[Hepatitis B and C infection as a part of hospital acquired infection at the Renal Dialysis Unit in Assiut University Hospital]

Background: Hospital-acquired hepatitis B [HBV] and C virus [HCV] infections continue to occur despite increased awareness of this problem among the medical community. Infection with hepatitis viruses continues to be a major concern for hemodialysis patients, who are recognized as a high-risk group

Objectives: To measure the HBV and HCV seroconversion in hospitalized patients at the hemodialysis unit in Assiut University hospital and to assess the potential risk factors for infection with these viruses in this unit

Methods: This study was performed in Assiut University Hospital at the renal dialysis unit. A total of 63 patients on regular hemodialysis who should be negative for anti HCV, HBsAg and IgG anti HBc with normal liver enzymes and abdominal ultrasound were included in this study between June 2011 and August 2014. An identification questionnaire for possible risk factors for HBV and HCV was done at the start of study. Then follow up after 3 months with another questionnaire for the risk factors and screening by anti HCV, HBsAg and IgM anti HBc were done. Then another follow up after 6 months with other questionnaire for the risk factors and screening by anti HCV and HBsAg. Qualitative PCR test for HCV was used for patients whose results were positive for anti HCV either at 3 months or 6 months follow up. The study also include 12 health care workers and they were screened for anti HCV and HBsAg. Their history of vaccination for HBV was also assessed. Assessment of adherence to infection control measures was also done

Results: Twenty one patients were anti HCV positive, seven of them were positive after 3 months follow up and 14 were positive after 6 months follow up with seroconversion rate of 33.3%. No patient was positive for HBV throughout the study period. All these positive for anti HCV were negative for qualitative PCR for HCV All the included health care workers were negative for HBV and HCV markers. Furthermore all of them had complete vaccination for HBV. The potential risk factors for HCV seroconversion were duration and frequency of dialysis, blood transfusions, dialysis with patients positive for HCV in the same room, lack of strict adherence to infection control measures by the health care workers

Conclusion: Regular screening of all patients and health care workers in hemodialysis units for HBV and HCV with improvements in infection control practices should be done. Therefor health education of the health care workers and their vaccination against HBV infection should be considered

Analytical evaluation of hepatitis c virus core antigen detection as a diagnostic test in diagnosis of HCV infection

The aim of the present study was to evaluate the efficacy of hepatitis C virus [HCV] core Ag assay by comparing it with anti-HCV antibodies and PCR-based technology for measuring viral load in diagnosis of HCV. HCV core Ag by ELISA in serum, in the presence or absence of anti-HCV antibodies was compared to HCV- RNA by PCR on total number of 100 subjects, divided into 3 groups; including 80 patients and 20 volunteers. The sensitivity of the test was [72.5%]] and the specificity was [86.6%]. Also positive predictive value of the test was [78.3%] and negative predictive value was [82.5%]. Core antigen detection by ELISA can be used as a reliable test for detection of vireamia in HCV infection

study of common allergen specific immunoglobulin-E. pattern in children with asthma attending Assiut university children hospital.

There is a significant rise in the prevalence of allergic diseases, including asthma and, food allergies. Studies indicated that the exposure to indoor allergens [mold, dust mites] may be more relevant to the development of asthma and atopy, lgE is best known as a mediator of allergic reactions ranging from allergic rhinitis and asthma to life threatening anaphylactic shock. The aim of this study was to detect the prevalence of food allergens [milk and egg] and indoor allergens [house dust miles and Alternaria], and [heir possible relation to the severity of disease in children with asthma attending. Assiut university Children hospital. The study included 50 cases with asthma attending Assiut University Children Hospital, during the period from September 2009 to August 2010. Their ages ranged from 4-14 years. They consisted of 30 males and 20 females. They were selected and classified according the GINA classification of asthma 2008. They consisted of 10 cases with mild intermittent asthma, 10 cases with mild persistent asthma, 15 cases with moderate persistent asthma, 15 cases with severe persistent asthma, as well as 25 apparently healthy children with matchable age and sex a control group. All cases and controls were subjected to full history and thorough clinical examination. Complete blood count, chest x-ray, pulse oxymetry, tuberculin test, urine and stool analysis and pulmonary function tests were done for all patients and controls. Specific IgE was performed by human allergen specific assay semi quantitative kit. The percentage frequency of asthma cases with significantly high IgE level for the studied antigens were significantly higher than those in the control group. Cases with significant increase in house dust mite specific IgE level were the commonest [84%] among our patients with by those with significant increase in milk specific IgE level [78%], followed by those with significant increase in Alternaria specific IgE level [68%,] and lastly by those with significant increase in egg specific IgE level [64%]. The percentage frequency of patients with significant increase in IgE level for the four studied antigens was significantly higher than those with significant increase in IgE level for three, two or one of the studied antigens. The distribution of these patients with significant increase in IgE level fir the four studied antigens was significantly higher in the group of cases classified as having severe persistent and moderate persistent asthma. Cases with moderate and severe increase in serum IgE level were more common in the moderate and severe persistent asthma patient groups. It could he concluded that house dust miles allergens followed by food [milk and Alternaria] allergens, then by egg allergens are common among our studied patients with asthma and correlate with the severity of asthma. Sensitization to more than one allergen was more common in our studied patients with asthma. This may suggest the role of patient susceptibility to immune reaction against various allergens. Laboratory, studies of patient with asthma particularly those with moderate and severe persistent asthma fir these allergens is recommended. Studies on the value of desensitization of these patients for such antigens for possible better management of their illness is highly recommended

Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection

Background: Spontaneous bacterial peritonitis [SBP] is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients: however, there is a lack of knowledge about this issue in ascitic infections

Aim of the study: The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous bacterial peritonitis which may help to understand the role of immune system in pathogenesis of SBP and consequently introduction of new therapeutic modalities

Subjects and methods: This case-control study included 50 decompensated cirrhotic patients [37 male. 13 female] from gastroenterology and hepatology unit of internal medicine department; Assiut university hospital with different etiologies. Patients with ascitic polymorphonuclear leukocyte count >/=250/mm[3] and/or positive ascitic bacterial cultures were classified as the 'patients group' [n=25, mean +/- SD of age was 57.84 +/- 6.66 years]. Patients with ascitic poly morphonuclear leukocyte count <250/mm[3] and/or negative ascitic bacterial cultures were classified as the controls group [n=25, mean +/- SD of age was 60.36 +/- 6.51years]. Comparison was made between the patients and controls groups for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of ascitic lymphocyte subsets [CD3, CD4. CD8, CD4/CD8 ratio. CD19, CD45] and ascitic cytokine TNF-alpha

Results: Ascitic total protein and albumin levels were significantly decreased in patients group. The C4, CD19. CD45 and CD4/CD8 ratio were significantly decreased in the patients group. Furthermore, ascites CD3, CD8 and TNF-alpha levels were significantly elevated in this group. The incidence of renal impairment, gastrointestinal bleeding and hepatic encephalopathy was higher in patients group and there was a significant correlation between TNF-alpha and renal impairment in this group

Conclusion: These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might he involved in the pathogenesis of ascites infections

Potential Correlation between Carboxylic Acid Metabolites in Biomphalaria alexandrina Snails after Exposure to Schistosoma mansoni Infection

Carboxylic acids play an important role in both aerobic and anaerobic metabolic pathways of both the snail and the parasite. Monitoring the effects of infection by schistosome on Biomphalaria alexandrina carboxylic acids metabolic profiles represents a promising additional source of information about the state of metabolic system. We separated and quantified pyruvic, fumaric, malic, oxalic, and acetic acids using ion-suppression reversed-phase high performance liquid chromatography (HPLC) to detect correlations between these acids in both hemolymph and digestive gland gonad complex (DGG's) samples in a total of 300 B. alexandrina snails (150 infected and 150 controls) at different stages of infection. The results showed that the majority of metabolite pairs did not show significant correlations. However, some high correlations were found between the studied acids within the control group but not in other groups. More striking was the existence of reversed correlations between the same acids at different stages of infection. Some possible explanations of the underlying mechanisms were discussed. Ultimately, however, further data are required for resolving the responsible regulatory events. These findings highlight the potential of metabolomics as a novel approach for fundamental investigations of host-pathogen interactions as well as disease surveillance and control.

