Evaluation of real time polymerase chain reaction and enzyme immunoassay in diagnosis of clostridium difficile infection

Background: Clostridium difficile infection [CDI] is the most common cause of antibiotic associated diarrhea [AAD]. Rapid diagnosis of CDI is essential to prevent hospital spread of infection

Objectives: The aim of this work were to determine the prevalence of CDI among cases of AAD in Zagazig University Hospitals, identify risk factors, and evaluate real-time polymerase chain reaction [PCR] and enzyme immunoassay [EIA], against toxigenic culture [TC]

Methodology: Stools were collected from 150 patients with AAD

Results: They were tested for TC, toxin A/B EIA, and C. difficile tcdA/tcdB genes. Thirty four toxigenic C. difficile isolates were obtained [22.7%] out of the 150 patients and those patients were considered positive for CDI. On the other hand, 6 non-toxigenic C. difficile isolates were obtained [4%], while culture of the remaining 110 patients [73.3%] did not yield C. difficile. The later 116 patients [77.3%] were considered negative for CDI. Analysis of risk factors revealed that advanced age, prolonged hospitalization, long duration of antibiotic intake, potentiated penicillins, 3rd generation cephalosporins, antibiotic combined therapy, liver cirrhosis, malignancy, proton pump inhibitors, enteral tube feeding, and cancer chemotherapy were significantly associated with CDI. Sensitivitiy, specificitiy, positive predictive value, negative predictive value, and accuracy of real-time PCR against TC were all 100%, however, values of EIA were 79.4%, 100%, 100%, 94.3%, 95.3%, respectively

Conclusions: CDI is an underappreciated nosocomial infection predisposed by many risk factors. Real-time PCR proved superior diagnostic performance to toxin A/B EIA

Activity of the plant syzygium jumbos against Biomphularia alexandrina snail's reproduction and infection with schistosoma mansoni

The toxic effects of dry powder water suspension [cold and boiled] and methanol extract of Syzygium jambos leaves determined against Biomphalaria alexandrina snails. Snail's fecundity and their infection with Schistosoma mansoni miracidia were evaluated post exposure to sublethal concentrations of methanol extract. In addition, the activities of aminotransferases [ASAT and ALAT] and phosphatases [AcP and A Ik P] enzymes and total protein levels in tissues of snails under such methanol extract concentrations were detected. The methanol extract was more toxic to the snails than both cold and boiled dry powder water suspension with LC[90]- s 17.9, 876 and 388 ppm respectively, after 24- hr of exposure at 25°C +/- 1. Snails exposed to LC[50] of methanol extract [13.4 ppm] for 24 hours followed by 6 weeks of recovery showed a low survival rate by the 6th week, being 23%. The survived snails laid few eggs, being 1.0 eggs/snail at the 5[th] week. However, no eggs were laid by the 6[th] week. This has a negative reflect on the net reproductive rate [Ro] that was reduced by 74.0%. Twenty-four hours in vivo exposure to the same concentration of methanolic extract [LC[50] caused a significant reduction in the activity of AcP while it increased AlkP, ASAT and ALAT activities in snail's tissues. Infection rate of B. alexandrina snails treated with LC[10] [8.7 ppm] during their exposure to S. mansoni miracidia was significantly less than control group being 32% and 67% respectively. The duration of cercarial shedding was shorter than that of control ones and the cercarial production was significantly reduced being 3209 cercariae/shedding snail compared to 13330 cercariae/control infected snails. From the forgoing data, methanol extract from leaves of the plant S. jambos may be suggested as a promising agent for control of medically important snails may be used as an alternative method to control the size of the populations of B. alexandrina

trial to assess the susceptibility of Biomphalaria Alexandrina to Schistosoma mansoni by protein electrophoresis, hepatic enzymes activities and random amplification polymorphic DNA [RAPD]

