Secreted Phosphoprotein 1 Promoter Genetic Variants Are Associated with the Response to Pegylated Interferon alpha Plus Ribavirin Combination Therapy in Egyptian Patients with Chronic Hepatitis C Virus Infection

BACKGROUND/AIMS: The T-helper 1 (TH1) immune reaction is essential for the eradication of hepatitis C virus (HCV) during pegylated interferon alpha (PEG-IFN-alpha)- and ribavirin (RBV)-based therapy in chronic HCV patients. Secreted phosphoprotein 1 (SPP1) was shown to be a crucial cytokine for the initiation of a TH1 immune response. We aimed to investigate whether SPP1 single nucleotide polymorphisms (SNPs) may influence sustained virological response (SVR) rates. METHODS: Two SNPs in the promoter region of SPP1 at the -443 C>T and -1748 G>A loci were genotyped in 100 patients with chronic HCV genotype 4 infection using a TaqMan SNP genotyping assay. RESULTS: Sixty-seven patients achieved a SVR, and 33 patients showed no SVR. Patients carrying the T/T genotype at the -443 locus showed a significantly higher SVR rate than those carrying the C/T or C/C genotype (83.67% vs 50.98%, pT and -1748 G>A loci may be useful markers for predicting the response to PEG-IFN-alpha-2b plus RBV therapy in Egyptian patients with chronic HCV genotype 4 infection.

Functional and prognostic relevance of -173 G/C gene polymorphism of macrophage migration inhibitory factor in sepsis patients in Egyptian intensive care units

This study aimed to evaluate the association of plasma MIF level and -173 G/C single nucleotide polymorphism of the MIF gene with the occurrence, severity and mortality of sepsis patients. A study was conducted in adult surgical intensive care units of Zagazig University Hospitals, Egypt on 25 patients with sepsis, 27 with severe sepsis and 28 controls. Gram-negative bacilli were the most common isolates in both severe sepsis [63.0%] and sepsis [56.0%] patients. A highly statistically significant difference was found in MIF levels between sepsis cases and controls and a statistically significant difference as regards MIF level in different genotypes of the studied groups. MIF level was significantly associated with mortality in sepsis cases. High MIF levels and MIF -173G/C gene polymorphism are powerful predictors of the severity of sepsis and its outcome

Role of focused ultrasound in the diagnosis of acute appendicitis in pediatric population. selection of a standard diagnostic criterion

To evaluate the diagnostic role of focused ultrasound of right iliac fossa in clinically suspected cases of acute appendicitis in pediatric population and its value as a standard diagnostic tool in that age group. A retrospective, cohort study was conducted at radiology department of Agha Khan University involving 239 children less than 16 years with clinically suspected appendicitis referred to radiology department from January 2009 to October 2011 were included. Medical records were reviewed for patient demographics, presenting signs and symptoms, sonographic, surgical findings and histopathological results. Two hundred and thirty nine patients with clinical suspicion of appendicitis were referred for focused ultrasound for appendix. Ultrasound examination showed 59 cases [24.6%] positive for appendicitis and thus they were operated. All of these were positive on histopathology. The remaining 180 cases [75.4%] that were negative on U/S were managed conservatively. Out of these 180 cases, 13 patients with negative findings on imaging studies were later operated due to clinical decision and/or CT examination. Acute appendicitis was proven in 10 out of the 13 cases. Focused ultrasound has high sensitivity in acute appendicitis for the assessment of clinically equivocal cases of pediatrics population. It can be used as an initial screening modality especially in pediatric population, thus reducing additional cost and radiation risk associated with CT scans and also reducing rate of negative surgery

Validity and reliability of the Arabic short version of the child oral health-related quality of life questionnaire [CPQ 11–14] in Medina, Saudi Arabia