Hepatitis B virus escape mutants after vaccination

Vaccine escape mutant may develop after immune prophylaxis with universal HBV vaccination. Aim of the study: to detect the frequency of HBsAg escape mutant among the patients with previous HBV infection and patients with HCV infection after full dose of HBV vaccination. A hospital control based study included 68 person. Twenty six with previous HBV infection patients, 25 chronic hepatitis C patients, and 17 apparently healthy persons as controls. Vaccination were carried out for all patients and control group. All patients and control groups were negative for HBs Ag before enrollment in this study. HBsAg, HbcAb, HBeAg and HBsAb were enrollment performed by micro particle immunoassay. HBV DNA and HBsAg mutants were performed by real time polymerase reaction [RT-PCR]. HBV DNA was detected in 10[38.5%] in HBV patients with previous infection and after full dose of vaccination. HBsAg mutants were detected in 8[30.8%] of them. In HCV patients with negative surface antigenemia HBV DNA was detected in 5 [20%] and HBsAg mutants were detected in 3[12%] of them. The frequency and levels of HBsAb in HBV patients with previous infection and after full dose of vaccination were significantly decreased when compared to those with HCV infection and healthy control group after dose of vaccination. From this study we concluded that the presence of HBsAg mutants in HBV and HCV patients with negative surface antigenemia after full dose vaccination .the measurement of HBV DNA by sensitive quantitative technique plays an important role in detection either with mutants in surface antigen or occult HBV infection [OBI]. Lower immune response was markedly observed after prophylactic vaccination of patients with previous HBV infection with and to lesser extent in those with HCV infection. HBcAb and or HBV DNA testing should be considered before HBV vaccination to avoid the vaccine induced pressure which may lead to development of HBV surface antigen mutations

Corrosion study of glaze-cermics doped cement-kiln-dust soaked in concentrated HCl

New glaze-ceramics formulated from industrial waste have been prepared. The method consists of introducing cement-kiln-dust [CKD] in the industrial glaze-ceramics with various ratios [10-50%] together with the addition of 10gm boric acid. The chemical durability of the prepared composite cement-dust-glaze-ceramics [CDGC] is investigated using high concentrations of [2,5 and 8N] HCI acid solutions. CDGC are vitrified by melting for four hours at 1400[degree sign] C +/- 250[degree sign] C depending on the amount of CKD introduced. Specifically, the experimental results indicate that the introduction of CKD in industrial glaze decreases durability. At high HCI concentrations, the durabilities of the prepared glaze-ceramics are observed to decrease with increasing the percentage of [CKD] until certain limit and almost constancy. The corrosion results are explained according to the ion exchange mechanism and formation or dissociation of the modified depleted layer. Some hollow and jogged areas are observed by SEM which might be interpreted as evidence of local corrosion phenomena. In addition, the pH values of the leachant solutions are measured. The comparison of hardness for the optimum glaze-ceramic and glaze-ceramic derivatives prepared in this study indicates a degradation% in their chemical and physical properties depending on the amount% of CKD introduced. It is observed that the degradation not only depends on the amount of CKD introduced, but also on the strength of the leaching HCI acid solution. Also, the results show that, the prepared glazes have a surface hardness values ranged from 5.5 to 2.5 in the Mohs scale

Effect of cryopreservation on human sperm motility, vitality and DNA integrity in fresh and processed sperms

To investigate The effects of cryopreservation on sperm motility, vitality and DNA integrity in fresh and processed sperms. Pre-cryopreservation and post-cryopreservation analysis of sperm vitality, motility and DNA integrity in fresh and processed semen. Department of Dermatology, Venereology and Andrology, in coordination with the Department of Clinical Pathology Assiut University Hospital. Patients: 50 fertile men [within the last year] who are clinically free and with normal semen parameters the, semen samples collected by masturbation into sterile containers after at least 3 days of sexual abstinence. Semen evaluation for, conventional semen analysis, sperm vitality with Hypo-Osmotic Swelling test [HOS], sperm DNA integrity by flowcytometry. Each sample was divided into 2 halves: The first half was cryoperserved without processing. The second half of the sample was processed by swim up technique. HOS test, percentage of progressive motility and DNA integrity after processing. Cryopreservation in liquid nitrogen for at least 24 hours for all samples [fresh and processed,] was done. HOS test, percentage of progressive motility and DNA integrity after thawing for all samples [fresh and processed]. Sperm DNA fragmentation index was determined using flowcytometry, sperm vitality was determined using HOS test and percentage of progressive sperm motility was determined using light microscopic examination according to criteria of WHO [1999]. Sperm frozen after processing had higher resistance to freezing damage as regards vitality and motility when compared with sperm frozen without processing however, sperm DNA fragmentation index was more in frozen processed than unprocessed sperms. Cryopreservation results in decreased sperm vitality, motility and increased sperm DNA fragmentation. Freezing processed sperm give better post-thawing vitality and motility but, increased sperm DNA fragmentation when compared with unprocessed sperm

