Knowledge, attitudes and intended behaviours towards HIV testing and self-protection: a survey of Omani pregnant women

Routine HIV testing of all pregnant women in Oman has been introduced without prior knowledge of women's attitudes towards testing or their behaviour in the event of a positive test. This study recruited 1000 Omani pregnant women from antenatal clinics to explore their knowledge of HIV/AIDS, attitudes towards HIV testing and intended behaviours in the event of a positive test. Mother-to-child transmission was recognized by 86.6% of the women but only 21.0% knew that it was preventable and a few acknowledged the important role of antiviral drugs. Half of the women [51.9%] reported having been tested for HIV and 75.8% agreed about routine HIV testing for all pregnant women. A higher level of knowledge was significantly associated with a favourable intended behaviour related to voluntary testing, disclosure and seeking professional assistance in the event of a positive HIV test. The results are discussed in relation to opt-in and opt-out approaches to voluntary testing during pregnancy

Effect of some herbal plants on liver function of rats treated with trichloroethylene

Curcumin [CCM], Cinnamon [CNN] and Ginger [GE] had been considered to possess antioxidant activities. This study aimed to investigate their protection effect against trichloroethylene [TCE]-induced hepatotoxicity and to demonstrate its possible mode of action. Rats were fed CCM, CNN and GE singly with or without 5mg/l of TCE in drinking water. The rat were killed after treatment period of 8 weeks, and the serum levels of alanine aminotransferase [ALAT], aspartate aminotransferase [ASAT], bilirubin, proteins, glucose, albumin and triglycerides were determined. TCE- receiving rat exhibited significant changes in biomarkers of liver function to indicate liver injury. The CCM containing diet significantly ameliorated the serum aminotransferases, especially ALAT, total protein and albumin. The CNN containing diet significantly ameliorated the total protein and albumin. The GE containing diet significantly ameliorated the serum aminotransferases, especially ALAT. In conclusion, this work indicated that CCM is the most herbal plant which can protected and alleviated the liver function

Cryptosporidium and giardia in water in Alexandria: detection and evaluation of viability by flow cytometry and different stains

Cryptosporidium oocysts and Giardia cysts have become ubiquitous in surface waters worldwide. The number and extent of outbreaks of waterborne diseases indicate a significant risk for their possible transmission by drinking-water. Since many Egyptian cities depend on surface water as their main source of drinking water, knowledge of the prevalence of waterborne protozoa in water resources is important. The present study was designed to use flow cytometry to detect Cryptosporidium oocysts and Giardia cysts in water samples in Alexandria city in comparison with the standard staining techniques. Testing the viability of the encountered parasites was also carried out comparing flow cytometry and trypan blue vital stain. Thirty water samples were collected from water tanks from different districts of Alexandria city. Samples were subjected to staining techniques and flow cytometry. Stains used were modified Zeihl-Neelsen [MZN], safranin methylene blue [SMeB], modified trichrome, fluorescent stains [phenol auramine and acridine orange]. Viability was evaluated comparing trypan blue stain and flow cytometry using 4'-6-Diamidino-2-phenylindole immunostain [DAPI]. Flow cytometry proved to be much more sensitive than staining techniques with a sensitivity of 100% for both Cryptosporidium oocysts [30 samples] and Giardia cysts [11 samples]. Following flow cytometry, the fluorescent phenol auramine stain had the greatest sensitivity of 94.74% and 80% [18 and 4 samples, respectively]. The percent of live parasites present in each sample was always significantly higher by DAPI than trypan blue stain. The results of the present study clearly demonstrate that incorporation of flow cytometry can improve sensitivity of detection of Giardia cysts and Cryptosporidium oocysts in water samples. Although it is more expensive than the other staining methods, it is rapid, simple and accurate in estimating the quantity and viability of the parasites in each sample. Thus, flow cytometry can be recommended for detection of protozoa in water

[Abu-Najma] Syndrome: exogenous steroid induced Cushing's with serious consequences. A report of two cases

