Finding Wolbachia in Filarial larvae and Culicidae Mosquitoes in Upper Egypt Governorate

Wolbachia is an obligatory intracellular endosymbiotic bacterium, present in over 20% of all insects altering insect reproductive capabilities and in a wide range of filarial worms which is essential for worm survival and reproduction. In Egypt, no available data were found about Wolbachia searching for it in either mosquitoes or filarial worms. Thus, we aimed to identify the possible concurrent presence of Wolbachia within different mosquitoes and filarial parasites, in Assiut Governorate, Egypt using multiplex PCR. Initially, 6 pools were detected positive for Wolbachia by single PCR. The simultaneous detection of Wolbachia and filarial parasites (Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens) by multiplex PCR was spotted in 5 out of 6 pools, with an overall estimated rate of infection (ERI) of 0.24%. Unexpectedly, the highest ERI (0.53%) was for Anopheles pharoensis with related Wolbachia and W. bancrofti, followed by Aedes (0.42%) and Culex (0.26%). We also observed that Wolbachia altered Culex spp. as a primary vector for W. bancrofti to be replaced by Anopheles sp. Wolbachia within filaria-infected mosquitoes in our locality gives a hope to use bacteria as a new control trend simultaneously targeting the vector and filarial parasites.

Comparative protective effect of Moringa and dandelion extracts against hepatic disorders and oxidative stress associated with prolonged use of Brufendrug in rats

Bachground: The nonsteroidal anti-inflammatory drugs [NSAIDs] are the most frequently used medications worldwide for the treatment of a variety of common chronic and acute inflammatory conditions. The association between NSAIDs and liver disease is poorly documented

Aim: the current study was carried out to investigate the hepatic disorders associated with prolonged use of Brufen drug and evaluate the role of both moringa and dandelion extracts as hepatoprotective agents against these disorders

Methods: rats were divided into six groups [six rats/ each] as follow: group 1: rats did not receive any treatment and served as control; group 2: rats orally administrated moringa extract [300mg/kg b.wt] daily for 12 weeks; group 3: rats orally administrated dandelion extract [300mg/kg b.wt] daily for 12 weeks ; group 4: rats orally administrated Brufen [18mg/kg b.wt] daily for 12 weeks;.group5: rats orally administrated moringa extract [300mg/kg b.wt] daily for one week alone then concomitant with Brufen [18mg/kg b.wt] for 11 weeks ;group 6: rats orally administrated dandelion extract [300mg/kg b.wt] daily for one week alone then concomitant with Brufen [18mg/kg b.wt] for 11 weeks

Results: the present results showed that the administration of Brufen led to significant increases in the levels of TL, TC, TG, LDL-C, ALT, AST, ALP, GGT, MDA and XO. While significant decreases in HDL-C, TP, ALP, GSH, TAC, SOD, CAT and GSH-Px, were recorded in Brufen treated rats group. On the other hand, the administration moringa or dandelion extracts succeeded to alleviate these abnormalities resulted from Brufen drug as indicated by the clear amelioration of occurred hepatic metabolic disorders, oxidative stress and histopathological changes in addition to improvement of the antioxidant status

Conclusion: it could be concluded that moringa or dandelion extracts have a remarkable role in management the hepatic disorders and oxidative stress associated with prolonged use of Brufen. Additionally it was recorded that moringa extract was more beneficial than dandelion extract in alleviating the occurred adverse effects of Brufen

Study of suspected cases of primary immunodeficiency disease attending Alexandria university children's hospital; a one year study

Objectives: To determine the clinical and epidemiological characteristics of patients with suspected primary immunodeficiency's [PID] seen at Alexandria University Children's Hospital from December 2013 to December 2014

Methods: Eighty one patients with suspected PID were seen at Alexandria University Children's Hospital in one year. Demogrpahic data of the patients as well as data related to their disease status were taken and evaluation sheet was developed for all patients

Results: 61.7% of patients satisfied the criteria of PID based on WHO Scientific Committee. According to modified IUIS classification predominant antibody deficiency was the commonest [34%] followed by other well defined immunodeficiency syndromes [30%], combined immunodeficiency [16%], phagocytic defects [14%], and diseases of immune deregulation 4% and complement deficiencies [2%]. The most frequent disorder was X-linked agammagloulinemia [XLA] [22%]. The mean age at diagnosis was 27.4 months. The consanguinity rate was 55.5%. A positive Family history was a strong pointer to diagnosis for PID [46.9%]. The commonest clinical presentation was pneumonia [82.7%]. 28.4% of patients died from infections. As observed in other patient registries, diagnostic delay remains the major cause of morbidity and mortality