Obesity in Saudi children: a dangerous reality

Obesity among children is an increasing concern. This cross-sectional study in 2006 determined the prevalence and demographic characteristics of overweight and obesity in children in the Eastern province of Saudi Arabia. A total of 7056 children [aged 2-18 years] were selected from schools and the outpatient department of a hospital. The overall prevalence of overweight was 19.0% and of obesity was 23.3%. More than 50% of children between 14 and 18 years had weight above the 85th percentile. More males than females were obese by ages 14-18 years [35.6% versus 19.2%]. Saudi and non-Saudi nationalities had the same distribution of body mass index. Interventions to encourage healthier lifestyles for children are needed at the national level

Carboxylic Acids as Biomarkers of Biomphalaria alexandrina Snails Infected with Schistosoma mansoni

Biomphalaria alexandrina snails play an indispensable role in transmission of schistosomiasis. Infection rates in field populations of snails are routinely determined by cercarial shedding neglecting prepatent snail infections, because of lack of a suitable method for diagnosis. The present study aimed at separation and quantification of oxalic, malic, acetic, pyruvic, and fumaric acids using ion-suppression reversed-phase high performance liquid chromatography (HPLC) to test the potentiality of these acids to be used as diagnostic and therapeutic biomarkers. The assay was done in both hemolymph and digestive gland-gonad complex (DGG) samples in a total of 300 B. alexandrina snails. All of the studied acids in both the hemolymph and tissue samples except for the fumaric acid in hemolymph appeared to be good diagnostic biomarkers as they provide not only a good discrimination between the infected snails from the control but also between the studied stages of infection from each other. The most sensitive discriminating acid was malic acid in hemolymph samples as it showed the highest F-ratio. Using the Z-score, malic acid was found to be a good potential therapeutic biomarker in the prepatency stage, oxalic acid and acetic acid in the stage of patency, and malic acid and acetic acid at 2 weeks after patency. Quantification of carboxylic acids, using HPLC strategy, was fast, easy, and accurate in prediction of infected and uninfected snails and possibly to detect the stage of infection. It seems also useful for detection of the most suitable acids to be used as drug targets.

study of sexual and reproductive dysfunctions in juvenile onset diabetic men

Diabetes affects an increasingly large number of young men of reproductive age To determine fertility status and to evaluate semen parameters and sexual dysfunction in men having juvenile onset diabetes comparing them to fertile controls. 73 male patients having juvenile onset diabetes mellitus. The study included clinical evaluation, erectile capacity scoring with IIEF-5 score, urine analysis after masturbation, conventional semen analysis and sperm hypoosmotic swelling test of 73 diabetic men and 33 fertile controls. Comparison between diabetic patients and fertile controls in conventional sperm parameters and hypoosmotic sperm swelling percentage [HOS%]. Additionally, assessment of prevalence of infertility, erectile and ejaculatory dysfunction in diabetic patients. There was a significant decrease in percentage of normal sperm morphology among diabetic patients [41.37 +/- 12. 38] than controls [57.27 +/- 8.11] [P < 0.001]. Percentage of progressive sperm motility was significantly lower in diabetic patients [33.42 +/- 13.38] than controls [54.84 +/- 5.92] [P < 0.001]. There was a significant decrease in sperm HOS% among diabetic patients [62.55 +/- 11.69] in comparison to controls [77.36 +/- 8.23] [P < 0.001]. There was no significant difference in sperm concentration [in million sperm/ml] between diabetic patients [69.75 +/- 62.11] and controls [74.55 +/- 50.78]. Similar results were obtained on comparing between fertile and infertile diabetics. Prevalence of infertility was 40%, erectile dysfunction [ED] was 75%, premature ejaculation was 31% and partial retrograde ejaculation was 5%. Diabetic patients had significantly lower normal sperm morphology, progressive sperm motility and hypoosmotic sperm swelling percentages. They had higher round cell number. They also had increased prevalence of infertility, erectile and ejaculatory dysfunctions

Effects of intensive rehabilitation on locomotor capacity after total knee replacement