The Arabic version of the Child Perception Questionnaire for assessing oral health-related quality of life in 11–14 year olds [CPQ 11–14] has been previously validated. This study tested the validity and reliability of the short version of the Arabic CPQ 11–14 in the general population of Medina, Saudi Arabia. A total of 268 schoolchildren completed the questionnaire and were examined to determine the prevalence of caries and malocclusion. The mean total score was 8.53 [SD 8.18], and 7% of children scored zero. There was a significant association between malocclusion and oral symptoms and between DMFT score and functional limitations. The test–retest reliability [0.78] and Cronbach alpha [0.82] were excellent. The construct validity was acceptable for oral health [P = 0.37] and overall well-being [P = 0.40]. The Arabic version of the short form CPQ 11–14 was reliable and valid for this general population of children

Nodular melanoma mimicking keratoacanthoma: lessons to learn

A 67-year-old man of Chinese descent presented with a painless nodular lesion that had been present on his right forearm for the previous 3 months. A single, well-defined, dome-shaped, firm nodule with a central keratin plug surrounded by erythema was noted. Keratoacanthoma with secondary bacterial infection was suspected and the patient underwent an excision biopsy. Biopsy of the nodule and immunohistochemical staining supported a diagnosis of nodular malignant melanoma. It should be noted both that nodular malignant melanoma may present with a wide variety of clinical appearances, and that the lack of melanin pigment in nodular malignant melanoma may hinder the diagnosis of this aggressive tumour

Neurological manifestations of dural sinus thrombosis

Dural sinus thrombosis is a clinical syndrome that has a diversity of signs and symptoms that can be easily misinterpreted with other common neurological diseases such as brain infections. To study the clinical presentation of dural sinus thrombosis among Sudanese patients seen at Elshaab Teaching Hospital. This is a prospective, descriptive, cross sectional, hospital based study conducted in Elshaab Teaching Hospital- Khartoum Sudan, in the period from November 2008 to July 2010. All adult Sudanese patients with dural sinus thrombosis who were admitted to the hospital and accepted to participate in the study during the period from November 2008-July2010 [50 patients] were enrolled. History, clinical examination and relevant investigations including MRI were done for all patients. Data were collected, analyzed, conclusions drawn and recommendations stated. Females [98%] in child bearing age were mostly affected. Delivery and pregnancy were the common risk factors; head ache, neck pain and stiffness were the frequent neurological symptoms. Papilledema was the commonest neurological finding. Saggital sinus thrombosis was found to be the major radiological finding and great majority of patients showed remarkable improvement with treatment. Dural sinus thrombosis is uncommon neurological problem, however the diagnosis should always be considered in the right clinical setting, as it is a treatable condition

Efficacy of combined topiramate/thioctic acid therapy in migraine prophylaxis

Migraine cannot be cured and the aim, shared with the patient, is to minimize the impact of the illness on the patient's life and lifestyle. The aim of prophylaxis is to reduce the number of migraine attacks. Prophylaxis should be considered when appropriately used acute management gives inadequate control of symptoms. The efficacy and safety of topiramate 50mg/d and thioctic acid [alpha-lipoic acid] 300 mg/d either as monotherapy or in combination were investigated as migraine prophylactic agents. Forty secondary school migraineur girls were enrolled in the study. The study was conducted in two phases, a prospective baseline phase and 1-month treatment phase. Combined topiramate/thioctic acid therapy was more effective than either topiramate or thioctic acid monotherapy as a migraine-preventive treatment. Combined topiramate/thioctic acid therapy decreased the mean monthly migraine frequency from 5.86 +/- 1.2 to 2.6 +/- 0.98 [P /= 50% reduction in monthly migraine frequency] was 85% in patients receiving combined topiramate/thioctic acid therapy compared to 30% and 20% in patients receiving either topiramate or thioctic acid, respectively. The incidence of adverse events was higher in patients receiving topiramate [50 mg/d] monotherapy. The most common adverse events were nausea, fatigue, paraesthesia and taste perversion. We conclude that combined topiramate/thioctic acid therapy is more effective and better tolerated than topiramate monotherapy. The combination has lower monthly medication costs compared to the traditionally used topiramate 100 mg monotherapy