Conclusion: Primary immunodeficiency disorders are not rare in Egyptian children. Creating awareness of PID should be targeted at hospital pediatricians and families with history of PID and this may reveal more cases within the community. The observed high frequency of combined T- and B-cell immunodeficiencies in this cohort made it a health issue in Egypt as in other developing countries

Serum leptin concentration, bone mineral density and bone biochemical markers in a sample of Egyptian women: a possible relationship

Adipocytokines secreted by adipose tissue participate in bone metabolism; leptin is one of the circulating peptides secreted by adipose tissue. To determine the serum levels of leptin in obese postmenopausal women in order to correlate these levels with bone mineral density and bone biochemical markers to find out the role of leptin in bone metabolism. This was a cross-sectional study which included 37 obese postmenopausal women with body mass index [BMI] >30 kg/m[2]. Thirty-seven lean postmenopausal women with BMI <25 kg/m[2] were included as control group. Serum leptin, bone specific alkaline phosphatase [BAP], osteocalcin and urine C-telopeptide of type collagen [CTx] were assayed. Bone mineral density [BMD] and soft tissue body composition were determined using dual energy X-ray absorptiometry. There was a statistically highly significant increase in serum leptin levels in obese than lean postmenopausal women [p < 0.0001]. There was a highly significant decrease in BMD of spine and hip [p < 0.0001] in obese than lean postmenopausal women. After adjustment of fat mass, a highly significant positive correlation was found between leptin and BAP [r = 0.562, p < 0.0001], a significant positive correlation was found between leptin and each of osteocalcin and urine CTx [r = 0.423, 0.456 respectively, p < 0.05] but there was no statistically significant correlation between leptin and BMD. Our results support the hypothesis that leptin can act directly or indirectly on bone remodeling by modulating osteoblast activities. Leptin was found to be associated with decreased BMD at different sites of the body and was positively correlated with bone biochemical markers. However, leptin did not come out to be an independent predictor of BMD whereas; fat mass was found to have a role in bone metabolism in postmenopausal women. However these comparisons of a single measurement of leptin with BMD, does not exclude possible long-term strong relationships between leptin and BMD

Role of trichinella spiralis adult and larval antigen in immunomodulation of nitric oxide [NO] expression in intestinal and muscular phase of trichinellosis

Nitric oxide [NO] mediates regulatory events that play key roles in cellular function. NO is produced through the action of nitric oxide synthase [iNOS] it is considered to be the main factor able to kill or at least to suppress various pathogens, including intracellular parasites as Plasmodium, Leishmania major, Trypanosoma cruzi and Toxoplasma gondii. The aim of this study is to investigate the role of. spiralis Adult Antigen [TAA] and Larval Antigen [TLA] on the expression of iNOS in both phases of infection at different postinfection intervals using specific anti-iNOS antibody. Immunohistochemistry was performed among muscle and intestinal parts excised from three groups of laboratory mice [along with control groups] at different post infection intervals: Group 1, [G[1]]: T. Spiralis infected mice and none immunized, Group 2, [G[2]]: T. spiralis infected mice and immunized with [TLA] and Group 3, [G[3]]: T spiralis infected mice and immunized with [TAA]. NO synthase immunoreactivity was detected by using peroxidase-labelled streptavidin-biotin technique and the CD3 activity [anti T-cells] was detected using Clone FC3/188A Ab The study results showed that Trichinella antigen [TLA and TAA] had modulated the expression of NO in each phase of infection. TLA was more potent than TAA in activation of NO during the muscular phase and decreasing its activity during the intestinal phase. By the inverse effect of these antigens on [NO], the integrity of the intestinal and muscular tissues had been maintained

Immunoinflammatory markers and disease activity in systemic lupus erythematosus: something old, something new