To evaluate the effectiveness of a pre- and post-operative exercise protocols and intensive functional rehabilitation [IFR] program on locomotory capacity in the first three months after primary total knee arthroplasty [TKA] for severe osteoarthritis. The study was conducted on 20 patients-with severe osteoarthritis knees who underwent TKA. They were divided randomly into 2 equal groups. The first group received an intensive rehabilitation program while the second received ordinary rehabilitation program. Before program start all patients were subjected to clinical examination. Postural assessment was done to all patients twice pre-operatively and 12 weeks post-operatively using Computerized Dynamic Posturography including motor control, adaptation and sensory organization tests, The ordinary rehabilitation group showed a statistically significant increase in post-operative weight symmetry p<0.05 compared with normal. There were statistically significant high values in both groups in pre- and post-operative strength symmetry p<0.05 compared with normal. Adaptation test toes down showed a statistically significant difference from normal in both groups of rehabilitation in all trials post-operatively, and in intensive rehabilitation group in trial 1, and trial 3, while in ordinary rehabilitation program in trial 2 pre-operatively p<0.05. Amplitude scaling f with affected side of the lower limb, showed a statistically significant decrease in ordinary rehabilitation group in small / and medium f. p<0.05. Intensive rehabilitation group showed no significant change in comparison to normal. There was more balance affection in toes up position in ordinary rehabilitation group. There was better balance in intensive rehabilitation group on affected side

Application and evaluation of the immunofiltration assay in the diagnosis of human schistosomiasis

In a trial to reach fast, simple and efficient diagnostic assay for schistosomiasis, Dot Dye Immunofiltration assay using protein A conjugated gold colloid was applied and evaluated in comparison to Dipstick assay and Enzyme Immunoelectrotransfer Blot Assay [EITB], Both soluble egg antigen [SEA] of Schistosorna mansoni and Schistosoma haematobium were used as capture antigens in each assay. Dot Dye Immunofiltration assay, Dipstick assay and EITB were found to be more efficient by using SEA of S. mansoni, than by using SEA of S. haeinatobium. Using SEA of S. mansoni, Dipstick assay was found to be the most efficient [82.2%] among all performed assays followed by Dot Immunofiltration assay and EITB [80.5%] for each. On the other hand Dot Dye Immunofiltration assay was found to be simpler and faster than Dipstick assay and EITB

Effect of different aqueous solutions on gamma irradiated commercial and simulated soda lime silica glasses

This study presents the results of chemical durability of either commercial or prepared soda lime silicate glasses immersed in different aqueous solutions of [HC1, HNO[3], NaOH or H[2]O] for different duration. The chemical durability of the glasses was investigated by the weight loss determined per unit surface. The monovalent network modifier ion Na[+] is leached out more easily than the divalent cation Ca[2+], which is probably due to the stronger bond of the divalent cation Ca[2+] to the nonbridging oxygen sites in the glass. In explaining the results obtained two possible mechanisms [ion exchange leaching and matrix dissolution] were considered to explain .the release of cations from the glass structure in different aqueous solutions. The leaching mechanism involves the replacement of Na with a hydrogen bearing ion from the solution leading to the formation of surface layer, i.e. alkali depleted layer. The relative higher weight loss as a function of time, which characterizes the corrosion in alkaline media can be referred to the local rise of the solution pH, which could facilitate the dissolution of the glass Si-network. Also the results reveal that the commercial SLS has a very good durability at room temperature in the acidic medium. This durability decreases with the increase of temperature but at 100°C the glass durability increases again. Corrosion of gamma irradiated SLS shows a marked increase in weight loss as a function of time, and leads to a higher weight loss. Our results and interpretations were supported through FTIR reflectance and SEM investigations