Studies on evaluation of inactivated lyophilized equine influenza vaccine in Egypt

Two batches of egg adapted monovalent inactivated freeze dried equine influenza vaccine [EIV] were evaluated. There was no abnormal appearance of the freezed disc, prepared from locally isolated strains. The efficacy was tested by lab animal [Guinea pigs] and target animal [horse], The vaccine proved to be safe and potent for both guinea pigs and horses. The mean haemagglutination inhibition [HI] antibodies of the vaccine reconstituted in DEAE-Dextran solution [as a solvent and adjuvant] were 120.4 and 153.7 in G. pigs, 179.2 and 230.4 in horses for the two batches of vaccine respectively. The keeping quality of the local prepared vaccine was studied. Shelf validity was stable at 4°C for one year, could be kept at -20°C for 3 years and 10 months at 40°C

Optic disc area in Malaysian population / 国际眼科杂志(Guoji Yanke Zazhi)

· AIM: To evaluate the optic disc parameters in the three main ethnic groups of Malaysia (Malay, Chinese and Indian). Possible relationships between optic disc parameters and gender, intraocular pressure and axial length of eye were also studied. · METHODS: The study included 244 eyes of 122 subjects (61 cases with open angle glaucoma and 61 non- glaucomatous individuals) with clear ocular media. Magnification corrected measurements of optic disc diameters and area were done using Zeiss FF450 Plus fundus camera. Differences between the three ethnic groups were tested by using ANOVA. The association between factors such as gender, intraocular pressure and axial length of the eye, and the optic disc size was tested through Pearson's bivariate correlation analysis. · RESULTS: The overall mean vertical optic disc diameter as (1.96 ± 0.20) mm, horizontal optic disc diameter was (1.84±0.20)mm and optic disc area was (2.84±0.56)mm2. Indians had larger optic disc area compared to Malay and Chinese. However, the difference was not statistically significant. · CONCLUSION: Optic disc size is larger in Malaysian population than Caucasians, Among the three ethnic groups, Indians have the largest optic disc size without any statistical difference.

A new parameter of ultrasonic measurement for follow-up of choroidal metastasis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the usefulness of a new parameter (maximum cross sectional area) in the measurements of B-scan ultrasonography to evaluate the progress of choroidal metastatic tumour size during the follow-up of patient.METHODS: Case report-the B-scan ultrasonographic measurements of height, base and maximum cross sectional area during the follow-up of the patient are presented.RESULTS: A 62-year-old Chinese lady, known case of non-small cell lung carcinoma, presented with painless blurring of vision in the right eye. She was diagnosed to have bilateral choroidal metastasis (advanced in the right eye and early in the left eye) with good vision in both eyes. The tumour size in the right eye reduced significantly after the first chemotherapy; but increased again 6 weeks after the end of last cycle of chemotherapy. She was given radiotherapy and another course of chemotherapy. The tumour size in the right eye did not respond much later on. However, the tumour size in the left eye was static through out the follow up period of 2years. The patient maintained best corrected visual acuity in both eyes (6/9 in right eye and 6/6 in left eye). The progress of tumour size in right eye was evaluated with serial B-scan ultrasonographic measurements.CONCLUSION: The ultrasonographic measurements were reproducible all through the follow up period and coincided well with clinical appearance of the tumour in right eye. We suggest the use of B-scan ultrasonography in the follow up of patients with elevated choroidal masses for quantitative assessment of progression/regression in their size during the treatment period.