This study assessed the utility of some novel inflammatory markers compared with traditional laboratory markers in patients with systemic lupus erythematosus [SLE]. In a cohort of 43 SLE patients [19 with inactive and 24 with active SLE] and 20 healthy controls, serial measures of soluble vascular cell adhesion molecule [sVCAM-1] were significantly associated with SLE disease activity, scored using the British Isles Lupus Assessment Group index. Inflammatory markers neopterin and soluble intercellular adhesion molecule [sICAM-1] appeared to be clinically useful for isolated assessments of disease activity. Both antibodies to double-stranded DNA [antidsDNA] and sVCAM-1 were relatively good markers of disease activity and could help to predict remission or monitor the therapeutic response in SLE

Comparative study between non lethal and lethal strains of Plasmodium yoelii with reference to its immunological aspect

Innate immunity has an important role in the protection against malaria. To clarify the effect on non lethal and lethal strain of Plasmodium yoelii, comparison between two groups of C57BL/6 mice infected with 10[4] parasitized RBCs was performed. Liver and spleen mononuclear cells were isolated and analyzed by flow cytometry. The parasite appeared in blood on day 3 in both strains, with non lethal infection parasitemia reached a peak of 60% on day 14 and mice completely recovered, while in lethal infection parasitemia was 80% on day 7 and mice succumbed to death. In non lethal strain, mice became anemic and the hematocrit percentage returned to its normal value during recovery, while in the lethal strain mice were severely anemic before death. The major expanding cells were found to be TCR Intermediate [TCR[int]] cells, mainly NK1.1 subset, these TCR[int] cells were distinguished from conventional T cells of thymic origin. CD4[-] and CD8[-] cells increased in both strains. During malarial infection, the population of conventional T cells did not increase and usually associated with thymic atrophy. The present results showed that TCR[int] cells were intimately associated with the protection against malarial infection in both non lethal and lethal strains but the mice died in lethal infection due to the massive destruction of red blood cells leading to fatal anemia

Correlation between old and new immuno-inflammatory markers and disease activity in systemic lupus erythematosus

To compare new SLE activity inflammatory markers with traditional ones. In addition, to correlate those with disease activity index of SLE. Forty-three patients fulfilling the American College of Rheumatology criteria for diagnosis of SLE and 20 apparently healthy controls were subjects for study. Neopterin, soluble intercellular adhesion molecule [sICAM-1] and soluble vascular cell adhesion molecule [sVCAM-1] were measured as well as anti-dsDNA antibodies, C3, C4 and CRP. The British Isles Lupus Assessment Group [BILAG] disease activity index was used to measure disease activity. Twenty-four [55.8%] patients had active SLE [total BILAG score > 5], involving more than one system in nine [37.5%]. Activity was more in musculoskeletal, mucocutaneous, and hematological systems. All markers showed significant differences between SLE patients and controls. Neopterin, sVCAM and CRP were highest when compared to controls [p>0.001] as well as to inactive subgroup. The level of sICAM-1 in active was insignificantly higher than inactive group. Significant correlations were found between total BILAG score and CRP, neopterin, sVCAM. No positive correlation was found between any marker and disease activity of different BILAG organ systems. All tests were done for 22 patients on 3 occasions over 6 months. Highest levels of sVCAM-1 were in active subgroup with flares during the first measurement. Significant decrease between first and third measurement was observed within all subgroups. Neopterin and sVCAM-1 appear to be clinically useful for isolated and serial concentrations assessments of SLE disease activity scored using the BIIAG index. Anti-dsDNA and sVCAM-1 are good markers to predict remission

Coproantigen versus EGG antigen in immunodiagnosis of intestinal capillariasis using Western Blot Technique

Capillaria philippinensis is a zoonotic nematode that causes severe diarrheal syndromes in humans. C. philippinensis coproantigen and egg antigen were fractionated using SDS-PAGE. Several protein bands were detected in both antigens. Protein profile of coproantigen of C. philippinensis infected patient included wide range of bands ranging from 10- 180 kD. Protein profile of egg antigen revealed only few bands detected at 10, 34- 36.5, and 148 kD. Using Western blot, a variety of protein bands were recognized by the infected patient serum. When tested against coproantigen, it detected a wide range of antigenic proteins at different molecular weight [10, 14, 34-36.5, 48, 54, 62, 66, 86, 94, and 148 kD respectively]. None of these bands were detected in normal human feces. When tested against egg antigen, the infected patient serum detected only two faint antigenic bands at 62 and 66 kD. It is concluded that coproantigen was more convenient than egg antigen in diagnosis of capillariasis by WB

