Comparison between ica operon expression and biofilm formation in methicillin-resistant staphylococcus aureus isolated from central venous catheters under different environmental conditions

Methicillin-resistant Staphylococcus aureus [MRSA] infections are complicated by the ability of the organism to grow in surface-adhered biofilms on a multitude of inert synthetic surfaces including those involving indwelling medical devices. Intensive care unit [ICU] patients using central venous catheters [CVCs] are particularly at risk of acquiring device-related infections, which involve biofilms. This study was carried out to compare intercellular adhesion [ica] operon expression and biofilm formation in MRSA isolated from CVCs grown under different environmental conditions. Seven hundred sixteen central venous catheters tips were tested for MRSA colonization. Semiquantitative measurements of biofilm formation were determined for all MRSA isolates grown under different environmental conditions: Brain heart infusion [BHI] medium, BHI supplemented with 4% sodium chloride [NaCl] and BHI supplemented with 1% glucose [Glu]. The ica operon expression were compared in all MRSA isolates grown under different environmental conditions using RT-PCR. The overall catheter tip colonization rate was 36.87%. Staphylococci were isolated from 56.06%. The distribution of the isolated Staphylococci was as follow: Staphylococcus epidermidis [S. epidermidis] 34.8%, Staphylococcus aureus [S. aureus] 12.12% and other Coagulase negative Staphylococci CoNS 9.09%. Out of 32 S. aureus isolates 9 were MRSA [28.125%]. Under standard laboratory conditions in BHI medium 22.22% of MRSA isolates were capable of biofilm development. This number increases to 77.77% when grown in BHI supplemented with 1% glucose. In contrast, growth in BHI supplemented with 4% NaCl induces biofilm in 11.11%. Among the 9 MRSA isolates, growth in the presence of NaCl resulted in activation of ica transcription in 8 strains but failed to induce substantial biofilm development in any of these isolates [weak -but measurable- biofilm formation was detected in medium supplemented with NaCl by one strain]. Glucose-mediated induction of biofilm formation in the 9 MRSA isolates correlated with weakly to moderately increased ica operon expression in 6 isolates. Interestingly, ica operon transcription was more potently activated by NaCl than by glucose in all of the MRSA isolates examined except one strain. There appears to be little correlation between ica operon regulation and biofilm formation in MRSA, suggesting that the ica operon and polysaccharide intercellular adhesin, or poly-Nacetylglucosamine [PIA/PNAG] may not be required for biofilm development in MRSA

Gene mutations in Wilson disease in Egyptian children: report on two novel mutations

Wilson disease [WD] is an autosomal recessive disorder, caused by defects in copper-transporting P-type adenosine triphosphatase [ATPase] encoded by the ATP7B gene, resulting in the deposition of copper in the liver and brain with significant disability or death if left untreated. An available regimen of treatment gives hope to those predisposed to the disease if diagnosed early. The objective of this study was to determine the frequency of the most common European mutation [p.H1069Q] in Egyptian children with WD, in addition to screening for previously reported mutations in the Egyptian patients in our selected group. Direct DNA sequencing was applied to exons [13, 14, 18, and 19] of the ATP7B gene for 19 patients previously diagnosed with WD. Then DNA sequencing and pedigree analysis were performed in the families of the patients showing variations in their results for the purpose of family screening and carrier detection. Six out of 19 patients were studied with their families [three families]. We identified five variants of which two were novel among the studied patients. One of the novel variants was synonymous substitution [p.A1074A] in 16% of patients and the other was predicted to be missense disease-causing mutations [p.T1076I] in 16% of patients, and three previously published mutations p.H1069Q were detected in 5% of patients, p.P1273Q in 10% of patients, and a silent variant p.A1003A in 26% of patients. Screening for the two exons 14 and 18 of the ATP7B gene is important in Egyptian patients especially in suspected patients without hepatic manifestations

Hepatoprotective effects of Astragalus kahiricus root extract against ethanol-induced liver apoptosis in rats / 中国天然药物