The identification of susceptible from refractory Biomphalaria alexandrina snails to Schistosoma mansoni is important in transmission studies and control programs. In this study, a trial was made in this respect utilizing three techniques, namely protein electrophoresis, assay for hepatic enzymes activities and Random Amplification Polymorphic DNA [RAPD]. The results show that, in protein electrophoresis there is one shard band only between susceptible and refractory snails [68.41KD]. The activities of hepatic enzymes, aspartate aminotransferase [AST] and alanine aminotransferase [ALT], alkaline [ALKP] and acid phosphatase [AcP], were higher in the tissue homogenate and hemolymph of susceptible snails than refractory ones. In RAPD, utilizing OPA-9 primer, approximately 1,900 bp band was characteristic for susceptible snails but did not appear in refractory ones

Determination of allozyme, protein and schistosome susceptibility in biomphalaria alexandrina progenies produced by self and cross fertilization

The mating system of B. alexandrina was studied under laboratory condition by allozyme analysis and SDS-PAGE protein analysis for parent snails and their progenies of two successive generations produced by self and cross fertilization. Allozyme analysis detected 11 genetic loci in 3 enzymes; ACP [3 loci], LDH [2 loci] and EST [6 loci]. The mean number of Allele [A], average heterozygosity over loci [H] and dendrogram from cluster analysis based on genetic distances between snail groups showed a genetic heterogeneity in parents and 1[st] generation higher than that in the 2[nd] generation. Cross-fertilization and genetic heterogeneity among snails decreased through generations. Snails practiced self-fertilization showed genetic alterations and genetic heterogeneity was either decreased or increased. SDS-PAGE profile of tissue protein revealed that the mating system in B. alexandrina showed specific bands, 204 and 214 KDa, in snails bred by self-fertilization. D value based on shared protein bands number and estimated similarity between parents and progenies showed that parents were approximately similar with self and cross progenies in 1[st] generation and only with cross progenies in 2[nd] generation as self progenies showed increase or decrease in similarity. B. alexandrina susceptibility to S. mansoni was not affected when snails were bred by cross or self fertilization

Effect of postnatal exposure to cigarette smoke on the tracheal epithelium of albino rat

Environmental tobacco smoke [ETS] is one of the most common indoor pollutants to which many children are exposed. The present work was carried out to investigate the his-ological changes of rat tracheal epithelium after postnatal exposure to cigarette smoke. Fifteen newborn albino rats were daily exposed to side-stream cigarette smoke [10 cigarettes a day, 6 days a week] for 12 weeks. From the trachea, paraffin sections were prepared and stained with Haematoxylin and eosin [H and E] stain and alcian blue-periodic acid-Schiff's stain [AB/PAS]. Toluidine blue stained semithin sections were also prepared and examined by light microscope. Ultrathin sections were processed for electron microscopic [EM] examination. In H and E stained sections the tracheal mucosa of the experimental animals showed erosion in the epithilium, oedema, and heavy mono-nuclear cellular infiltrate in the corium which resulted in polyp formation and decreased number of ciliated cells. Preneoplastic variants in the form of squamous metaplasia and dysplasia were also seen. AB/PAS stained sections revealed progressive increase in the number of goblet cells. Semithin sections showed increased number of globule leucocytes, basal cell hyperplasia and dysplasia. Electron microscope revealed swollen cilia, intracytoplasrmic cilia and loss of some basal bodies. Goblet cells were packed with numerous confluent mucus granules. Moreover, degenerated and apoptotic cells were also observed Therefore, it is strongly recommended to protect children from exposure to ETS and to warn parents about the hazards of continuous exposure of their children to cigarette smoke

Morphometric and ultrastructural changes in the sciatic nerve of the albino rat after a long period of immobilization of the knee and ankle joints