Risks and benefits of conservative management in severe pre-eclampsia

This prospective study was designed to detect whether conservative management in cases of severe pre-eclampsia is possible or not and to avoid prematurity and its related complications. This prospective case controlled study was conducted at Ain Shams University Maternity Hospital, over two years from April 2003 to April 2005, to detect whether conservative management in cases of severe pre-eclampsia is possible or not and to avoid prematurity and its related complications. Eighty five [85]: patients with severe pre-eclampsia [PET] were included in this prospective case controlled study. All patients included in this study were primigravida, not in labor, had a living fetus and had documented evidence of pre-eclampsia. The gestational age of the patients included in this study was more than 30 weeks gestation. Patients with maternal or fetal indications necessitating immediate delivery on admission were excluded from this study. All patients were admitted to the MICU of Ain Shams University Maternity Hospital. Before starting conservative management, patients and their relatives were informed about the management plan and possible maternal or fetal risks and benefits. If the patient agreed to continue conservative management, she signed a consent form. After counseling, forty five [45] patients refused the conservative management were included in the first group of this study [severe pre-eclampsia with immediate TOP], and conservative management was accepted by forty patients [40], included in the second of this study [severe pre-eclampsia managed conservatively]. The goal of the conservative management was to prolong pregnancy until 36 completed weeks [to avoid prematurity and to decrease the chance of neonatal incubation] or until the onset of either maternal or fetal complications [impending eclampsia or fetal distress]. The management was started immediately following admission with: bed rest, magnesium sulfate and an antihypertensive [methyldopa or nifedipine +/- hydralazine]. After control of blood pressure and prevention of convulsions, either TOP was started in the first group or conservative management in the second group. All patients in the second group received dexamethasone 12 mg IM every 12 hours for 48 hours and dexamethasone therapy was repeated weekly till delivery. 24 hours urinary total protein [UTP], Blood urea, creatinine, uric acid, SCOT, SGPT and platelet count were determined in all cases on admission. These laboratory investigations were repeated weekly for patients in the second group. Patients of the second group were monitored by senior obstetrician and senior anaesthiologist managing the MICU every day. Monitoring included inquiry about any complaints, blood pressure measurement 4 times daily, fetal heart sound auscultation 4 times daily, fetal growth monitoring, assessment of fetal wellbeing twice weekly and repetition of other tests whenever necessary. Patients were instructed to report the development of features such as persistent headaches, visual disturbances, epigastric pain, uterine contractions, vaginal bleeding, ruptured membranes or decreased fetal movement. TOP was based on both maternal and fetal indications. All patients were discharged after delivery with stable blood pressure levels and absent or + I urinary albumin. There was a high significant difference between the two groups of this study as regards the gestational age at TOP which was 32.4 weeks +/- 2.5 in the first group with immediate TOP compared with 35.4 weeks +/- 6.2 in the second group managed conservatively. Although, the first group with immediate TOP had shorter hospital stay before TOP [0.25 days +/- 0.5] than the second group managed conservatively [20.5 days +/- 4.5], the same group with immediate TOP had longer hospital stay after TOP [7.5 days +/- 3.5] titan the second group managed conservatively [5.0 days +/- 1.5]. The two groups of this study were matched with no significant difference as regards the mean systolic and diastolic blood pressure on admission, but the mean systolic blood pressure on TOP was significantly lower in the second group managed conservatively 140.8 mmHg +/- 12.5 compared with 155.5 mmHg +/- 22.5 in the first group with immediate TOP, also, the mean diastolic blood pressure on TOP was significantly lower in the second group managed conservatively 101.5 mmHg +/- 10.5 compared with 112.5 mmHg +/- 15.5 in the first group with immediate TOP. In the first group with immediate TOP, the serum uric acid was significantly decreased from 6.8 mg/dL +/- 1.73 on admission to 5.5 mg/dL +/- 0.35 on TOP, also, the SCOT was significantly decreased from 38.0 IU/L +/- 1.5 on admission to 31.2 IU/L +/- 3.58 on TOP and the SGPT was significantly decreased from 42.0 IU/L +/- 7.21 on admission to 20.0 IU/L +/- 5.7 on TOP. In the second group managed consewatively, the blood urea level was significantly decreased from 37.25 mg/dL +/- 7.32 on admission to 34.30 mg/dL +/- 5.67 on TOP, and the serum creatinine was significantly decreased from 1.35 mg/dL +/- 0.56 on admission to 1.24 mg/dL +/- 1.1 on TOP. Also, in the second group, the SCOT was significantly decreased from 40.50 IU/L +/- 3.5 on admission to 29.85 IU/L +/- 8.36 on TOP, and the SGPT was significantly decreased from 41.62 IU/L +/- 10.2 on admission to 19.8 IU/L +/- 7.35 on TOP, but there was a significant increase in the level of uric acid from 7.2 mg/dL +/- 1.12 on admission to 7.5 mg/dL +/- 0.87 on TOP and a significant decrease in the Platelet count from 192.907 x 1000/mm3 +/- 93.25 on admission to 156.484 x 1000/mm3 +/- 77.387 on TOP. The incidence of accidental hemorrhage was significantly higher in the first group of this study with immediate TOP [two patients = 0.44%], compared with the second group managed conservatively [one patient = 0.25%] and the incidence of antepartum eclampsia was signifantly higher in the second group managed consematively [3 patients = 0.75%] compared with the first group with immediate TOP [two patients - 0.44%]. In the second group of this study, The consewative management was successful and was continued till 36 weeks gestation in 22 patients out of 40 [55.0%]. 23 patients [57.5%] delivered vaginally in the second group managed conservatively compared with 21 patients [46.67%] in the first group with immediate TOP [P < 0.05 S.] and the number of the patients delivered by cesarean section was 24 out of 45 [53.33%] in the first group with immediate TOP and was 17 out of 40 [42.5%] in the second group managed conse-rvatively [P < 0.001, H.S.]. Also, there was a significant difference between the two groups of this study as regards fetal birth weight, which was 1.890 Kg +/- 0.850 in the first group with immediate TOP versus 2.425 Kg +/- 1.55 in the second group managed conservatively [P < 0.001, H.S.]. The number of the infants admitted to the NNICU was 29 out of 45 [64.4%] in the first group with immediate TOP compared with 12 out of 40 [30.0%] in the second group managed conservatively [P < 0.001, H.S.]. The neonatal deaths were significantly higher in the first group with immediate TOP [12 neonates - 26.7%] compared with the second group managed conservatively [3 neonates = 0.75%] [P < 0.001]. The duration of admission to NNICU was significantly longer in the first group with immediate TOP [37.5 days +/- 9.0] compared with the second group managed conservatively [19.0 days +/- 11.5] [P < 0.001]. The postpartum complications were significantly higher in the first group with immediate TOP compared with the second group managed conservatively. Two patients [0.44%] in the first group developed post-partum hemorrhage, while no cases of post-partum hemorrhage recorded in the second group [P < 0.001], also, one patient [0.22%] developed post-partum renal failure in the first group, while no cases of post-partum renal failure recorded in the second group [P < 0.05]. Six patients [13.4%] developed post-partum eclampsia in the first group compared with 3 patients [0.75%] in the second group [P < 0.001] and two patients [0.44%] developed HELLP syndrome in the first group compared with one patient [0.25%] in the second group [P < 0.05]. Consewative treatment with continuous monitoring and supervision is possible in selected cases of severe pre-eclampsia, in order to improve the fetal outcome in developing countries where NNICU is not available, without increasing the maternal risk