The hepatoprotective activity of the ethanol extract of Astragalus kahiricus (Fabaceae) roots against ethanol-induced liver apoptosis was evaluated and it showed very promising hepatoprotective actions through different mechanisms. The extract counteracted the ethanol-induced liver enzymes leakage and glutathione depletion. In addition, it demonstrated anti-apoptotic effects against caspase-3 activation and DNA fragmentation that were confirmed by liver histopathological examination. Moreover, the phytochemical study of this extract led to the isolation of four cycloartane-type triterpenes identified as astrasieversianin II (1), astramembrannin II (2), astrasieversianin XIV (3), and cycloastragenol (4). The structures of these isolates were established by HRESI-MS and 1D and 2D NMR experiments. The antimicrobial, antimalarial, and cytotoxic activities of the isolates were further evaluated, but none of them showed any activity.

Pulsed electromagnetic field [PEMF]: effective adjuvant therapy in venous and vasculitic leg ulcers

Chronic leg ulcers occur in 1% of the adult population with considerable associated morbidity and tend to follow a chronic course of recurrent healing and breakdown. Venous insufficiency is the commonest cause of chronic leg ulcers in the community, but vasculitic ulcers are known to be more resistant to treatment and also more painful than ulcers of other aetiologies. A proportion of leg ulcers will heal on conservative treatment, those which do not respond cause considerable distress. Many modalities have been used for conservative treatment of leg ulcers and pulsed electromagnetic field [PEMF] was used for wound healing as it has a number of well-documented physiological effects on cells and tissues. A total of 48 patients with 53 resistant venous and vasculitic leg ulcers unresponsive to medical treatment were enrolled in this study. The patients were randomly divided into control group who received standard wound care and active group who received standard wound care plus active [PEMF] therapy 3 days per week for 12 weeks for a total of 36 sessions. Ulcer size, appearance of the ulcer and surrounding skin, and pain intensity were assessed at the entry of the study, at 6 weeks and at the end of the treatment. At week 12 the active group showed a 56.4% reduction in the ulcer surface area for venous ulcers, and 48.6% for vasculitic ulcers compared to only 17.2% in controls [P=0.01, 0.007, respectively]. A significant decrease in pain intensity was seen in the active group [P= 0.007, 0.006 respectively]. No adverse events were reported. PEMF therapy improve the rate and degree of healing and reduces pain in resistant venous and vasculitic leg ulcers, this suggests that it could be a useful addition as an effective adjuvant treatment to non surgical therapy of leg ulcers. There is need for further studies in a larger population to determine the optimal treatment dose, timing and duration of electromagnetic therapy and applicability of using it in resistant ulcers of other aetiologies

Clinical relevance of cryoglobulinaemia and extrahepatic neurocutaneous manifestations of chronic hepatitis C

The association of hepatitis C virus [HCV] with the extrahepatic complications of cryoglobulinaemia is widely recognized. The aim of this research was to examine the prevalence of cryoglobulinaemia [Cg] in patients with chronic HCV infection and its relation to extrahepatic neuro-cutaneous manifestations. Forty patients [26 males and 14 females], with clinical, laboratory and histopathologically established chronic HCV, with a mean age of 37.5years were submitted to clinical examination with stress on stigmata of chronic liver disease, dermatological and neurological evaluation as well as neurophysiological evaluation, laboratory assessment including liver function tests, serum cryoprecipitate immunoelectrophoresis, and revision of histopathlogical findings. a high prevalence of Cg: 62.5% in patients with chronic HCV infection, the presenting symptoms were fatigue [67.5%], artheralgia [32.5%], parathesia [30%] and pruritus [25%], however, there were no statistically significant difference between cryo +ve versus Cryo -ve patients except for pruritis, face pigmentation. Skin manifestations inclding face pigmentation [42.5%], leukocytoclastic vosculitis [LCV] [22.5%], Porphyria cutanea tarda [PCT] [20%], Lichen planus [17.5%], acral necrolytic erythema [15%] and vitiligo [15%]. Neurological manifestations including symptomatic neuropathy in 10%, neuropathic changes detected by nerve conduction velocity [NCV] and electromyography [EMG] in 30% and electroencephalographic changes in 22.5%. Interestingly, these cutaneous and neurological manifestations were significantly associated with the presence of cryoglobulinaemia. Liver histopathology of the studied patients according to METAVIR score [Activity] A0-3 [Fibrosis] F0-4 showed no statistically significant difference between cryo positive versus cryo negative patients. conclusion findings confirmed a clear association between cryoglobulianemia and extrahepatic neurocutaneous manifestations of HCV infection. The presence of these manifestations in the appropriate clinical setting should suggest the presence of HCV infection