Preliminary study on the production of nitric oxide and expression of nitric oxide synthase by camel macrophages [with one table and one figure]

Nitric Oxide is produced by macrophage when activated or invaded by certain antigens or microbes. In the present study, camel peripheral blood leukocytes were obtained by ficoll cushion. Monocytes were separated and grown to macrophages. The mature macrophages were exposed to E. coli LPS as well as sheep pox virus antigen. Nitric oxide [NO] production, by stimulated macrophages as well as the mRNA specific for production of inducible nitric oxide syntheses [iNOS], were investigated. Production of NO was stimulated by both pox antigen and LPS and was more with the latter. The obtained results indicated the similarity in the tested parameters between camel macrophages and those of other mammals tested so far viz mice

Treatment outcome of smear positive pulmonary tuberculosis patients

Introduction: The prime goals of tuberculosis treatment are to cure diseased individuals and minimizing transmissibility of Mycobacterium tuberculosis within the community. Tuberculosis treatment imposing many challenges for patients, health care providers and control program and non adherence to this regimen increases the risk of treatment failure, relapse, emergence of drug resistance and prolonged infectivity. Directly observed treatment short course [DOTS] had been evolved as the standard care to improve treatment compliance. Despite the free availability of these medications, many patients are not successfully treated

Objective: To evaluate the treatment outcome among patients with smear positive pulmonary Tuberculosis. To identify factors that may be associated with non-successful treatment

Subjects and Methods: A multi stage sample consisted of about 849 smear positive TB patients new and previously treated pulmonary cases selected from 14 Governorates. They were submitted to sputum culture and sensitivity to determine the pattern of resistance to the first line anti TB drugs. All the included subjects were followed using a special data collection form to determine the treatment outcome among them

Results: Treatment outcome could be reported in 776 patients, successful treatment occurred 87% among new patients vs. 47% in the previously treated group, non-successful treatment in the form of failure [11%], defaults [3.6%], transferred out [4.7%], and death in [3.4%]. Treatment outcome was favorable among females compared to male patients [83.3% vs. 75.5%]. Drug resistance was significantly higher among previously treated males. Successful treatment outcome was dependent on the gender, type of the patients, and the presence of multi-drug resistance using the logistic regression model

Conclusion: Treatment outcome is highly dependent on the pattern of drug resistance, type of the patient, and the gender

Assessment of knowledge and attitude towards tuberculosis among samples Egyptian population

Tuberculosis continues to rank among the world's most serious problems despite unparalleled biomedical achievements of effective chemotherapy. Several factors are responsible for high incidence and prevalence of tuberculosis is underdeveloped and developed countries as cultural-determined beliefs about the knowledge of tuberculosis, failure to adhere to treatment, delay in diagnosis, patients' gender and low level of patient information. Beliefs about tuberculosis and its causes are major influences of people's behavior, understanding such attitudes and beliefs can aid health providers and policy makers in rectification through provision of properly designed educational strategies. Distorted tuberculosis knowledge and beliefs could participate in the patients delay, non-compliance and unfavorable outcome

Objectives: To assess the possible effect of anti tuberculosis health education campaign, and to explore areas of deficiency of tuberculosis knowledge among a sample of Egyptian community

Subjects and Methods: a multistage sampling technique was followed to select a sample of 3800 interviewees in 20 Egyptian Governorates. A questionnaire was designed and field pre-tested before being used in the pre and post assessment. Data collectors were trained on interviewee's selection as well as on the questionnaire

Results: The study demonstrated a possible positive some aspects of knowledge concerning the nature of tuberculosis as an infectious disease which is treatable and curable. About 30% of the included subjects considered TB as malignant tumors, God's punishment or will, related to extra marital sexual activities, and drug addition. Positive changes have been found regarding the ways of how TB is transmitted but still as substantial knowledge deficit on how to prevent infection, early symptoms of the disease and care seeking behavior in case of chest problems. Tuberculosis accompanying stigma is deeply settled and needs multiple educational interventions to ameliorate its effects. The study pointed out the potential role of the private sector, school and institutional curricula in addition to the role of the media in improving the TB knowledge among the population