Role of some inflammatory markers in recent ischemic stroke

The onset of cerebral ischemia triggers a cascade of pro-inflammatory molecular and cellular events. Clinical studies suggest that the strength of this acute response is important in early and late clinical outcomes, early clinical worsening, and extent of brain damage. The aim of this work was to estimate the. role of some inflammatory markers in recent ischemic stroke, and to correlate these inflammatory markers with the short term outcome. Twenty sex patients presented with recent history of hemiplegia within 24 hours were included. The patient group was planned to contain 13 patients with the age between 20 and <40years and 13 patients with the age between 40 and 60 years. 15 subjects, [age and sex matched to the patients] were included in the study as control Neurological deficits were rated by Scandinavian Stroke Scale. Clinical assessments and serum levels of the inflammatory markers, Neopterin C -Reactive Protein [CRP], Tumor Necrosis Factor-alpha [TNF-alpha], Complement 4 [C-4], Interleukin-8 [IL-8], and Neopterin, were done at the time of admission, day 3, and day 7 from the stroke onset. Serum levels of neopterin started to increase from the 3 rd day and remained high to the end of the first week from the onset of the stroke. The increase was more obvious in the young aged patients. Serum levels of IL-8, raised rapidly in the acute phase of the stroke and then gradually decreased through the first wee and but still higher than the base line of the total patients and control. Serum levels of TNF-alpha and CRP had rapid significant increase from the first day to reach maximum levels in the 3 rd day and still significantly high till the end of the first week Serum CRP levels were higher in the old age group while serum C4 levels decreased from the 1 st day then gradually increased to reach maximum levels in the 7 th day, but still significantly lower than the control group. Also, there were statistically positive correlations between serum levels of neopterin and C-4 in the 3 rd sample with the Scandinavian scale in the 3 rd assessment. Brain ischemia induced an inflammatory cascade by the increase in serum levels of neopterin, IL-8, TNF-alpha, CRP and decrease in C4. This inflammatory response continued through the first week by the increase in the levels of complement -4. The inflammatory response was more obvious in the young aged patients. There were positive correlations between serum levels of neopterin, and C-4 with the short-term outcome of the stroke patients

Plication of Haemorrhoids [haemorrhoidorrhaphy] versus milligan-morgan haemorrhoidectomy