Clinical relevance of cryoglobulinaemia and extrahepatic neurocutaneous manifestations of chronic hepatitis C

To examine the prevalence of cryoglobulinaemia in patients with chronic hepatitis C infection and its relation to extrahepatic neuro-cutaneous manifestations. Forty patients [26 males and 14 females], with clinical, laboratory and histologically established chronic hepatitis C infection, with a mean age of 37.5 years, were submitted to clinical examination, dermatological and neurological evaluation. Neuroimaging as well as neurophysiological evaluation, laboratory assessment including liver function tests, serum cryoprecipitate immunoelectrophoresis, and revision of histopathlogical findings were performed. A high prevalence of cryglobulenemia: 62.5% in patients with chronic hepatitis C infection, the presenting symptoms were fatigue [67.5%], arthralgia [32.5%], paresthesia [30%] and pruritus [25%]; however, there were no statistically significant difference between cryo + ve versus cryo - ve patients except for pruritis, and face pigmentation. Skin manifestations including face pigmentation [42.5%], leukocytoclastic vasculitis [22.5%], porphyria cutanea tarda [20%], lichen planus [17.5%], acral necrolytic erythema [15%] and vitiligo [15%]. Neurological manifestations; symptomatic neuropathy in 10%, neuropathic changes in 30% and electroencephalographic changes in 22.5%. These cutaneous and neurological manifestations were significantly associated with the presence of cryoglobulinaemia. Our findings support an association between cryoglobuliaemia and extrahepatic neurocutaneous manifestations of hepatitis C infection. The presence of all these manifestations in the appropriate clinical setting should suggest the presence of hepatitis C infection

Serum neopterin as a marker of severity of unstable angina

The current study aimed to assess serum neopterin level in patients with chronic stable angina and unstable angina and to assess the relation between neopterin concentration and complex coronary artery stenosis in patients with unstable angina. There is increasing evidence that inflammation plays an important role in atherogenesis and may determine plaque vulnerability. At angiography, disrupted or ulcerated plaques appear as complex stenosis. Plaque vulnerability has been shown to be a function of the increased local number of inflammatory cells within plaques, particularly activated macrophages and lymphocytes. Neopterin is a pterydine derivative produced by activated macrophages, so it can be used as a marker for severity in patients with unstable angina. Fourty patients were involved in this study [30 patients with the diagnosis of unstable angina and 10 patients with the diagnosis of chronic stable angina], ten healthy subjects of matched age and sex were involved as control group. All members of the study were subjected to complete medical history, general and local cardiac examination, 12 lead ECG, echocardiography, and the following laboratory investigations: CK and CKMB, C-reactive protien, Neopterin level, serum cholesterol, LDL, HDL, triglycerides, creatinine, urea and blood glucose. Coronary angiography was done to all members of group 1 [patients with the diagnosis of unstable angina]. Our study revealed that: Neopterin level was significantly higher in patients with ischaemic heart disease than in healthy controls. It was also significantly higher in patients with unstable angina than in patients with chronic stable angina. Neopterin and CRP levels were significantly correlated with the presence of multiple complex lesions in angiography. There is a strong association between neopterin level and the number of complex lesions in angiography in patients with unstable angina, so, it can be used in risk stratification in these patients

Paraoxonase gene polymorphism and serum paraoxonase activity: relationship with type I diabetes and nephropathy