We describe and report two cases of what we called Abu-Najma Syndrome, caused by the ingestion of 'Abu-Najma' tablets: dexamethasone containing tablets promoted as [beauty tablets]. We believe the use of Abu-Najma is fast spreading among young ladies in Sudan. The syndrome has very serious consequences; a concerted effort is required to increase public awareness and prevent the problem. The commonest cause for Cushing's syndrome as well as secondary adrenal failure is the use of exogenous steroids. In this setting steroids are almost always prescribed for treatment of a medical condition. Side effects are usually discussed with the patients beforehand. However, self medication with steroids for non-medical reasons puts patients at increased risk of side effects. The use of steroid containing preparation either topical or oral for cosmetic reasons is on the increase. The following case histories illustrate the dangers associated with such a practice

Comparative topography and ultrastructure of tegument in a polyopisthocotylean parasite [Metamicrocotyla cephalus] and a monopistho-cotylean parasite [Dactylogyrus Extensus]

Comparative topography and ultrastructure was done for the tegument architecture between a polyopisthocotylean parasite [Metamicrocotyla cephalus] and a monopisthocotylean parasite [Dactylogyrus extensus] for the first time. The result showed that the tegument of M. cephalus is characterized by many foldings producing closely packed annular corrugations superimposed with a complex configuration of many robust papillae bearing microvillus-like projections, thin terminal web just underneath the apical plasma membrane, membranous projections from the basal plasma membrane inside the syncytium, one type of tegumental cell producing two tegumental secretory bodies inside the syncytium [electron-lucent bodies "ts1" and electron-dense bodies "ts2"] and the syncytium is thick [1.3-3 micro m]. The tegument of D. extensus was characterized by the weak annulations and many minute folds like microvilli, some invaginations in the apical plasma membrane form small vacuoles, eruption of some secretory bodies through the apical plasma membrane, three kinds of secretory bodies inside the syncytium from two different tegumental cells [small electron-dense granules "td1" and large fusiform moderately electron-dense bodies containing fibrous threads "td2" from one cell type and thin dumbbell-shaped electron-dense bodies "td3" from other cell type] and the syncytium is thin [1.4-1.5 micro m]. The possible functions of the distinctive features of the tegument whether presence or absence have been discussed, especially the proposed role played during the life of the parasite and the possibility of making them as characteristic features of the polyopisthocotyleans than the monopisthocotyleans

efficacy of antihelminthic compound; clorsulon against experimental schistosoma mansoni infection

The efficacy of Clorsulon[R] [CLS] against experimental schis-tosomiasis mansoni, using Praziquantel[R] [PZQ] as a therapeutic control was evaluated. Swiss Albino mice were divided into infected non-treated control, PZQ-treated group given a single dose of 500 mg/kg four weeks post infection [PI], and infected mice treated with single, double, and triple doses of 5 mg/kg CLS per dose, one week apart starting from the 4[th] week PI. All animals were perfused for adults count. Parts of livers and intestines were examined for granulomata number and sizes. Pathological changes in hepatic parenchyma by H and E and Masson trichrome stains were also examined. Results revealed that a single treatment with PZQ caused a significant percentage reducetion [%R] of worm load [92.68%], mean egg count in liver and intestine [91.20 and 94.01% respectively], and mean size of liver granulomata was reduced [92.06%]. Regarding CLS, the worm burden was reduced proportionally with number of doses given; 87.80, 96.34 and 97.56% in single, double and triple exposures successively. Egg count in liver was decreased by 85.90, 97.01 and 96.23% respectively in treated mice. Number of intestinal granulomata was decreased by 85.28, 94.24 and 95.49% in a similar way. Size of hepatic granulomata was decreased by 89.02, 94.51 and 95.05% by 1, 2 and 3 doses consecutively. All parameters reflected non significant difference between 2 and 3 dose of CLS. The results were critically discussed

Influence of the antioxidant drug [antox] on experimental giardiasis and microsporidiosis