Excision of advanced haemorrhoids involving most of the anal circumference is associated with excessive bleeding, extensive raw area and anal stenosis. On the other h and, incomplete eradication means recurrence. Plication of haemorrhoids or haemorrhoidorrhaphy obliterates any degree of haemorrhoids without leaving raw areas. This r and omized study compared plication with Milligan-Morgan haemorrhoidectomy. A total of 120 patients having advanced 3rd or 4th degree haemorrhoidal disease were r and omized to undergo haemorrhoidorrhaphy [73 cases forming Group A] or conventional haemorrhoidectomy [47 cases forming Group B]. The two methods showed no significant difference as regards the operative time, cost of surgery and postoperative care, amount of pain on days 1 and 7 and on first evacuation, length of postoperative hospital stay and patients' overall satisfaction score after 6 months. However, haemorrhoidorrhaphy was associated with a significantly smaller amount of bleeding. Conventional haemorrhoidectomy was associated with temporary incontinence to flatus in 5 cases, a persistent painful raw area beyond 6 weeks postoperatively in 4 cases, anal stenosis in 2 cases and recurrence in 2 cases, while none of the cases of haemorrhoidorrhaphy had such complications. Postoperatrive retention of urine that needed catheterization was noted in 6 cases of Group A and 7 cases of Group B.A peri-anal abscess was also reported in 2 cases of group A and 3 cases of group B within the first postoperative month and were completely cured by urgent drainage. Plication of haemorrhoids gives better results in comparison to conventional haemorrhoidectomy in advanced cases although it is applicable to all grades of the disease. Such advanced cases will have the advantage of minimization of bleeding, complete avoidance of leaving raw areas which precipitate anal stenosis and complete eradication of the disease that prevents recurrence, together with preservation of the normal anal cushions

Comparative study between prolene hernia system mesh and pre-peritoneal mesh in treatment of recurrent inguinal hernia

Repair of recurrent inguinal hernia is technically more dem and ing than a primary repair, with potential for a new recurrence, and a higher risk of complications. Between June 2002 and December 2003, sixty-four patients with recurrent inguinal hernia had been selected for this prospective comparative study. The patients were r and omized to undergo treatment using either the prolene hernia system [PHS] or the open pre-peritoneal configured prolene mesh repair [group A and B respectively]. No re-recurrence or mesh infection was reported in both groups. In group A, haematoma was reported in 2 cases [6.25%] cord injury and testicular atrophy in one case [3.12%] and scrotal oedema in 12 cases [37.5%]. These complications were not reported in group B which showed an incidence of seroma in one case [3.12%]. Compared to the PHS, the open pre-peritoneal configured prolene mesh repair for recurrent inguinal hernia is technically easier, safer and cheaper. The incidence of scrotal oedema is significantly less with the pre-peritoneal approach than with the open anterior approach using the PHS. The open pre-peritoneal repair using a configured prolene mesh should be considered at the top of hierarchy for treatment of recurrent inguinal hernia especially in bilateral cases

Is stored expressed breast milk an alternative for working Egyptian mothers?

Expression and storage of breast milk is way to maintain breastfeeding when mother and infant are separated, if the nutritional value can be conserved. Three expressed breast milk samples were collected from 61 healthy lactating mothers in Cairo, Egypt, for determination of total protein, fat, lactose and zinc content, as well as vitamins C, A and E concentrations. One sample was analysed immediately without storage, 1 after storage for 24 hours in a refrigerator [4 degrees C] and 1 after storage for 1 week in a home freezer [-4 degrees C to -8 degrees C]. Refrigeration and freezing of breast milk caused a statistically significant decline in levels of vitamins C, A and E. Nevertheless, the values of all nutrients were still within the international reference ranges for mature breast milk

Effect of storage of breast milk on its chemical composition

The aim of this work was to study the effect of storage of breast milk on some of its chemical constituents. Three expressed breast milk samples were collected from each of 61 healthy lactating mothers for determination of total proteins, fat, lactose and zinc content as well as vitamins C, A and E concentrations. The first sample was analyzed immediately without storage, the second after storage for 24 hours in first shelf of refrigerator [4C], while the third after storage for one week in a home freezer [-4 to -8C]. The results revealed that storage of expressed breast milk [EBM] for 24 hours in first shelf of refrigerator [4C] and for one week in home freezer [-4 to -8C] caused a statistically significant decline in all of the studied nutrients, except for zinc content. Despite this decline after storage, the composition of the stored breast milk was still within the ranges of the international reference of mature breast milk composition