Human serum paraoxonase-I [PON1] is physically associated with high density lippprotein [HDL] and has been implicated in the prevention of LDL lipid peroxidation. PON1 gene displays several polymorphisms that influence both its level of expression and its catalytic activity. The goal of this study was to examine the association between paraoxonase-1 [PON1] activity and gene polymorphism and the micro-vascular complications in children and adolescence suffering from type 1 DM [TIDM]. Case-control study. One study centre at a University hospital. Thirty eight patients, with type 1 diabetes [n=38], 13 patients presenting with diabetic nephropathy [mean age 18.76 +/- 5.59 years. 8 males and 5 females] and 25 without diabetic nephropathy [mean age 14.48 +/- 3.69 years. 14 males and 11 females] and 16 healthy controls [mean age 12.38 +/- 8.25 years, 10 males and 6 females]. The allele variants of PON1 gene polymorphisms in the PON1 coding region Q192R and L55M have been identified by polymerase chain reaction followed by restriction fragment length polymorphism analysis. Serum PON1 enzyme activity was measured spectrophotometrically. Serum PON1 activity was significantly decreased in complicated diabetics when compared to both non-complicated patients and the control persons [103.33 +/- 35.46 nmol/ml/min, 462.57 +/- 200.69 nmol/ml/min and 1132 +/- 317.61 nmol/ml/min respectively]. As regards PON1 Q192R polymorphism, the R allele was more frequent in complicated diabetics versus both non-complicated diabetics and controls [p=0.0113 and p=0.001 respectively]. PON1 192QR genotype is a risk factor for developing type 1 diabetes OR=7.8; 95% CI [1.12-65.7] with p=0.043. PON1 192QR genotype and 192R allele are risk factors for developing micro-vascular complications with OR =6.40 and 4.00; 95% CI [1.44.28.29] and [1.15-13.87] with p=0.01 and 0.023 respectively. In PON1 L55M polymorphism, non significant differences in the genotype or allele frequency were found between T TIDM, both complicated and non-complicated diabetics and control persons. The association of PON1 Q192R polymorphisms, lower PON1 activity and poorer diabetic control found in patients with diabetic nephropathy further support an idea of genetic factors contributing to development of vascular complications in diabetes

Parenteral use of iron and ascorbic acid [vitamin C] in haemodialysis patients

The aim of this work was to study the effect of supplementation of iron and vitamin C therapy to hemodialysis patients, hoping that this therapy is effective in the treatment of anaemia in these patients. In this work, 40 stable hemodialysis patients suffering from severe to moderate anemia not receiving any form of replacement therapy [i.e., neither erythropoietin [EPO] nor iron], were selected and divided into two groups: The first group was treated by injection with ferrosac 100 mg/5ml twice a week for 3 months, and the second group was treated by injection with 500 mg/2.5ml of vitamin C in combination with 100 mg/5ml ferosac twice a week for three months. The results of this study indicated that: There was a significant decrease in both urea and creatinine in hemodialysis patients after i.v. treatment of ferosac alone [100 mg/5ml] [group I] and combined ferosac [100 mg/5ml] with ascorbic acid [500 mg/2.5ml] [group II] twice weekly for 3 months. There was a significant increase in hemoglobin concentration and serum iron in both hemodialysis patient groups [I and II] after treatment, the highly increase markedly occurred in group II rather than group I after treatment. Moreover, there was a significant decrease in serum ferritin concentration in group I and a more pronounced decrease in group II after treatment, indicating the importance of vitamin C in decreasing the serum ferritin level and therefore the better correction of anemia

Comparative bioavailability of norfloxacin tablets based on blood and urine data

To assess the bioavailability of norfloxacin from urinary excretion relative to plasma concentration. Twelve healthy volunteers [22-33 years] participated in the study. Each received a previously developed [M], a local [L] and a multinational [Noroxin] tablet [Ref], 400 mg each, according to a random balanced three-way crossover design on 3 different days. Blood samples were collected over a 12-hour period and urine over a 24-hour period. Norfloxacin concentrations were analyzed by a validated HPLC method. An initial estimate of bioequivalence of the three products was obtained using analysis of variance on transformed data and based on confidence interval calculation. Elimination pharmacokinetic parameters [half-life and renal clearance] calculated from plasma concentration and urinary excretion data [mean values, n = 36] were comparable to reported values for norfloxacin. Interproduct differences in elimination parameters [mean values, n = 12] were statistically insignificant [F values, ANOVA]. Strong association was found between the mean of plasma concentration and urinary excretion rates for many volunteers [F values, regression analysis]. Relative bioavailability values calculated for the local and previously developed products relative to Noroxin were higher than 85% based on area under the curve and urinary excretion. Bioequivalence could not be established among the three tested products based on calculated 90% confidence intervals. Urinary excretion of norfloxacin may be a useful noninvasive tool for bioavailability assessment of norfloxacin oral formulations