The effect of antioxidant [Antox] on Giardia lamblia and Microsporidium sp. in rats and mice respectively was studied. Pa-rasitologic effect was assessed by the mean parasitic count in infected animals' stool treated and non-treated, and infection intensity in stained section. Biochemical by measuring activities of lactate dehydrogenase [LDH], superoxide dismutase [SOD], malondialdehyde [MDA], myeloperoxidase [MPO] levels and cytokine induced neutrophil chemoattractant-1 [CINC-1] in intestinal homogenates in these animals as shown by cell injury, lipid peroxidation and neutrophil infiltrations. The present results showed that Antox significantly exacerbated G. lamblia and Microsporidium sp. This was manifested by a significant increase in number of G. lamblia cysts and trophozoites in stool and intestinal sections of treated infected rats. Also, microsporidian spores were significantly higher in stool of treated infected mice and infection intensity increased in the intestinal sections. The biochemical study showed a significantly higher degree of cell injury, lipid peroxidation and intestinal neutrophils accumulation in non-treated infected animals whether with G. lamblia or microsporidia. The changes reduced after treatment in giard-iasis but none in microsporidiosis. The results were tabulated photographed, and critically discussed

Prognostic factors for ovulatory response to letrozole in polycystic ovary syndrome

To evaluate prospectively the prognostic factors for ovulatory response to letrozole therapy in polycystic ovary syndrome [PCOS]. The IVF and Assisted Reproduction Center in Sana'a, Yemen. Thirty-three infertile patients with anovulatory PCOS were recruited. Ovulation was induced using 2.5 mg/day letrozole administered from day 3 to 7 of the cycle. When the dominant follicle reached a diameter > 18 mm, HCG 10.000 IU was given IM and timed intercourse was advised. Clinical and endocrinal parameters between responder and non-responder groups were analyzed. There was no significant difference between letrozole responders and non-responders as regards to the period and type of infertility, BMI, LH, FS H or LH/FSH ratio and E[2] levels. However, statistically significant differences were found with respect to patient age, menstrual pattern, hirsutism and fasting insulin levels between responders and non-responders to ovulation induction with letrozole in PCO patients. Response of the PCOS patients to ovulation induction by letrozole may be related to patient age, menstrual pattern, presence of hirsutism, and serum insulin levels

adjuvant effects of IL-12 and BCG on autoclaved leishmania major vaccine in experimental cutaneous leishmaniasis

Cutaneous leishmaniasis is a universal disease causing skin ulceration and deformity. A reliable vaccine remains to be a possible practical means of control. The amastigotes multiply intracellulary in macrophages provoking a cell-mediated type of immune response. IL-12 is the central cytokine of CMI. It is produced by sensitized macrophages, stimulates both Th 1 and NK cells to secrete IFN-gamma which in turn activates the intracellular killing of Leishmania in macrophages via increased oxygen radicals. This work aimed mainly at studying the adjuvant effect of IL- 12 on autoclaved L. major [ALM] vaccine, compared to that of BCG in L. major infection. The material included five groups of Swiss albino mice; the test group infected after receiving ALM + IL-12, a non-infected control group, and three other control groups infected after receiving ALM + BCG, IL-12 alone and BCG alone L. major was cultured to provide promastigotes for vaccine and infection. The measured parameters included the lesion size, type and progress; the parasite density and the level of IFN-gamma in serum. The results showed that the best protection against challenge infection was obtained by ALM + IL-12 followed by ALM + BCG. The former is recommended for use as a vaccine with regards to its proved efficacy and known safety

Influence of photon beam irradiation on lymnaea natalensis snails infected with fasciola gigantica

Lymnaea natalensis is the intermediate host of Fasciola gigantica in Egypt. The effect of photon beam irradiation on the ability of the laboratory reared L. natalensis to support the larval development of F. gigantica has been studied. 120 snails were divided into two groups: The control infected non irradiated group [GI] and the experimental infected irradiated group [GII]. The later group was subdivided into two subgroups: GIIa: snails irradiated before infection and GIIb: snails irradiated after infection. Photon beam irradiation had non significant effect on the survival rate between the all groups at the 30th day post infection. The life span, the number of infected snails and the length of the shedding period were significantly decreased in the two irradiated subgroups than the control group. The effect was more obvious on GIIb without significant difference. The number of metacercariae significantly decreased in the 2 irradiated subgroups than the control one. Also, it was significantly decreased in GIIb when compared with GIIa. So, photon beam irradiation has a great role on retarding larval development of F. gigantica inside the snail. This opens the way to a new strategy for fascioliasis control of in Egypt