The sciatic nerve was used as a model to study the effect of a long period of immobilization on the peripheral nerves. Ten young adult male albino rats were used in this investigation. The left knee and ankle joints were immobilized for 12 weeks using a plaster cast. The contralateral right side was used as control. After removal of the cast, segments from the sciatic nerves of the immobilized and control sides were excised and processed for ultrastructural and morphometric studies. Morphometric study revealed that immobilization of the rat hind limb resulted in a highly significant reduction [43%] in the cross-sectional area of the sciatic nerve, a highly significant reduction [33%] in the total number of the myelinated fibers, a highly significant reduction [21%] in the mean diameter of the myelinated fibers and a highly significant increase [19%] in the myelinated fiber density/mm[2]. The size distribution of the myelinated fibers showed marked changes after immobilization. The statistical data showed a shift toward, the small size distribution and the small diameter myelinated fibers outnumbered the medium-sized and the large diameter fibers. Moreover, myelinated fibers with a diameter >15 micro were observed only in the experimental sciatic nerve. These results indicate that the small myelinated fibers were the least affected and may confirm the assumption that the motor fibers are those who are usually affected by immobilization. Ultrastructural observations revealed splitting of the myelin lamellae, presence of marked intramyelinic edematous clefts between the split myelin lamellae, infolded myelin loops and myelin degeneration. Changes in the axons included formation of myelin rings and figures in some of the larger axons, degeneration, compression, irregularity and shrinkage of axons. Degradation of myelin lipids was reflected by formation of large vacuoles and layered structures inside Schwann cells. These ultrastructural and morphometric changes may shed some light on a definite structural neural involvement in the mechanism underlying the immobilization-associated polyneuropathy

Difference in the susceptibilty to certain molluscicides and Schistosoma mansoni infection of three forms Egyptian Biomphalaria glabrata

The first generation of three morphologically different forms of B. glabrata collected from Giza was compared for LC50 values susceptibility to bayluscide and copper sulfate [chemical molluscicides], Anagallis arvensis and Calendula micrantha [plant molluscicides] as well as to Schistosoma mansoni infection. Form 2 as juvenile and adult was less sensitive to C. Micrantha and A. arvensis. Form 3 as juvenile and form 1 as adult were least sensitive to CuSO4. Approximately, the same susceptibility to bayluscide was observed in the three forms, either as juvenile or adult. The sublethal concentrations of the molluscicides on the three forms of B. glabrata showed no significant difference in the growth or survival rate in-between. Form 2 was significantly higher in the egg-laying capacity. The total protein concentration was not affected, except in certain cases, where the increase was primarily due to the increase in the globulin concentrations which was observed with the marked increase observed in the urea concentration and the marked increase or inhibition in the activity of either aspartate aminotransferase [AST] or alanine aminotransferase [ALT]. The digestive gland of the three forms of B. glabrata showed a low susceptibility to infection with the local strain of S. mansoni

Light and electron microscopic study of the thyroid gland of female albino rats after collagen-induced arthritis

Adult female albino rats were subjected to experimental arthritis by the injection of arthritic material formed of bovine collagen II dissolved in acetic acid and mixed with Incomplete Freund's Adjuvant [IFA]. Thyroid glands were processed for light and electron microscopic examination. Two groups of control rats were used. The first control group comprised healthy non-treated rats. The second control group comprised IFA -treated rats. Compared with the control rats, light microscopic examination of the thyroid gland of the arthritic rats revealed a marked distortion of the thyroid architecture. The thyroid follicles appeared either degenerated, homogenized or lost. The follicular cells appeared low cubical or flattened with scanty cytoplasm and darkly stained nuclei. The parafollicular C-cells were ill-defined. The colloidal material was either highly vacuolated or depleted. Intraluminal and interfollicular mononuclear cell infiltration was observed. Compared with the control rats, electron microscopic examination of the thyroid gland of the arthritic rats revealed a distorted ultrastructure of the follicular cells. The rough endoplasmic reticulum appeared dilated, distorted, vesiculated and partially degranulated. Secretory granules were rarely seen. Lysosomes and apical cytoplasmic granules were absent. Large cytoplasmic vacuoles and secretory crystalline deposits were seen in some follicular cells. The luminal border lost its apical microvilli and the follicular lumen of some cells contained crystalline colloidal deposits. The nucleus appeared folded and contained more electron-dense clumped chromatin. Pyknotic and karyolytic nuclei were observed. The C-cells showed irregular plasma membrane, disintegrated nucleus and grouping of the secretory granules at one pole of the cell. The present observations may reflect a reduction in the functional activity of the thyroid gland [hypothyroidism] in the female rats subjected to collagen-induced arthritis. Therefore, it is recommended to monitor the thyroid hormones in patients with rheumatoid arthritis and to check the presence of thyroid auto-antibodies in these patients