Conclusions: Proper messages, collaboration between different health sectors and partners with implementation of effective culturally-sensitive educational strategies should be employed to increase TB knowledge regarding the nature of the disease, the early presentation, early diagnosis, and how to ameliorate the accompanying stigma

Role of nitric oxide and endothelin-1 in pathogenesis of primary open angle glaucoma

Aim: as a leading cause of blindness worldwide, glaucoma continues to be a clinical problem. In the era of neuroprotection as a new trend in the management of glaucoma today, the demand on more knowledge about the pathogenesis of glaucomatous optic neuropathy [GON] is increasing. So, the aim of our study is to get a deep insight about the role of nitric oxide [NO], and endothelin-l[ET-1] in the pathogenesis of primary open angle glaucoma [POAG]

Method: the present study was carried out on forty subjects of both sexes and different age groups, where they were classified into two groups: group I: Included twenty glaucomatous patients diagnosed as having POAG and scheduled for surgical intervention [subscleral trabeculectomy]; where fourteen patients were selected from those patients attended the Ophthalmology Outpatient Clinic in Minia University Hospital and six patients were selected from those patients attended the glaucoma unit in El-Nour Eye Hospital [Cairo]. The degree of glaucomatous drainage was categorized .according to the clinical state of the optic disc and visual field examination into 4 stages: mild [grade l]; moderate [grade 2]; severe [grade 3] and end stage [grade 4]. The degree of glaucoinatous damage in the examined patients was ranging from moderate to severe. The other group [group II]: Included 20 healthy subjects with senile cataract admitted to the Ophthalmology Outpatient Clinic in Minia University Hospital to do cataract surgery as a control

Results: table 2 shows the demographic and biochemical data of the studied groups, where the results were expressed as mean +/- SD. In addition, it shows comparison of the statistical significance [P- value] of all parameters in the studied groups, where there was highly statistically significant difference in the aqueous levels of NO [p = 0.02] between group I [31.23 +/- 5.29 [micro]Ml/L] and group II [16.42 +/- 2.75[micro]M/L], and on the other hand, there was highly statistically significant difference in the aqueous levels of ET-1 [p = 0.001] between group I [32.47 +/- 3.33 pg/ml] and group II [18.12 +/- 1.9 pg/ml]. Moreover, there was no statistically significant difference as regard age between group I and group II [P= 0.58]. . Table 3 shows Comparison of the statistical correlation coefficient [r] of the aqueous levels of NO and ET-1 between the studied groups where there was a significant positive correlation between aqueous levels of NO and ET-1 in the glaucoma group [P=0.0001]

Conclusion: our results have clearly shown that elevated ET-1 and NO levels in POAG may occur as a response to elevated IOP or the high levels of these parameters could be the cause of glaucoma, so elevated ET-land NO could be a cause or an effect

Laparoscopic simple nephrectomy: preliminary experience in theodor bilharz research institute

Aim: The open simple nephrectomy is associated with significant mobidity and laparoscopic nephrectomy is now becoming the standared of care in many centers. In this study we will try to evaluate the actual results of laparoscpic nephrectomy for benign renal lesions in comparison to open nephrectomy

Methods: 17 patients were divided into 2 groups in a non-randomized trial. 8 patients 5 males and 3 females, aged 19-56 underwent open simple nephrectomy. 9 patients, 3 males and 6 females, aged 16-53, underwent laparoscopic simple nephrectomy [3 retroperitoneal and 6 transperitoneal]

Results: In spite of the high conversion rate [4 out of 9 cases] the laparoscopic simple nephrectomy was superior to the open technique in terms of intraoperative complications [0 versus 2 patients who needed blood transfusion and another with pleural injury], duration of analgesia requirements [2 versus 4.5 days post operative], starting oral feeding [1 versus 3 days post operative], wound infection [0 versus 2 cases], hospital stay [3 versus 7.5 days] and time for full recovery [22 versus 40 days] The superiority of the laparoscopic simple nephrectomy in terms of analgesia requirement, post operative oral feeding, hospital stay and time for complete recovery were all statistically significant

Conclusion: In spite of this being a preliminary experience of the Urology Department started in association with the General Surgery Department in TBRI, laparoscopic simple nephrectomy was not only found to be a safe procedure but also other all parameters were in favor of the laparoscopic versus the open simple nephrectomy. The conversion rate was expectedly high but it is not until the learning curve peaks up before the true rate appear and properly judged

