Molecular mechanisms of the anti-obesity potential effect of Moringa oleifera in the experimental model

Objective To elucidate the molecular mechanisms of the potent anti-obesity effect of Moringa oleifera Lam. (M. oleifera) ethanolic extract and to clarify the link between these mechanisms and the associated metabolic and vascular risks in the experimental model of visceral obesity. Methods M. oleifera ethanolic extract was orally administered at 600 mg/kg body weight in obese female rats daily for 12 weeks. At the end of treatment, body weight was determined, and the atherogenic index, coronary artery index, glucose level, insulin resistance status, liver and kidney functions were assessed. Also, the mRNA of leptin, adiponectin and resistin in visceral adipose tissue was determined by quantitative real time-PCR. Results The results showed that M. oleifera extract down-regulated mRNA expression of leptin and resistin, while it up-regulated adiponectin gene expression in obese rats relative to untreated obese control counterparts. This amelioration of genes expression was paralleled by a reduction in body weight and improvement of the atherogenic index and coronary artery index, as well as glucose level and insulin resistance value without adverse effects on liver or kidney functions, versus the untreated obese control ones. Conclusions It is reasonable to assume that the anti-obesity, anti-atherogenic and anti-diabetic properties of M. oleifera are mechanistically achieved via working directly on the adipokines of the visceral adipose tissue. Therefore, M. oleifera may be a good therapeutic candidate for the symptoms of metabolic syndrome.

Prevalence and molecular epidemiology of extended spectrum β-lactamase producing Escherichia coli from hospital and community settings in Egypt.

The prevalence and molecular epidemiology of Escherichia coli that produce extended spectrum β-lactamase (ESBL) in Cairo, Egypt was investigated. Ninety E. coli isolates were collected along the period of September to November 2012 from hospital and community settings. Antibiotic susceptibility of the E. coli isolates was determined by disk diffusion method. All isolates were screened phenotypically for ESBL production by combination disk method. The presence of blaCTX-M-I, blaCTX-M-IV, blaTEM and blaSHV genes in ESBL-producing E. coli was examined by PCR and sequencing experiments. The results showed high prevalence of ESBL-producing E. coli, 52% of the collected isolates were ESBL producers. The ESBL-producing isolates significantly (P < 0.05) had increased resistance compared with non–ESBL producers to cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, and co-trimoxazole. Imipenem was the most effective drug against ESBL producing isolates. All ESBL producing E. coli isolates were multi drug resistant (MDR) to eight antibiotics or more. Detection of ESBL genes in selected MDR-ESBL producing E. coli revealed that blaCTX-M-I was the most prevalent ESBL type. It is clear that the prevalence of ESBL producing E. coli in Cairo, Egypt is alarming high. This study is useful for clinician in order to improve the empiric treatment.

Comparison of immunochromatographic test and microscopy in the detection of some enteric protozoa in stool samples

Infection with pathogenic intestinal protozoa as Giardia lamblia, Entamoeba histolytica and Cryptosporidium parvum cause considerable gastrointestinal morbidity, malnutrition and mortality worldwide, especially among young children in developing countries. The present study was carried out on 71 cases [44 males and 27 females] chosen from Pediatric and Internal Medicine Inpatient and Outpatient Clinics of Zagazig University Hospitals, complaining of different gastrointestinal troubles with an age range of 6-60 years. Also, 20 apparently healthy individuals [11 males and 9 females] cross matched were considered as a control negative group. All stool samples were examined by direct wet smears, concentration techniques, staining of the smears using trichrome stain and Modified Ziehi-Neelsen method. Copro-antigen detection in faecal sample was by using quick immunochromatographic test. A total of 71 cases suffering from different GIT manifestations showed G. lamblia [30.7%], Cryptosporidium parvum [19.8%], Entamoeba histolytica /E. dispar [11%] and mixed infection of three protozoa [6.6%]. However, by copro-antigen G. lamblia was positive in [31.8%] of C. parvum in [20.9%]; E. hisiolytica/E. dispar in [11%] of cases. lmmunochromatography/copro-antigen test recorded sensitivity and specificity of [100%] and [96.6%] respectively in G. lamblia detection. For C. parvum, sensitivity vas [100%] and specificity was [97.1%] while for E. histolytica/E. dispar sensitivity and specificity were [100%] for both. lmniunochrornatographic assay proved to be simple, easy and useful in confirming absence or the presence of intestinal protozoan infection in clinically suspected cues with negative stool examination