In vivo, attenuation of Schistosome cercarial development and disturbance of egg laying capacity in Biomphalaria alexandria using sublethal concentrations of plant molluscicides

The dry powder of Sinapis arvensis, Thymelaea hirsuta, Callistemon lanceolatus and Peganum harmala showed molluscicidal activity against Biomphalaria alexandrina, specific intermediate hosts to Schistosoma mansoni. Effect of LC[25] of dry powdered plant molluscicdes on hexokinase [HK], glucose phosphate isomerase [GPI], AMP deaminase, adenosine deaminase and phenol oxidase [PO] of B. alexandrina was traced. C. lanceolatus showed the highest molluscicidal activity as it has the lowest LC[50] compared to S. arvensis, T. hirsuta, and P. harmala, LC[25] of the latter three plants resulted in more significant inhibition of HK, GPI, AMP deaminase and PO than C. lanceolatus. Treatment of snails with LC[10] of these plants markedly affected compatibility of B. alexandrina to S. mansoni infection. Significant decrease in cercarial production was recorded in snails treated with sublethal concentrations of S. arvensis, T. hirsuta, and P. harmala. Remarkable impairment of the egg laying capacity of molluscicide treated snails was also recorded. Correlation between activity levels of HK, GPI and AMP deaminase and compatibility to parasitic infection and role of PO in the egglaying capacity of these snail species were discussed

Comparative study of different diagnostic modalities of m. tuberculosis and evaluation of rifampicin resistant strains using line probe assay versus conventional proportional method

Tuberculosis remains a major health problem around the world being responsible for 3 million deaths each year. The spread of TB is expected to worsen as infection with multi-drug resistance M. tuberculosis isolates [MDR-M] increases in many countries. Rifampicin is an important component of effective multi-drug therapies of TB. Thus, Rif-resistance means that short course therapy is no longer an option and those second-line drug susceptibilities are required in order to make an informed choice for alternative therapy. Furthermore, resistance to Rif serves as a useful surrogate marker for the detection of MDR isolates. The aim of this study is to shed some light on the line probe assay [LiPA] in comparison to the conventional proportion method for detecting Rif susceptibility genotype and phenotype of M. tuberculosis clinical isolates. This study was conducted on 154 patients with age ranged from 18 to 72 years who were divided into 2 groups. The first group included 130 cases [80 males and 50 females] suspected of having pulmonary TB, and the second group included 24 cases [18 males and 6 females] suspected of having extrapulmonary TB. All cases were subjected to tuberculin skin test. The clinical specimens were collected according to the site of presenting symptoms. At least 3 successive samples of sputum, urine and stool were collected for each case. Contaminated specimens [98 sputum, 13 bronchial lavage, 7 urine and one stool samples] were subjected to a digestion-decontamination procedure. Aseptically collected specimens [13 peritoneal aspirate, 19 pleural aspirate, one fallopian tube and 2 lymph node samples]. All used for smear staining with Kinyoun's stain and culture. Mycobacterial isolates on L-J slants were biochemically typed by niacin accumulation, nitrate reduction and heat stable catalase test. The susceptibility of M. tuberculosis to Rif was performed using both the proportion method on MB7H10 agar and LiPA using LiPA Rif TB strips. The distribution of tuberculous patients according to clinical specimens among all cases showed that 98 sputum samples revealed 26 positive culturers. Two sputum samples were positive by stained smear after processing but negative by either direct smear or culture. The overall positivity of sputum samples were 28 specimens. One positive culture/negative Kinyoun's stain was recovered from fallopian tube specimen. Tuberculin skin test revealed positive induration diameter in 28 [96.6%] out of 29 tuberculous patients, whereas the tuberculin skin test was positive in 78 [62.4%] out of 125 negative smear/culture cases. Direct Kinyoun's stain showed positive smear in 15 out of 154 specimens, which were also positive by L-J culture. Also 12 positive cultures were recovered from the 139 negative direct smears. The sensitivity and specificity of direct Kinyoun's stain versus L-J culture were 55.6% and 100% respectively, and the negative and positive predictive values were 91.4% and 100% respectively. Stained smears after processing revealed positive smear in 22 out of 119 patients, of which 20 were positive by L-J culture. However 6 positive cultures were recovered from 97 negative smears. Its sensitivity and specificity versus L-J culture were 76.9% and 97.8% respectively, and the positive and negative predictive values were 90.9% and 93.8% respectively. There was a statistically significant difference in comparing direct Kinyoun's smear and Kinyoun's smear after processing of the 115 contaminated specimens. The results of mycobacterial biochemical reactions revealed 24 M. tuberculosis and 3 mycobacteria other than tuberculosis [MOTT] isolates. As regard Rif-susceptibility testing of the 24 M. tuberculosis isolates, 8[33.3%] isolates were Rif-resistant and 16 [66.7%] were Rif sensitive by the proportion method, whereas 6[25%] isolates were Rif resistant and 18 [75%] were Rif-sensitive by LiPA. The type of rpoB gene mutations in the 6 Rif-resistant M. tuberculosis isolates by LiPA showed that the most frequently detected mutations were H526Y [57.1%] and S531L [28.6%] and H526D 14.3%. One strain showed double mutations atH526Y and S531L. It is concluded that LiPA is a simple technique which provides clear results requiring only a basic knowledge of molecular technique

