased in moderately active SLE patients, the data did not reach statistical significance in comparison with healthy controls nor with the mildly active group [p > 0.05]. Apart from nephritis [p<0.05], Fas expression was not associated with the clinical presentation of the patients, as regard the presence or absence of lung, cardiac or neurological affection [p>0.05]. The percentage of Fas expression was higher in class IIb than either class III or IV as well as patients without nephritis and those with nephritis without indication for renal biopsy [27.32+/-13.62 vs. 19.8, 19.14+/-5.12, 14.8+/-3.57 and 17.2+/-6.8]. However, on comparing only the patients who did renal biopsy, the renal parameters as well as the percentage of CD3+CD95+ cells was statistically non significant [P > 0.05]. Correlation between the percentage of CD3+CD95+ cells and different parameters revealed highly significant positive correlation as regard ESR, current steroid treatment dose and SLAM scoring, [p<0.001], statistically significant positive correlation as regard platelets, nephritis, arthritis, fever, lymphadenopathy and chronicity index in renal biopsy [p < 0.05], and tendency toward urinary albuminuria and casts. [p= 0.061 and 0.056 respectively]

In conclusion: The increased CD3+ CD95+ cells from patients with SLE and its correlation with disease activity suggests that abnormalities of apoptosis may be related to the pathogenesis of the disease [especially with high grades of activity] and its serious complication, nephritis. In patients with nephritis, the lower Fas expression [CD95+] on peripheral blood T lymphocytes [CD3+] in patients with class IV nephritis than those with class IIb nephritis could be possibly explained by the effect of treatment or by the natural process of the proliferative disease itself. However, further studies including large number of SLE patients, evaluating apoptosis both systemically and locally in tissue biopsies and studying various apoptotic pathways are needed to understand its role in the pathogenesis of the disease and its value as a therapeutic target

Increased prevalence of human papilloma virus type 5 in patients with psoriasis: relation to PUVA therapy or disease severity?

Introduction: Psoriatic skin colonization by Human Papilloma Virus [HPV] seems to be restricted mainly to HPV-5 which is a ubiquitous virus that replicates at a high rate in hyper-reactive psoriatic keratinocytes. The aim of the present study was to determine whether the increased prevalence of HPV-5 DNA in psoriatic lesions is related to PUVA [Psoralen and Ultraviolet A] treatment or to disease severity

Subjects and Methods: Thirty psoriatic patients were enrolled in the study after their informed consent. Patients were divided into two groups; group I patients [n =16] had no history of PUVA exposure during the past 6 months, while group II patients [n = 14] are on PUVA treatment. The calculated Psoriasis Area and Severity Index [PASI] score for patients varied between 8 and 66. Among the thirty patients, 22 had severe psoriasis with PASI score >20, five patients had moderate psoriasis with PASI score from 10 to 20 and three patients had mild psoriasis with PASI score < 10. Six patients of group I were on methotrexate treatment. Skin scales from lesions were collected from each patient. A type-specific nested PCR was performed using two sets of primers designed to detect the HPV-5 E6 gene. PCR reactions were done in Light Cycler to achieve optimal sensitivity

Results: In the present study 57% of psoriatic patients had HPV-5 infection in psoriatic lesion. Results showed statistically non significant difference between the two groups of patients regarding the presence of HPV-5 [P>0.05], while the difference between patients with severe psoriasis [PASI > 20] and patients with mild to moderate psoriasis [PASI

Forms of elderly abuse in residential homes in Alexandria

This study was carried out in six elderly homes in Alexandria. An elderly abuse assessment form including abuse indicators was used. The results revealed that almost all the studied elders were abused and the most common form of elderly abuse seen was neglecting an older person's need for help with basic daily living or emotional needs. This was followed by exploitation. A physical violence was the least common form of abuse. Sexual abuse was not reported at all and males and females were equally neglected. Age was also considered a factor leading to abuse