Effect of schistosome mansoni infection on physiological gastrointestinal transit and contractility

The work aimed to study the effect of Schistosoma mansoni [S. mansoni] on gastrointestinal transit and contractility of the colonic muscles of two subgroups of experimental mice, in-faceted by 50 and 200 cercaria/mouse respevtively, at 8th and 12th week postinfection [PI]. In addition, the histopathologic changes in the colon, and the immunological changes of the host were studied at different durations. At 8th weeks PI, in both sub-groups, gastrointestinal transit was statistically significant decreased, in concurrent with statistically significant increase in the colonic muscle contractility compared to the controls. The colon was inflamed as shown by mucosal inflammatory infiltrates, with large size and number of schistosomal granulomas. The se-rum antigen was absent, while the serum antibody was detec-table at low titre. At 12th weeks PI, there was a more statistically significant decrease in gastro-intestinal transit, and increase in the colonic muscle contractility. The colon was still inflamed, but the granulomas were reduced in size and in number, with increase in the fibrocytes density. These alterations coincided with absence of serum antigen and increase in the antibody titre. All changes were more pronounced in the 2nd group of mice [200ceraria/mouse] than the 1st one [50cercaria/mousa]. So, intestinal schistosomiasis is associated with great structural, functional and immunological changes, related to the time coursa and the infection intensity which may be involved in the pa-thogenesis and clinical manifestations of the disease.

Congenital trichinellosis in experimentally infected mice

The present study aimed at allocating the time during pregnancy at which transpiacental transmission of Trichinella spiralis [T. spiralis] larvae took place. Swiss albino mice were infected at different durations of pregnancy; five days before mating, on gestation day zero and five days after mating. Furthermore, to study the effect of immunosuppression on transplacental transmission, half of the experimental mice were immunosuppressed using cyclophosphamide drug [Endoxan]. The percentage of infected uteri, embryos and placentas and the mean larval count were calculated on day 8 post infection [PT]. Moreover, the percentage of infected offspring and the mean larval count in their muscles were estimated on day 30 P1. The results of the present study revealed that, transpiacental transmission of T. spiralis could occur in offspring of mice when their mothers are infected before or after pregnancy. This was documented by the presence of larvae in the muscles of offspring. However, the rate of this transmission increased when the mothers are infected at late pregnancy whether they were immunosuppressed or not. The administration of the immunosuppressive drug whether before or after pregnancy increased the rate of infection and the mean larval count in both uteri of mothers and muscles of their offspring. A higher percentage of abortion was demonstrated in females infected before mating in different studied groups

utility of lactoferrin in differentiating parasitic from bacterial infections

Lactoferrin is an iron binding glycoprotein found in the 2 ry granules of PMN. In order to determine the usefulness of such marker for neutrophilic activity in differentiating cases suffering from amoebic and bacillary dysentery, Schistosoma and bacterial UTI infections, we examined stool and urine specimens using anti-lactoferrin antibodies [lactoferrin latex agglutination test: LFLA], compared with different standard gold techniques. Our results demonstrated that cases with either shigllosis or UTI revealed a high lactoferrin titer which was positively correlated with the number of PMN. In addition cases with Entamoeba histolytica or S. haematobium were characterized by relatively lower inflammatory process as expressed by mild lactoferrin titer which was also correlated with the PMN count. In addition, the findings of the present work indicated that LFLA was sensitive and specific when used alone and its sensitivity was augmented after coupling with other simple indirect methods of diagnosis. In conclusion, results described the reliability of using LFLA as a simple, rapid, sensitive method in differentiating, certain parasitic from bacterial diseases

Management of adolescent tibia in obese patients with high tibia neutral wedge osteotomy and llizarov fixator