Value of urinary free cortisol/cortisone in assessing the activity of 11-beta-hydroxysteroid dehydrogenase in obese children: optimization of high performance liquid chromatography

Increased secretion of glucocorticoids is associated with obesity and cortisol secretion is increased in subjects with idiopathic obesity, especially of central distribution. Intercon-version of active cortisol with inactive cortisone is catalysed by the isozymes of 11 beta -HSD activities in different tissues can be assessed by ratio of urinary free cort isol to cortisone. The present study was carried out to evaluate the free cortisol/cortisone ratio in urine of obese children and adolescents to clarify the role of 11 beta-HSD in the pathogenesis of exogenous obesity. Thirty obese children were included in the present study; they were recruited from those attending Diabetic Endocrine Metabolic Pediatric Unit [DEMPU], Children Hospital, Cairo University, for assessment of obesity. Ten apparently healthy, non obese children matched in age and sex, were also included as controls. Urinary free cortisol [UFF] was measured by radio immune assay [RIA] and High performance liquid chromatography [HPLC] while urinary free cortisone [UFE] was measured by HPLC. The obtained results showed higher ratio of UFF/UFE in obese children suggesting that cortisol metabolism may be enhanced in children with higher body fat. This finding is supported by the positive correlation encountered between UFF and both BMI and fat%, which can be attributed to a higher activity of 11 beta-HSD-1 expressed in both subcutaneous and visceral fat with increased reactivation of cortisone to cortisol. This highlights the value of the UFF/UFE in demonstrating 11 beta-HSD activity more than measuring UFF or UFE alone. Finally, HPLC method under adopted conditions was found to be rapid, reliable and specific for measurement of both UFF and UFE

Role of leptin in patients with chronic idiopathic thrombocytopenic purpura [ITP]

Leptin hormone, synthesized by the adipose tissue, binds with a receptor member of the class I cytokine receptor family. It plays a role in the pathogenesis of several autoimmune diseases. Idiopathic thrombocytopenic purpura [ITP] constitutes the prototype of autoimmune diseases characterized by the production of the autoantibodies against platelet antigens, resulting in enhanced destruction of the platelets by macrophages. Recently, more evidences have been found related to the effects of hormones on the immune system, including their effect on autoimmunity. The aim of this study was to evaluate serum leptin level in patients with chronic ITP in order to determine the role of leptin in the pathogenesis of ITP. This study comprised 40 patients with chronic ITP and 20 healthy controls of similar age, sex and body mass index [BMI]. Serum leptin level was measured by enzyme amplified sensitivity immunoassay [EASIA]. It was found that, the mean serum leptin level in patients with ITP was significantly higher [P<0.001] than in healthy controls. Furthermore, the positivity of platelet-associated antibodies [PAIgG] and platelet count was significantly different between leptin-positive [level greater than mean of control value + 2SD] and leptin-negative patients. From the present study we can conclude that leptin might play an important role in the pathogenesis of ITP

Inching technique and comparative tests in the diagnosis of mild carpal tunnel syndrome

Introduction: Carpal tunnel syndrome [CTS] is the most common entrapment neuropathy. Its diagnosis depends on its typical clinical signs and symptoms and confirmed by electrophysiologic studies. Routine motor and sensory conduction studies failed to diagnose CTS in about 25% of cases [mild cases with distal motor latencies less than 4.2 ms]. The aim of the work: was to study the sensitivity and reliability of inching sensory technique of median nerve around wrist as well as comparative nerve conduction tests in diagnosis of mild CTS. and hence early application of suitable lines of treatments