histological and biochemical study of the protective effect of melatonin on acute paraquat toxicity in albino rats

The acute toxic effect of the herbicide paraquat [PQ] and the protective effect of the antioxidant melatonin against its toxicity were experimentally investigated both biochemically and histologically. Sixty rats were divided into six equal groups. Melatonin [Mgroup] and saline [Control group] were given once i.p. [10 mg /kg] to rats of both groups. PQ in high dose [50 mg /kg] and low dose [15mg /kg] was given i.p. to rats of high and low PQ groups i.p. [HPQ and LPQ]. A single dose of melatonin was injected i.p. 30 minutes prior to high and low PQ doses in rats of MHPQ and MLPQ groups. All rats were sacrificed after 24 hours and blood samples were collected for the biochemical analysis. Lung, liver and kidney specimens were processed for staining with haematoxylin and eosin, and P.A.S. reaction for light microscopic examination. Liver frozen sections were prepared and stained by Sudan black for lipid demonstration. The results revealed that both doses of PQ significantly increased serum malondialdehyde level and decreased serum concentration of glutathione and glutathione reductase activity compared to control values. These changes improved significantly in groups received melatonin prior to PQ i.e. MHPQ and MLPQ groups. Histologically, extensive damage to lung, liver and kidney was observed in rats of HPQ group. In the lung, marked congestion and bleeding were observed and the alveoli appeared filled with coagulated material, collapsed or manifested a compensatory emphysema. The bronchiolar wall showed sloughing of the epithelial lining and peribronchiolar lymphocytic infiltration. In the liver, blood sinusoids were markedly congested, the normal lobular pattern was lost and the hepatocytes exhibited vacoulation, fatty degeneration and necrosis. In the kidney, glomerular alterations and renal tubular necrosis were observed. Melatonin did not improve the toxic effect of PQ on the three organs in rats of MHPQ group. The low dose of PQ induced minimal tissue damage compared to HPQ group and the kidney was the most affected organ. Melatonin prior to low PQ dose improved the histological picture of the three organs which appeared almost similar to the controls, except the kidney which showed some degenerative changes. In conclusion, melatonin affords protection for the biochemical parameters affected by both doses of PQ while histologically, the single dose of melatonin can protect the organs only in animals exposed to low dose of PQ