P wave dispersion and severity of obstructive sleep apnea syndrome

OSA is associated with an increased prevalence of coronary artery disease heart failure and rhythm disturbance. Also, P-wave dispersion [Pd] reflects inhomogeneous atrial depolarization secondary to insults such as chronically elevated atrial pressure, ischemia, or metabolic stress that promote atrial structure remodeling and provide a substrate for atrial fibrillation. We aimed to investigate Pd in patients with OSA and to determine if there is any relationship with severity of the disease. This study was conducted in Chest and Cardiology Departments, Assuit University Hospital, Egypt on 40 OSA patients [29 males and 11 females], and 20 healthy controls. We excluded patients with COPD and any diagnosed cardiac disease. For every patient, we did a polysomnography and ECG. Pd was significantly more in OSA [98.50 +/- 4.77 m/s] than controls [72.00 +/- 3.37 m/s] Rvalue <0.05]. Pd in severe, moderate and mild OSA were 111.43 +/- 5.62 m/s, 95.00 +/- 7.83 m/s ando5.71 +/- 8.41 m/s, respectively with a significant positive correlation with severity of OSA. Multiple linear regression shows that systolic blood pressure and BMI are independently associated with Pd [beta = 0.56, p = 0.00] [beta = 0.27, p = 0.05]. Pd is increased and correlated with severity of OSA. Systolic blood pressure and BMI are independent risk factors for Pd. Follow up of patients to detect clinical implications is recommended

Pulmonary functions after injection sclerotherapy of esophageal varices and after band ligation

Aim of the study: To study changes in pulmonary function tests after esophageal variceal injection sclerotherapy in comparison to changes after esophageal variceal band ligation

Patients and methods: This study was designed as non randomized controlled study. Thirty patients with hepatic cirrhosis and portal hypertension who were admitted to Hepatology, Gastroenterology and Infectious Diseases department , Benha university hospital for elective esophageal variceal therapy [secondary prophylaxis] were classified into group I:15 patients treated with sclerotherapy by using 5-15 ml ethanolamine oleate and group II:15 patients treated with band ligation. Patients were subjected for full clinical evaluation including history, general, chest, and abdominal examination. Laboratory and radiological investigation including complete blood count, liver function tests, kidney function tests and blood sugar and plain chest x-ray [P.A. and lateral views] were done. Pulmonary function tests and arterial blood gasses were done before, one day after and one week after the procedure

Results: The results revealed , significant decrease in vital capacity in group I one day after injection [ p < 0.05],but no significant decrease in vital capacity in group II. There was a significant decrease in PaO2 in group I one day after injection sclerotherapy [ p < 0.05] but no significant changes in group II and no significant changes in PaCO2 in both groups one day after the procedures. The study has also revealed no significant changes in FVC,FEV1/FVC and PaCO2 in group I and group II after procedures. The study revealed significant linear correlation between the decreases in PaO2 and the percentage decrease in vital capacity[ p < 0.05]. One week after procedure, pulmonary functions that has been affected in group I returned back to baseline values

Conclusions: esophageal injection sclerotherapy produces restrictive defect [decrease in PaO2 and vital capacity] in pulmonary functions one day after injection and improved within one week, while there was no effect for band ligation on pulmonary functions tests

On improving assessment of in-hospital mortality and ICU admission in community-acquired pneumonia patients using the eCURB