Antiphospholipid syndrome manifesting as papilledema / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To report a rare case of antiphospholipid syndrome presenting as papilledema and sixth nerve palsy in right eye due to superior sagittal sinus thrombosis, and regression of papilledema following anticoagulation and acetazolamide therapy.·METHODS: A 44-year-old Chinese gentleman presented with headache, diplopia and mild blurring of vision. Clinical examination revealed the presence of sixth nerve palsy in right eye and papilledema. There was enlargement of blind spot in the visual fields and red green deficiency in both eyes.Computed tomography and magnetic resonance imaging showed superior sagittal sinus thrombosis. Hematological investigation confirmed the presence of antiphospholipid syndrome as the underlying cause.·RESULTS: The condition was treated successfully in three months with the adjunctive use of anticoagulation and acetazolamide. Reversal of papilledema changes in the optic disc to normal indicates the anatomical recovery, while reduction of enlargement of blind spot to normal size,recovery of red green deficieny to normal colour vision in both eyes and visual improvement after regression of papilledema in right eye indicate functional recovery in this patient.·CONCLUSION: Antiphospholipid syndrome should be considered in the differential diagnosis of papilledema, and oral acetazolamide is an important adjunct therapy to anticoagulation in cases of refractory papilledema to protect the optic nerve from potential damage which results in blindness.

Relation of gall stone type with bile composition

The present study was planned to investigate the relation of gall stone type with bile composition. This study was carried out on 41 patients who underwent elective cholecystectomy for calcular cholecystitis. These patients were classified into three groups according to the chemical constituents of stones: group [1] comprised 25 patients with cholesterol gall stones, group [2] comprised 8 patients with mixed stones, and group [3] comprised 8 patients with pigment stones. In addition 8 subjects were included as a control group. Blood sample, gall bladder bile and stones were collected from every patient. Fasting blood glucose, bilirubin, albumin, AST, ALT and lipid profile were measured by the traditional colorimetric methods. At the same time plasma ascorbic acid was determined by dinitrophenyihydrazine thiourea copper sulphate [DTC] reagent. In addition serum insulin was measured by chemiluminescent method and leptin by enzyme immunoassay. Biliary bile acids were measured by HPLC while biliary cholesterol, phospholipids, calcium, bilirubin and total protein were determined by colorimetric methods The present study revealed that ages of patients with pigment stones were significantly higher while BMI was elevated in patients with cholesterol gall stones. Serum cholesterol, TG, LDL, insulin and leptin were significantly increased while HDL and serum ascorbic acid were significantly decreased in patients with cholesterol gall stones when compared to control group. In addition, there was significant positive correlation between leptin and BMI, insulin and biliary cholesterol. In patients with cholesterol gall stones there were significant increase of biliary protein, biliary cholesterol and decrease of biliary phospholipids, total and direct bilirubin when compared to control group. In patients with mixed and pigment gall stones, there were significant decrease of serum HDL, biliary phospholipid, total and direct biliary bilirubin beside significant increase of indirect bilirubin when compared to control group. Concerning biliamy bile acids there were significant decrease of primary bile acids conjugates [GCA, TCA, GCDCA, and TCDCA] and significant increase of secondary bile acids conjugates [GDCA, TDCA, GLCA, and TLCA] in all patient groups when compared to control group. Leptin was associated with increased risk of cholesterol gall stone formation while advance of age was associated with pigment gall stone. Hypovitaminosjs C may have a pivotal role in gall stone formation specially cholesterol type. Expand of secondary bile acid pool and contracted primary bile acid pool play an important role in various types of gall stones

Traumatic and non-traumatic coma in children in the referral hospital, Al-Hasa, Saudi Arabia

We determined the incidence, etiology and outcome of paediatric coma patients in King Fahad Hospital, which is the only referral centre for Al-Hasa region, Saudi Arabia. From April 1999 to March 2002, 91 children with coma [age range 28 days to 12 years] were admitted. The Glasgow Coma Scale for children was used for assessment. Neurological outcomes were categorized as intact, impairment or death. Incidence of coma was 4.77 per 100 000 population per year. Trauma [head trauma or polytrauma] was the commonest cause of coma [52.8%], followed by infection [25.3%]. Mortality was 47.2% [35.4% among traumatic cases and 60.5% among non-traumatic cases]. There was impaired outcome in 19.8% of patients [22.9% with traumatic coma and 16.3% with non-traumatic coma]

Frequency of ABO and RH blood groups in major ethnic groups and casts of Pakistan