Histopathological and ultrastructural changes in opiate-related deaths

This study was carried out to highlight histopathological and ultrastructuralchanges in livers, kidneys and lungs of 35 opiate related fatalities. Thestudy also included a comparative study of ten accidental fatalities ofhealthy subjects served as controls. The study revealed that causes of deathin the selected series of autopsy were opiate intoxication [57%], violence[suicide, homicide or accidental, 17%] and medical complications [26%] aspneumonia and acute renal failure. The mean concentrations of morphine inblood were 20.5 +or- 3.7, 2.8 +or- 0.94 and 3.36 +or- 1.1 ug/dL in the threegroups, respectively. Light microscopic examination of the liver revealedcentrilobular sinusoidal dilatation with thickening of perisinusoidal wall andvenular wall in all cases of opiate abuse. However, in the lung, evidence ofpulmonary edema was observed in 86% of the cases with intraalveolar red bloodcells and birefringent materials and siderophages were present in 93% of thecases. Examination of renal tissue showed histologic signs of toxic acutetubular necrosis in 20% of the cases, while other cases showed evidences ofmembranoproliferative glomerulonephritis. Electron microscopic examination ofliver sections revealed that ultrastructural changes may occur as a result ofeither sinusoidal dilatation secondary to terminal hepatic vein damage or adirect cellular effect of the drug causing perisinusoidal fibrosis

Troponin T in the diagnosis of myocardial infarction: the qualitative [slide] and quantitative tests compared

To Compare a qualitative with a quantitative method for cardiac Troponin T. One hundred and ten consecutive patients admitted to the Cardiac Care Unit for possible myocardial infarction comprised the study subjects. The usual WHO criteria for diagnosis of myocardial infarction were applied on admission and after 12 hours. The usual WHO criteria for diagnosis of myocardial infration were applied on admission and after 12 hours. At the same time cardiac troponin T levels were measured by two methods [qualitative TROPT[R] Sensitive slide test and quantitative Enzymun[R]; Boehringer Mannheim, Mannheim, Germany]. The study was double blinded. Clinical diagnosis was carried out without knowledge of troponin T results, and troponin T results were measured without knowledge of diagnoses. Cardiac Care Unit and Biochemistry Unit of Al-Adan General Hospital, Kuwait Concordance between the two methods was 92% at a 0.1 mg/L cut-off for troponin T. With the same cut-off, sensitivities for the qualitative tests were 30.5% and 25.0% on admission and 82.9% and 73.5% after 12 hours, respectively. Positive predictive values were 78.6% and 60% on admission and 82.9% and 78.1% after 12 hours respectively. Negative predictive values were 73.4% and 70.3% on admission and 90.8% and 86.8% after 12 hours respectively. Using the WHO criteria 38 of the 110 patients were diagnosed as having acute myocardial infarction. The qualitative test [Trop T[R] Sensitive] performed at least as well as did the quantitative Enzymun[R] test. Because of its quick turn-around time, the slide test is to be preferred. Slides and reagents were provided free by Boehringer Mannheim

Bacteriological and immunological study of childhood otitis media especially H.influenzae infection and role of cytokines