Assessment of severity of the disease in community-acquired pneumonia [CAP] is very important to decide the site of care. The conventional CURB-65 score is composed of five separate elements namely, Confusion, Uremia, Respiratory rate, BP, and age >/=65 years. These elements could be calculated electronically. The electronic CURB [eCURB] utilizes the 5 CURB-65 data elements as continuous, weighted variables. The aim of this study was to evaluate the performance of eCURB elements in predicting in-hospital mortality and ICU admission in comparison to the conventional CURB-65. This study was conducted upon 134 adult patients diagnosed as CAP and confirmed by radiographic findings, admitted to chest department, Assiut University Hospital, Egypt. The CURB-65 elements were retrospectively extracted from the medical records. The eCURB variables were introduced to electronically calculate the risk using the Excel appendix model [provided by Prof. Nanthan Dean, University of Utah, Salt Lake city, USA] and its predictive values and area under the receiver-operating characteristic [ROC] curve were compared with the conventional CURB-65 in predicting in-hospital mortality and the need for ICU admission. The study revealed that the conventional CURB-65 score could predict in-hospital mortality with an area under the curve [AUC] of 0.81 and the need for ICU admission with an AUC of 0.87. Using the eCURB-65 elements proved to be superior to the conventional CURB-65 in predicting in-hospital mortality with cut off point > 7.5 and an AUC of 0.83 [P < 0.0001]. Also, eCURB was better than conventional CURB-65 in predicting ICU admission with cut off point > 3.8 and an AUC of 0.89 [P < 0.0001]. Using the eCURB proved to be a valuable tool in predicting in-hospital mortality and ICU admission in patients with CAP with a significant superiority over conventional CURB-65 in both variables. Further prospective studies on a larger cohort are recommended

Non-invasive proportional assist ventilation in management of severe asthma exacerbation

NIV could be beneficial in selected patients with severe asthma exacerbation [SAE]. However, its role is still not well defined. To evaluate the efficacy of NIV using proportional assist ventilation [PAV] in severe asthma exacerbation after failure of conventional medical therapt [CMT]. Thirty patients with severe asthma exacerbation were failed to respond on conventional medical therapy. NIV was applied via face mask as a last option before intubation and mechanical ventilation. The mean age was 39.2 +/- 9.7 with female predominance [19 females vs. 11 males]. The successful outcome was achieved in 23/30 patients [76.6%]. Follow up of the mean of respiratory distress and gasometric parameters before recruitment vs. 1 h after NIV in successful group showed statistically significant improvement after NIV application as follows: HR [125.4 vs. 107.4], RR [38.2 vs. 25.4], PH [7.28 vs. 7.36], PaCO2 [55.3 vs. 42.5], PaO2 [58 vs. 87] and PEFR% Predicted [39 vs. 64] respectively [P < 0.001 for all items]. Also, the same improvement was in PEFR, tidal volume, peak inspiratory pressure and triggered breaths% in successful group vs. failure group. NIV can relieve respiratory distress and improve gas exchange in the majority of patients with severe asthma exacerbation who are candidate for intubation after failure of conventional medical therapy

antigenic fractions of strongyloides stercoralis filariform larval crude soluble antigen

This study was carried out on the sera of fifteen Strongyloidiasis patients, twenty-five cases with other helminthic infections and five cases free from parasitic infections [control]. Enzyme immunoblot transfer assay [EIBT] was used to assess IgG response against the different fractions of Strongyloides stercoralis filariform larval crude soluble antigen separated by sodium dodecyl sulfate- polyacrylamide gel electrophoresis [SDS-PAGE]. In the immunoblot, all sera of 15 strongyloidiasis patients disclosed IgG antibodies reactivity against immunogenic bands having molecular weights. Five immunodominant antigenic bands of 66, 50, 41, 38 and 31 KDa were commonly recognized by the strongyloidiasis sera IgG suggesting that these antigenic components may be suitable for specific immunodiagnosis of human strongyloidiasis

Congenital syringobulbia a radiological study with clinical correlation, study of its incidence and probable aetiopathogenic factors