To find out the frequency of ABO and RhD phenotypes in different ethnic groups and casts of Pakistan. Design: cross sectional descriptive study. Place and duration of Study: Combined Military Hospital Attock Punjab Pakistan from 1St Jan 2003 to 31 11 Dec 2003. Material and All healthy young adults reporting for recruitment in Armed Forces. Cast and sub cast were recorded. ABO grouping and Rhesus typing was done by slide method. Eight thousand three hundred seventy five young adults were screened. ABO blood group distribution in Arains was: A 25.6%, B 40.5%, AB 9.2%, O 24.7%. Awans: A 22%, B 31.7%, AB 9.9%, O 36.5%. Rajputs: A 23%, B 33.2%, AB 8.8%, O 35.1%. Misc Punjabi sub casts: A 23.6%, B 33.2%, AB 7.5%, O 35.7%. Balochs: A 23.3%, B 27.9%, AB 7.8%, O 40.9%. Sindhis: A 24.9%, B 31.8%, AB 6.9%, O 36.5%. Kashmiris: A 23.7%, B 32.5%, AB 10.2%, O 33.6%. Pathans: A 24.3%, B 31.4%, AB 8.9%, O 35.4% Rh-D negative [n=749] blood group in Araeens 8.3%, Awans 10.4%, Rajputs 8.5%, Misc Punjabi sub casts 8.8%, Balochs 7.8%, Sindhis 8.7%, Kashmiris 10.9% and Pathans 7.7%. There is no statistically significant difference of ABO and Rh-D distribution among various ethnic groups, O is the most common blood group except in Arains where B is the most common and O is less common

ESBL producing Nosocomial Enterobacteria isolated from clinical specimens detected by double disc diffusion method

To identify extended spectrum betalactamases [ESBL] producing organisms of Enterobacteriacae family from clinical specimens. Simple descriptive study Setting: The study was carried out in Microbiology Department of Army Medical College, Rawalpindi from 1 Jan 02 to 31 Dec 02 on clinical samples received from admitted patients in Military hospital, Rawalpindi Samples consisting of urine, blood, high vaginal swabs, catheter tips, fluids including CSF, sputum, chest tube, [HVS] and IV canula central vascular line specimens received for routine culture from outpatient as well as indoor cases of Rawalpindi/Islamabad. The samples were inoculated on Blood agar and Mac Conkeys agar [chocolate agar was also used for sputum and CSF]. Urine samples were cultured on CLED agar. The samples were incubated at 37C under aerobic conditions. The organisms were identified by standard techniques. Confirmation to the species level was done by API 20 E and API NE where required. Sensitivity testing was carried out by Modified Kirby Bauer disc diffusion method on Mueller Hinton agar incubated at 37°C in ambient air for 24 hrs. ESBL producing strains were identified by double disc diffusion method test according to Jarlier et al [1988]. Clavulanate was applied as the inhibitor of beta lactamases [AMO/CLAY disc].The results were tabulated as frequencies. 1. Forty seven percent of clinical isolates yielded ESBL producing enterobacteria. 2. Enterobacter cloacae, Klebsiella oxytoca, Proteus mirabilis and Klebsiella pneuumoniae were the most frequent ESBL producing bacteria. These bacteria were frequently recovered in fluids, drainage tubes/ catheter tips and canulas

Frequency of campylobacter jejuni in diarrhoea/dysentery in chidren in Rawalpindi and Islamabad

To determine the frequencyof Campylobacter jejuni infection in children suffering from diarrhoea/dysentery in the Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi, from 29 August 2002 to 29 November 2002.The study was carried out on one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production and resistance to cephalothin.Eighteen% of samples yielded the growth of Campylobacter jejuni. Mean age of children with Campylobacter jejuni infection was 18 months with peak incidence from 12 to 21 months. Male female ratio was 1.7:1. All the children had loose motions. Seven out 18 [39%] had a combination of symptoms of loose motions, vomiting and pain abdomen. Those having fever with or without other complaints constituted 11 out of 18 [61.11%] i.e. more than 50% of all the children yielding C. jejuni had fever. About 90% of diarrhoeal stools had blood and fifty% also had mucous. There was either history of chicken meat consumption or contact with cattle and pets in most of the cases and both in some of them.Campylobacter jejuni is a frequent cause of diarrhoea/ dysentery in children in our set up. In children it is often related to pets keeping and chicken meat consumption. In the remaining, untreated drinking water may be the source. Campylobacter jejuni frequently presents with blood and mucous in stools with sporadic cases presenting with watery diarrhoea