Subjects and methods: This study comprised fifty apparently healthy subjects as a control group and patients group included one hundred and fifteen patients with mild CTS in 150 affected hands. Patients were thoroughly selected from 379 patients with 512 affected hands diagnosed clinically as having typical CTS and referred from Outpatient Clinics in Mansoura University Hospitals. Cases with mild CTS were selected according to conventional motor and sensory nerve conduction studies [NCS] and were having distal motor latencies less than 4.2 ms. All the studied groups were subjected to; sensitive NCV tests: mediansecond lumbrical versus ulnar-inrosseous test, median versus ulnar digit 4 sensory latencies test [ringdiff], median versus ulnar palm-to-wrist mixed nerve latencies test [palmdiff], median versus radial digit one antidromic sensory latencies [thumbdiff], combined sensory index [CSI] and inching sensory technique for median nerve at wrist. different surgical approaches were planned to relieve nerve compression after failure of other therapeutic modalities depending on accurate diagnosis using inching sensory test and other comparative tests

Results: Mild CTS was diagnosed in 29.3% of all cases of CTS. In comparative tests, median versus ulnar palm-to-wrist mixed nerve latencies [palmdiff] was the most sensitive [93.33%] with specificity of 99.3%. CSI was the most sensitive test in our study [sensitivity=99.33% and specificity =100%] followed by inching sensory test as its sensitivity was 94% and specificity 100%

Conclusion: Comparative studies and CSI are easily applied, non painful, sensitive and specific tests can be applied firstly in diagnosis of mild CTS and followed by inching sensory technique which is also, very sensitive and specific but it may be painful and time consuming. We can approach to diagnosis of mostly all cases of mild CTS by this regimen so early diagnosis with selection of suitable lines of treatment will improve the results of patient's outcome

Extracellular accumulation of bioactive substances; interleukin -1beta [IL-1beta] and plasminogen activator inhibitor-1 [PAI-1] in stored blood units, relation to bacterial contamination

Bacterial contamination of blood and its cellular components remains an unresolved problem in transfusion medicine. Its relation to release of some bioactive substance from cellular blood components is not determined. The present work was designed to explore the levels of two bioactive compounds Interleukin-1 beta and Plasminogen activator inhibitor-1 in stored blood and their relation to bacterial contamination of these units. This study was conducted on 112 blood units obtained from blood bank of Mansoura University Children Hospital. Sequential blood samples were obtained both immediately after donation and 10 days after for measurement of interleukin-1 beta and Plasminogen activator inhibitor-1 and for bacterial culture by BACTEC 9050 system. There was statistically significant increase in both IL-1 beta and PAI-1 [p= 0.0001] after 10 days of blood units storage. Bacteriological culture revealed no growth in 68% and positive growth in 32% of blood units. The commonest isolated organism was Staph. aureus [15%] followed by Staph. epidermedis [13%] then Yersinia sp. and Enterobacter sp. [2%] for each.From the present study we could conclude that; stored blood units contain platelets and WBCs derived bio-active substances PAI-1 and IL-beta which increase with the duration of blood storage. Furthermore, the extended duration of storage carries the danger of blood contamination by bacteria. Automated blood culture system seems to be helpful in identification of bacterial contamination of blood units. We recommend fresh blood transfusion as early as possible and the practice of Leucofilteration to avoid blood transfusion complications

Management of venous hypertension complicating haemodialysis access in patients with chronic renal failure