Middle ear fluids [MEFs] from 500 children of whom 150 children aged 3 months to 2 years presented with acute suppurative otitis media [ASOM] and 350 children aged 2-8 year diagnosed as chronic suppurative otitis media [CSOM] with perforated drum membrane were examined bacteriologically for the causative bacteria. Gram- positive cocci; including S. pneumoniae, S. viridans were the most common causes of ASOM. Whereas in CSOM, both Gram- negative bacilli, including P. aeruginosa, P. mirabilis, E. coli, H. influenzae and Gram- positive cocci were equally affecting he middle ear [42% and 42.6% respectively] H. influnzae was isolated from cases of ASOM and CSOM with a percentagte of 10 and 2.6 respectively. Biotype [IV] was the commonest biotype isolated from ASOM and CSOM with a percentage of 60 and 77.8 respectively. Serotype [b] seems to be more frequently associateed with biotype [IV] which was the commonest biotype in non capsulated strains. Using the Enzyme Linked Immunosorbent Assay [ELISA] system, the number of positive cases for interlukin-1 [IL-[1]], in cases of ASOM was of high statistical significant value [P<0.001] compared with that of CSOM and the number of positive cases for tumour necrosis factor [TNF] in cases of CS OM was of high statistical significant value [P<0.001] Compared with that of ASOM. The level of [IL-[1]] in cases of ASOM was of high statistical significant value [P<0.001] compared with that in cases of CSOM but the level of IL-[6] in cases of ASOM was of statistical significant value compared with that in cases of CSOM [P<0.05]. TNF levels in cases of CSOM was of high statistical significant value compared with that in cases of ASOM [P<0.001]. This may explain, on immunological basis, the frequent recurrences of ASOM and the more destructive pathologly in CSOM

Third genration ELISA [ELSIA-3] versus recombinant immunoblot [RIBA] and polymerase chain reaction [PCR] in diagnosis of hepatitis C virus infections

Forty patients were selected, and their sera were tested for anti-hepatitis [C] virus [HCV] Ig[G] by both recombinant immunoblot assay [RIBA] and third generation enzyme-linked immunosorbent assay [ELISA-[3]] and for HCV-RNA by polymerase chain reaction [PCR] to compare between them as diagnostic methods for HCV infection. Liver transaminases'level, alanin aminotransaminase [ALT] and aspartate transaminase [AST], were also measured in all cases, 24 samples were positive by RIBA, 25 by ELISA-[3] and only 20 by PCR. On comparing the sensitivity and specificity of both RIBA and ELISA-[3] regarding PCR techinque, the two tests achieved 83.33% and 80% sensitivity respectively, while, both were 100% specific. A correlation was found between high levels of tranaminases and positive cases by both RIBA and ELISA-[3] [p<0.01] as well as PCR [P<0.05]. In conclusion, both RIBA and ELISA-[3] are reliable diagnostic tests, especially, when combined with raised liver transaminases. PCR is a tedious and expensive technique, however, it can be applied as a confirmatory test for doubtful cases and assessment of HCV - RNA seroconversion with antiviral therapy

Otitis media in children: bacteriological and immunologic views

Middle ear effusions [MEEs] from 452 children of whom 120 children aged 3 months to 2 years presented with acute suppurative otitis media [ASOM] and 332 children aged 2-8 years diagnosed as chronic suppurative otitis media [CSOM] with perforated drum were examined -bacteriologically for the causative bacteria. Our results showed that the prevailing bacteria in cases of AS OM were S. pneumoniae [30.8%], S. aureus [22.5%], H. influnzae [10.8%], S. viridans [10%] and E. coli [1.6%] and that H. infleunzae biotype [IV] was the commonest biotype isolated from cases of ASOM caused by H. infleunzae with a percentage [61. 5] followed by biotype [II] with a percentage [30.7] then biotype [III] with a percentage [7.8] The Prevailing bacteria in cases of CSOM were S. aureus [30.4%] P. aeruginosa [25.3%], S. viridans [12.6%], P. mirabilis [8.1%], E. coli [5%] and H. infleunzae [2.4%] and that H. infleunzae biotype [IV] was the commonest biotype isolated with a percentage [75] from cases of chronic otitis media caused by H. infleunzae followed by biotype [II] and biotype [III] with a percentage [12. 5] for each. The resistance of 21 strains of H. infleunzae to benzyl penicillin, ampicillin, flumox, cepharidine, cefoxitine, tetracycline, chloramphenicol, gentamycin, erythromycin, amikacin and sulfamethoxazol was 42.9%, 38.1%, 19.1%, 9.6%, 4.8%, 81%, 28.6%, 333.4%, 14.3%, 57.1% and 23.8% respectively. All strains were sensitive to ofloxacin, cefotaxime and aztreonam. Using the Enzyme Linked Immuno-sorbent Assay [ELlSA] system,, significant levels of interlukin- [1] [IL-1], interlukin-[6] [IL-6] and tumour necrosis factor [TNF] were detected in 50%, 36.67%, and 13.33% of cases of ASOM respectively and in 20%, 16.67% and 60% of cases of CSOM respectively. The number of positive cases for interhikin-[1] [IL-l], in cases of ASOM was of highly statistical significant value [P<0.001] compared with that of CSOM and the number of positive cases for TNF in cases of CSOM was of highly statistical significant value [P<0. 001] compared with that of ASOM. The number of cases positive for [IL-[6]]; showed no statistical significant difference between ASOM and CSOM. The level of IL-[l] in cases of ASOM was of highly statistical significant value [P<0.00] compared with that in cases of CSOM but the level of IL-[6] in cases of ASOM was of statistical significant value compared with that in cases of CSOM. TNF levels in cases of CSOM was of highly statistical significant value compared with that in cases of ASOM