Predictors for early diagnosis of CNS infiltration in acute lymphoblastic leukemia

The study was held to define the factors helping in prediction of CNS infiltration by leukemia [ALL], type and rate of relapse. Also studing clinical and laboratory diagnosis especially CSF analysis at the primary diagnosis. The study was done in pediatric oncology unit of Zagazig University Hospital on 24 cases of newly diagnosed ALL ranging from 1-14 years. Males were 16 cases and females were 8 cases with male to female ratio of 2: 1. L[1] represented 75% of cases, Patients were subjected to different tests e.g CBC with differential count, hemoglobin level and B[2] microglobulin, bone marrow aspiration, morphological and chemical tests. CNS relapses were 20.9% of cases, hematological relapses were 12.9% and testicular relapses were 4.2%. Serum B[2] microgIobulin, CSF B[2] microglobulin and CSF LDH are useful indicators for cytological diagnosis of CNS infiltration at time of presentation. Cases with elevated B[2] M and/or LDH levels at presentation should be subjected to intensive CNS prophylaxis and CSF monitoring and follow up for better diagnosis and prognosis

Bed utilization pattern in the neonatology unit of zagazig University Hospitals in the year 1999

The objective of this study was to assess case mix and its effects on the average length of hospital stay, average bed turnover and their outcome over the year 1999. Among 1169 admitted cases, there were significant relationship between the cause of admission and sex, mean age at admission, birth order, place of admission and outcome. On other h and, the outcome of the admitted cases was not affected by the mode of delivery and sex but affected by the weight of infant at admission. Hyperbilirubinemia was the most common cause of admission [29.43%] with the best outcome [89.83% improved] and the lowest average length of stay [4.7 days], while preterms constituted a third cause of admission [20.19%] with the worst outcome [62.71% dead] and the highest average length of stay [12.5 days]. The average length of stay for beds and incubators were 5.6 and 10.7 days respectively, and the bed occupancy rate for beds and incubators were 94.84% and 90.48% respectively. The average bed turnover for beds and incubators were 61.33 and 30.92 turn/year respectively. It is concluded that preventive aspects are important in order to decrease the neonatal morbidity and mortality

Supercritical fluid extraction of color Borellana seeds

The coloring materials of Bixa orellana L. [Bixaceae] seeds were extracted using supercritical fluid extraction [SFE] methods. The extraction conditions were systematically investigated in relation to the effect of temperature, pressure, static extraction time, mobile phase [carbon dioxide] mass and modifier type and concentrations in order to optimize the efficiency of supercritical fluid extraction of the red coloring matter of the powdered seeds. The crude extract was analyzed and quantified using HPLC. It was found that the color extraction was dramatically improved under supercritical fluid extraction conditions and proved to be superior to conventional organic solvent extractions. HPLC has been used to examine the effect of these parameters

Total intravenous anesthesia [TIA] propofol-ketamine versus propofol-fentanyl in major surgical procedures

In this study comparison between ketamine and fentanyl was done on two groups of patients, 30 cases each, scheduled for major surgical operations. Ketamine-propofol infusion reported many advantages over fentanyl-propofol infusion. These advantages were more cardiovascular stability, longer postoperative analgesia, no postoperative respiratory depression and less nausia and vomiting effect postoperatively. The only drawback of ketamine infusing was the emergence psychotomimetic reactions which were among only 20% of the cases. These reactions were treated successfully with midazolam 0.1 mg.kg-1 b. wt. IV