As survival for patients with renal failure continues to improve, the complexity of vascular access procedures and the complications from these procedures will continue to increase. Venous hypertension is one of the most distressing complication in patients creating ar-teriovenous fistula resulting in swelling of the ipsilaterai arm, cyanosis as well as formation of collaterals on the chest wail when associated with central venous stenosis or obstruction. From April 2002, to April 2004, 519 patients with end stage renal disease [ESRD] on regular haemodialysis with already functioning vascular access. There were 21 patients [4.2%] presented with variable degrees of oedema and venous hypertension. The patients were classified clinically into three groups: Group A : included cases with mild oedema. Group B : cases presented with moderate and painful oedema Group C : cases presented with extensive oedema of the whole limb, oedema of the ipsilateral breast, congestion, discolouration of the affected limb and cases with collaterals on the shoulder and anterior chest wall of the affected side, 21 patients representing [4.2%] of the studied cases presented with variable degrees of venous hypertension, 7 males [33%] and 14 females [67%]. All patients presented with oedema, 12 patients associated with bluish discolouration of the skin, 6 patients with increased venous pressure and one patients with venous ulcer. 14 patients had AVF without central venous line and 7 patients with history of ipsilateral central venous line. Venous dialysis pressure was > 150mmHg in 6 patients and normal in 8 patients, not measured in 6 patients. Management of patients by limb elevation and compression therapy lead to improvement of symptoms in only 4 cases. Endovascular procedures were done in 10 cases using PTA without stent in 9 cases and PTA with stent in one case. Surgery was applied for 16 cases, 3 patients underwent surgical bypass using synthetic graft for one patient and autogenous vein graft for 2 cases. Ligation of the distal veins was performed for 7 cases. Ligation of the fistula was done in 5 cases and surgical revision in one case. Venous hypertension resulted from proximal venous obstruction or stenosis or by distal venous reflux. Early detection and treatment of venou hypertension is essential to provide adequate care for chronic renal failure patients. Percutaneous Angioplasty for stenosed central vein is the method of choice in management of venous hypertension in well selected cases and surgical bypass using autogenous vein or synthetic graft is a good alternative when complete obstruction of central vein or failed endovascular technique

Plasma nitric oxide level in myocardial disorders with left ventricular diastolic dysfunction

Nitric oxide is a free radical that is elevated in the plasma of patients with heart failure due to contractile dysfunction. This study examine the relation between plasma NO level and Left Ventricular [LV] diastolic function and its aetiology in heart failure patients in the pediatric age group. We performed echocardiographic Doppler studies in 47 patients [mean age of 6.16 +/- 2.8 years, 31 males and 16 females] with congestive heart failure. Left ventricular diastolic dysfunction was classified as either a restrictive [RFP] or non restrictive filling pattern [non-RFP]. Same day venous total nitrite and nitrate levels were measured by colourimetric assay. Plasma NOx level was significantly higher in the studied patients than the control group [141 +/- 54 and 43 +/- 4 micromol/L, respectively, p<0.001]. ROC curve found that the cut off point for plasma NOx level was 60 micromol/L to differentiate between normal children and patients with heart failure. Patients with RFP showed insignificantly higher levels of plasma NOx than the non-RFP patients. Only in muscular dystrophy patients, there were negative correlation between plasma NOx level and LV ejection fraction [r = -0.61, p = 0.06] and LV fractional shortening [r = -0.64, p = 0.04]. On correlating the plasma NOx levels to the severity of heart failure by multiple linear regression analysis, the pulmonary artery systolic pressure was the only variable independently associated with an elevated plasma NOx level [p = 0.05]. Plasma NOx level is elevated in patients with isolated diastolic heart failure. In addition, in patients with LV systolic failure, the severity of LV diastolic dysfunction determines the amount of NO production

Assessment of fenestration of the tunica vaginalis testis during palomo varicocelectomy in adolescent boys for the prevention of postoperative hydrocele

Palomo varicocelectomy is widely accepted as the preferred treatment of primary varicocele in childhood. However, there is a high incidence [up to 33%] of postoperative hydrocele following this procedure. It is frequently nuisant and reaches a considerable size that necessitates surgical intervention for cure. Many procedures have been examined for the prevention of such complication. However, we evaluated one of these procedures, namely the technique of simultaneously incising the ipsilateral tunica vaginalis testis with the Palomo varicocelectomy. Forty-five patients were included in this study. They were subdivided into two subgroups. The first one was subjected to only Palomo varicocelectomy while the second to Palomo procedure in addition to ipsilateral incision of the tunica vaginalis. None of the patients of the second subgroup developed a postoperative hydrocele. Incising the tunica vaginalis adds no morbidity to the varicocelectomy. It is rather safe and simple technique that proved effective in the prevention of postoperative hydrocele after Palomo procedure

Hepatorotective effect of garlic [Allium sativum] and vitamin E on experimental liver injuries induced by ultraviolet radiation