Comparative studies on the microbial load of flavoured and unflavoured drinking yoghurt

To assess the accuracy and helpfulness of plain and flavoured drinking yoghurt, one hundred and fifty random samples [thirty each] of plain, strawberry, mango, banana and orange were collected from different supermarkets in Cairo and Giza Governorates, Egypt. The examined samples were analyzed to assess and compare the microbiological quality of plain and flavoured drinking yoghurt samples before their expiry or sell-by date. The data obtained revealed that, aerobic spore former count were determined in different types of examined plain, strawberry, mango, banana and orange samples with a mean values of 6.4x10[3] +/- 1.1x10[2], 1.3x10[5] +/- 2.1x10[4], 3.2x10[6] +/- 4.3x10[5], 6.9x10[5] +/- 7.2x10[4] and 4.2x10[6] +/- 6.6x10[5], respectively. Mould and yeast counts were detected in 30, 100, 100, 100 and 90% of the examined samples. Coliforms, Enterococci and, Staphylococci were detected in different kinds of examined flavoured drinking yoghurt. Pseudomonas and Aeromonas as well as Bacillus cereus were present in the examined samples with percentages ranged from 23.3 to 66.7% and 0 to 36.6%, respectively. Salmonella and Yersinia were not detected in all examined samples. The survival of Listeria monocytogenes in drinking yoghurt stored at refrigerator for 30 days was investigated. The public health significance and economical importance of different microbial groups as well as recommended hygienic measures were discussed

Diagnostic and therapeutic applications of ureteroscopy in upper urinary tract filling defects

To evaluate diagnostic and therapeutic uses of ureteroscopy [URS] in upper urinary tract filling defects. Fourty patients with upper urinary tract filling defects underwent Ureterorenoscopy [URS], their age ranged from 38 to 83 years [Mean 68 yrs]. Clinical presentation included: gross hematuria [20 cases], flank pain [13 cases], microscopic hematuria [5 case], and fever [2 cases]. Radiological studies [intravenous urography and/or retrograde urography], revealed filling defects in the renal pelvis [4 cases], upper ureter [16 cases], middle ureter [one cases], and lower ureter [19 cases]. Introduction of ureteroscopy was done without preliminary ureteral dilation in 60% of the cases. The procedure was completed in 38 cases and aborted in 2 cases because of inability to engage the ureter [one case], and perforation with extravasations [one case]. Diagnosis was established by direct endoscopic visualization in 26.3% of patients while 57.9% of patient's required additional biopsy. These procedures revealed that 34.2% of patients had malignant urothelial tumors, 18.4% had radiolucent stones. Benign ureteral polyps were found in 10.5% of patients, ureteritrs cystica in 7.9%, blood clots in 7.9% and papillary necrosis in 5.3% of patients. No abnormalities were detected in 6 patients [15.8%] by URS, further angiography's identified vascular anomaly in only one patient. In conclusion, URS proved to be of value in dealing with upper urinary tract filling defects. This procedure, whenever the lesion is accessible, can add in diagnosis and treatment of the underlying lesion causing a pelvic or ureteric filling defect. URS can disclose the nature of these lesions, and extensive surgery can be avoided

Antikeratin antibodies and antiperinuclear factor as diagnostic criteria for rheumatoid arthritis