In the present study 25 patient with the clinical diagnosis of congenital syringomyelia are included. All cases were examined MRI. The brain, craniocervical junction, the cervical and upper dorsal spine were scaned in every patient. Special focus of attention was given to the brain stem for evidence of syringobulbia. 9 patients were also examined by CT myelography with early and late study [done 6 Hr later]. The brain stem, craniocervical junction and the cervical spine were scanned. Four, cases [16%] were found to have brain stem cavitations in conjunction with syringomyelia. Cases with syringomyelia and syringobulbia are compared with syringomyelia cases without syringobulbia hoping to find out aetiopatho genie factors or risk factors that are responsible for extension of syringomyelic cavitation to the brain stem, as early correction of these factors might help preventing extension of syringomyelic cavitations to the medulla. Full description of the pathoanatomical types of syringobulbia will also be made

idiopathic parkinson disease. A magnetic resonance imaging study correlation with the clinical picture and the pattern of levodopa responsiveness

In the present study 20 patients with the clinical diagnosis of idiopathic parkinson disease are included. All patients were subjected to [1] full clinical examination and MRI study of the brain with a special focus on the mid-brain and the basal ganglia. Based on the duration of the parkinsonian symptomatology and the clinical response to levodopa treatment, patients were classified into two main groups. Group [A] is characterized by short duration of the parkinsonian symptomatology and a good sustained response to levodopa treatment, while group [B] was characterized by a longer duration of the parkinsonian symptomatology and a fluctuant response to levodopa treatment. MRI demonstrated important structural changes at the level of the substantia nigra and the red nucleus in both groups, while structural changes at the level of the basal ganglia [putaminal hypointensity on the T2 weighted images] were demonstrated only in group [B] patients. The significance of the MRI findings, their probable aetiology and pathogenesis, their value in explaining the pattern of clinical levodopa responsiveness and their implications in the management of parkinson disease will be discussed

acyclovir responsive herpes simplex encephalitis definition of its radiological features; correlation with the clinical picture and CSF analysis

In the present study 13 patient with the clinico- radiological diagnosis of herpes simplex encephalitis [HSE] are included. All patients were subjected to [1] full clinical examination [2] CSF analysis that included CSF chemistry [protein, glucose and chloride], cells, latex test for bacterial antigens, CSF culture of pyogenic bacteria and TB and PCR [polymerase chain reaction] for detection of both type I and type II herpes simplex virus [HSV] DNA [3] Both MRI and CT scan of the brain with and without contrast were done to all patients. CSF analysis showed moderate rise of proteins [average 860 mg/dl, normal values up to 450 mg/dl] with normal sugar and glucose and with a predominately lymphocytic pleocytosis in all patients. Latex test was negative for all patients. Both CSF bacterial and TB cultures were eventually negative. HSV type I DNA was detected in the CSF by the PCR test in all patients, type II HSV DNA was not detected in the CSF of any of the patients examined. Involvement of the temporal lobes unilaterally or bilaterally were the cardinal radiological feature demonstrated in all patients. Other areas of the brain, such as the orbital frontal region, the paraventricular region, the basal ganglia or the brain stem, are involved but less frequently. The significance of these findings for the early diagnosis of herpes encephalitis are discussed. Also the clinical course of the patients and their response to treatment will be presented and discussed

Pedicle screws fixation with posterolateral fusion in treatment of lumbar spondylolisthesis

Between 1991 and 1998, forty-five consecutive postero-lateral lumbar fusion [twenty males and twenty five females] with pedicular screw fixation in patients with grades I and II lumbar spondylolisthesis. The youngest age of the patients was 26 and the oldest was 65 years with median age of 40 years. Twenty patients were degenerative, twenty five with isthmic type, ten of them had a history of previous laminectomy. All the patients were treated at El-Zahra University and Heliopolis Hospitals. Follow -up period ranged from 2 to 8 years with an average of four years. All patients were evaluated according to J.O.A. scoring system for pre and postoperative clinical evaluation. The low back pain [LBP], leg pain, neurological symptoms, and Activity Day Living [ADL], according to improvement rate, were excellent in 56%, good in 28.5% fair in 13.3% and poor in 2.2%. The overall fusion rate was 70% We concluded that the clinical success rate of fusion, and patient satisfaction in the study was reproducible, with acceptable rate of complications