Previous researches have demonstrated that the garlic and vitamin E were able to exert preventive properties against sunburn, delay the onset of skin tumors and reduce radiation induced tissue damage. These compounds may act as antioxidants able to scavenge free radicals and lipid peroxidation. The aim of the present study is to investigate the possible protective effect of garlic and vitamin E against ultraviolet radiation induced liver damage. A total of 60 male albino rats weighing 180-200 g were used in this study. The rats were divided into six groups. Each group contained 10 rats. Group [1] Animals were kept as control. Group [2] Animals were exposed to ultraviolet C-rays 180-280 nm for 30 successive days. Group [3] was given ethanolic extract of garlic at dose level of 0.18 ml/100 g.15 min before exposure to ultraviolet C-rays 180-280 nm for 30 successive days. Group [4] was given vitamin E at dose level of 100 mg/kg b. w 15 min before exposure to ultraviolet C-rays 180-280 nm. The fifth and sixth groups were given garlic and vitamin E respectively for 30 successive days. Histopathological effects in liver were demonstrated as necrosis, fibrosis, fatty changes, inflammatory cellular infiltration and vacuolar degeneration. Deep nuclear basophilia and karyolysis were also seen in some hepatocytes. No pathological, histochemical and ultrastructural changes could be observed in rats treated with garlic or vitamin E. Histochemical results showed marked diminution of glycogen content, DNA, protein content and increase in collagen deposition. Ultrastructural changes were observed in irradiated rats in the form of areas of cytoplasmic dissolution, partial clumping of nuclear chromatin and partial disappearance of nuclear membrane. Mitochondria had dense matrix with proliferation and vesiculation of endoplasmic reticulum. The treatment of rats with ethanolic extract of garlic or vitamin E before exposure to ultraviolet C-rays alleviated the deleterious effects of ultraviolet radiation

Genotoxicity of ranitidine-Hcl histochemical cytogenetical and teratological study

Ranitidine-HCl is widely prescribed by Egyptian physicians as an acid-supperssing medication in patients with some gastrointestinal diseases. It is frequently continued when symptoms persist. The genotoxicity of ranitidine is controversial. In the present study, its genotoxicity was assessed after drenching pregnant mice [from the 6[th]-15[th] day of gestation] saline, half therapeutic, therapeutic or double therapeutic doses of ranitidine. Teratogenicity in the offspring were detected. Chromosomal aberration were assessed in bone marrow cells of the mothers, and the embryonic cells of the 18-day embryos. The DNA frequency distribution in mother's hepatocytes and placenta were measured and statistically analyzed. Teratogenic study indicated that ranitidine causes a dose related decrease in body weight and skeletal size. The cytogenetic data indicates that ranitidine administration results in a dose dependent increase in the total aberration in both mothers and embryos. The rate of increase in polyploidy in relation to the dose is higher in mothers than embryos. The frequency distribution of DNA in hepatocytes of pregnant mice shows that the population of cells in the sub G2 representing apoptotic cells, hyper G2 representing S-hase and aneupoloid cells, and polyploid cells are increasing in dose dependent fashion. Such changes were less pronounced in the cells of the placenta. In conclusion, oral administration of ranitidine-HCl results in genotoxic features especially in adult pregnant mice

Immunological identification of fasciola hepatica antigens containing major human T - cell and B - cell epitapes

Fasciola hepatica whole worm homogenate [Fhwwh] separated fractions were used in enzyme linked immunoelectro-transfer blot [EITB] to identify the antigen[s] which induce antibody formation in human fascioliasis. The immuno-reactive antigens recognized by the infected patients were 25-29 kDa and 12 kDa. The antigens were biochemically purified by model 491-prep cell fraction [BIO-RAD]. The capability of the purified antigens to induce humoral and cellular responses with cells and sera of infected patients was investigated using enzyme linked immunosorbent assay [ELISA] and lymphoproliferative responses techniques. The 25-29 kDa cluster of the antigen[s] were found to be more efficient in inducing lymphoproliferative response than 12 kDa; thus, it was considered as the target antigens used in the generation of human monospecific polyclonal immunopurified antibody probes [IPAb]. The specificity and immuno-reactivity of the IPAb with Fhwwh, F. hepatica excretory secretory products [FhESP] and S. mansoni adult worm antigen [SAWA] were evaluated by using EITB. The results showed that IPAb was immuno-reactive with 25-29 and 12 kDa antigens of both Fhwwh and FhESP