Various auto-antibodies have been described in the serum of rheumatoid arthritis [RA] patients, such as rheumatoid factor [RF], Antiperinuclear factor [APF] and antikeratin antibodies [AKA]. The aim of this study was to evaluate the association of AKA with the activity and severity of RA. Also, to assess their diagnostic value in relation to RF and APF, as well as to determine whether measurements of these antibodies are useful to distinguish early RA from other inflammatory connective tissue disorders. One hundred and ten serum samples from connective tissue [CT] disorders patients who were diagnosed according to the American College of Rheumatology [ACR] criteria were enrolled in this study. They included 68 RA and 42 different rheumatic disorders. They were tested along with 30 serum samples from apparently healthy subjects. AKA and APF were detected with the indirect immunofluorescence [IIF] technique. RF was estimated with latex fixation test [LFT] and then titrated with Rose Waaler test [RW]. Detection of erythrocyte sedimentation rate [ESR] and C reactive protein [CRP] were used as disease activity parameters. Hands and wrists x-ray films were obtained from all RA patients for joint damage evaluation. A positive AKA test was found in 48.5% of RA patients and turned to be highly specific for RA cases [disease specificity 95.8%]. RF and APA were more sensitive than AKA in detection of RA [78% and 58.8% respectively] but less specific [83.3% and 90.2% respectively]. RF positivity [>1:128] was restricted to RA but occurred only in 39.6% of sero-positive RA cases. AKA fluorescence intensity grade 2 and 3 occurred only in RA patients and in 57.5% of AKA -positive RA cases. APF titer >1:20 was restricted to RA and occurred in 42.5% of APF-positive RA cases. No significant differences were found between RA positive and negative cases of AKA, APF or RF as regards the age or the disease duration. While significant differences were found when positive and negative cases of AKA and RF were compared as regards the ESR, CRP and radiographic changes. A significant positive correlation was found between the degree of positivity of AKA and RF titers. Moreover, a significant positive correlation was found between the degree of positivity of AKA levels and ESR and CRP levels, and also with the radiographic changes

Multimodality therapy for locally advanced breast cancer

In the present study, 20 patients with locally advanced breast cancer were treated with a combined modality strategy from September 1999 to June 2002. Their age ranged from 30-65 years with a mean of 50 years. Thirteen patients were postmenopausal and seven patients were premenopausal. Fourteen cases were in stage IIIb, while six cases were in stage IIIa. A metastatic work up was done and all patients were found to be free from distant metastases before neoadjuvant chemotherapy. The patients received three cycles of different regimens of neoadjuvant chemotherapy. Fourteen patients received 5-flurouracil, adriamycin, cyclophosphamide [FAC], three patients received 5-flurouracil, epirubicin, cyclophosphamide [FEC], two patients received 5-flurouracil, novantrone, cyclophosphamide [FNC]and one patient received cyclophosphamide, methotrexate, 5-flurouacil [CMF]. 90% of the patients had partial responses to the neoadjuvant chemotherapy [the tumor decreased more than 50% of its size]; while only two patients did not respond to treatment. Modified radical mastectomy was done for all patients. Postoperatively, all patients received adjuvant treatment, radiotherapy 5000 cGY, 25 fractions, 3-4 cycles of further adjuvant chemotherapy [FAC, FEC, CMF and FNC] and hormonal treatment, tamoxifen 20 mg/day. The patients were followed up for a variable period of time ranging from 12-24 months. No local recurrence was detected in all patients. Only two patients developed distant metastasis. Disease free survival was 90%. This multimodality approach to locally advanced breast cancer rendered most of the patients disease-free and produced an excellent local control rate

Association of fasting and postprandial hypertriglyceridemia and carotid intima-media thickness in patients with type 2 diabetes

Purpose: serum triglyceride level are important in the development of atherosclerosis. To investigate the role of fasting and postprandial triglyceride levels in atherosclerosis, we examined the correlation between FTG and PTG and Carotid intimal - medial thickness [IMT]. Material and methods: carotid IMT was measured by ultrasonography in 50 patients with type 2 diabetes. Plasma glucose [PG], insulin, total cholesterol, triglycerides, LDL cholesterol and HDL cholesterol levels were measured after overnight fasting and 4 h after a meal. we classified patients into the following three groups: patients with fTG level <150mg/dl and PTG levels <200mg/dl formed the normo-normo group [NN] [n=24]. Patients with fTG levels <150 mg/dl and PTG levels <200 mg/dl formed the normo-hypergroup [NH] [n=12]. Patients with fTG levels <150 mg/dl and PTG levels >200 mg/dl formed the hyper-hyper group [HH] [n=14]. Carotid IMT was [0.72 +/- 0.12 mm], [0.86 +/- 0.13], and [0.87 +/- 0.12] for the NN, NH, and HH groups respectively. There was statistically significant difference of carotid IMT between HN and NN groups, and also between HH and NN groups [P< 0.01] but not between HH and HN groups [p< 0.05]. Although postprandial PG, pTG and fasting LDL cholesterol were all independently correlated with carotid IMT, pTG levels had the strongest statistical influence [p = 0.002]. postprandial hypertriglyceridemia despite normal fTG levels may be an independent risk factor for early atherosclerosis in type 2 diabetes