prospective study of bacterial infections in patients with liver cirrhosis

One hundred hospitalized patients with cirrhosis were included in a prospective and sequential study, to verify the prevalence and most frequent causes of bacterial infection. The differences in clinical and laboratory data between the two groups were analyzed: Group 1, 60 patients who developed bacterial infection and group II, 40 patients without bacterial infection. The prevalence or commutative frequency of the development of bacterial infection during one hopsitalization was 60%. Among these, the most frequent types of infection were: Urinary tract infection U. T. I. [30.85%], respiratory infection [26.34], and spontaneous bacterial peritonitis SBP [14.35%]. Community infections were more frequent [49.64%] than nosocomial infections [35.42%] and they occurred sequentially in 14.74% of the case. Clinical and biochemical parameters in bacterial infection were generally correlated with the severity of liver disease. During hospitalization, the mortality rate of group I was 38.20%, whereas in group II, it was [8.94%]. SBP and respiratory infections were the most severe types of infections, with high mortality rates 30%, and 43% respectively. Urinary tract infections with active urinary bilharziases constitutes 20% of the total urinary tract infection cases. These results indicate that bacterial infection is a severe complication in the course of liver cirrhosis

Immune response in bilharzial farmers [uncomplicated and complicated cases]

This study was done in the Outpatient Clinic of Zagazig University Hospital and in the Bacteriology Department of Zagazig University during the year 1991. The aim was to evaluate the immune response [humoral and cellular] of bilharzial patients in various stages of infection through quantitation of specific antibodies using indirect hemagglutination test [IHAT] and quantitation of sensitized T- lymphocytes and their subpopulations using indirect immunofluorescent technique. The study included 25 normal healthy individuals, 25 simple urinary bilharziasis, 25 simple intestinal bilharziasis, and 25 hepatosplenic patients. There was a marked increase in the mean titer of IHAT of bilharzial groups compared with normal controls, but there was no significant statistical difference among the bilharzial groups. The study revealed a decrease in the means of total leucocytic count [TLC], absolute lymphocytic count [ALC], T3+ count, T4+ count and T4+/T8+ ratio of bilharzial groups. Comparable with the normal cases, T8+ counts of bilharzial groups were within normal. There were highly statistically significant lower mean values of total leucocytic count [TLC], T4+ counts, and T4+/T8+ ratio of complicated intestinal [hepatosplenic] group comparable with simple bilharzial groups

Antibiotic resistance in pseudomonas aeruginosa [aztreonam versus others]

This study was done in the Bacteriology Department, Faculty of Medicine, Zagazig University, during the year of 1991 on 116 clinical strains of P. aeruginosa isolated from Zagazig University Hospital. The study aimed to evaluate the efficacy of aztreonam, the first member of a new class of antibiotics, monobactams, in P. aeuroginosa infections compared with a number of antibiotics currently used to treat P. aeruginosa infections by determination of the minimum inhibitory concentration [MIC] using the agar dilution method. The study revealed highly significant statistical values [p < 0. 001] in resistance of P. aeruginosa to all groups of antibiotics compared with aztreonam