Twenty-six lower extremities of nineteen obese patients with adolescent tibia vara, the mean age was 17.4 years, were treated with Ilizarov external fixator and neutral wedge osteotomy "open-closed wedge". Active movements of the joints of the extremity were encouraged the day after surgery and partial weight bearing began two days later. The mean follow up was 25 months ranging from 6 to 56 months. No neurovascular complications, delayed union, or nonunion were observed. The mean pre-operative varus was improved from 29.6 degree to 6.7 degrees valgus postoperatively. The epiphyseal slop angle was improved from 36 to 17 degree. Pre-operative internal tibial rotation was improved from 18.9 degrees to 4.9 degrees exernal rotation. Residual deformity was seen in three extremities. this osteotomy type and the Ilizarov fixator allow for immediate correction, early weigh bearing and joint motion, address and corrects all deformity components at the same time, and shortens the time of the frame on

Prophylactic use of an antiprostaglandin or antifibrinolytic after IUD insertion

Copper T-380 A was inserted to 300 women seeking contraception. 100 were given a prostagl and in synthetase inhibitor [mefenamic acid], the second 100 were given an antifibrinolytic [tranexamic acid] after IUD insertion and with the subsequent two cycles. The third 100 were given no treatment post-IUD insertion. The incidence of pain, bleeding and IUD removals on account of pain and bleeding was significantly less in women given mefenamic or tranexamic acid. The incidence of pain was less in women given an antiprostagl and in compared to those who were given an antifibriolytic. Therefore, the prophylactic use of a prostagl and in synthetase inhibitor was recommended in the regimen described in women choosing the IUJD for contraception

Aluminum related encephalopathy in uremic patients on haemodialysis

The role of aluminum as a causative agent of encephalopathy in uremic patients on haemodialysis, and the effect of lowering serum aluminum level by the chelating agent deferoxamine [DFO] in improving clinical and electroencephalographic [EEG] features of dialysis encephalopathy [DE] was evaluated in eight patients with dE. This work was carried out on [10] control persons and [32] uremic adult patients on hemodialysis [HD] and receiving aluminum containing phosphate binder to prevent hyperphosphatemia. Patients were divided into three subgroups according to the duration of haemodialysis. The first subgroup [10] patients who have been on [HD] for a period up to 6 months. Second subgroup [10] patients who have been on HD for 6-12 months. The third subgroup [12] were on [HD] for more than 12 months up to 6 years. All patients underwent neurological examination and a waking EEG. We diagnosed dE only in the presence of the typical EEG, charges with or without manifest clinical symptoms. Thirteen [20%] patients under study showed clinical and/or typical EEG signs of DE. Five of the 13 patients developed serious clinical deterioration which led to death of four of them. Four of the remaining patients with DE showed both clinical and EEG signs, while the remaining four showed only EEG signs. Comparatively the serum alminum [SAL] level in patients with dE was significantly higher than in patients without neurologic dysfunction [p<0.05]. After the DFO infusion test, there was a significant high increase in SAL levels in DE patients when compared with those without [t = 5.4, P<0.05]. In our patients with SAL over 100 micro g/L the prevalence of DE was unexpectedly high when this neurological disorder was carefully investigated. We conclude that regular and continuous monitoring of SAL levels both basal and after DFO test, is of considerable value in detecting those patients at risk for DE and that regular EEG recordings, at least every six months, for all patients with serum level > 100 micro g/L is a sensitive method of detecting subclinical DE. Although DFO therapy has been applied to a limited number of patients in this study, we believe that it offers an effective treatment for DE, hoping that this disorder be a disease of the past

Screening pregnancies for low birth weight for gestational age by simple clinical measurements

Standard charts of uterine height, abdominal girth, abdominal length and uterine height/abdominal length ratio from 20 to 40 weeks of singleton uncomplicated pregnancies were derived from 160 women attending for prenatal care at Ismailia General Hospital. These women were delivered at term of infants weighing more than the 10th percentile for gestational age. The standard charts were used to assess the sensitivity of the above measurements in predicting intrauterine growth retardation in 16 women with low birthweight for gestation. Fourteen of the 16 women [87.5%] would have been predicted to have low birhtweight for gestation using uterine height measurement in reference to the standard chart. The sensitivity of abdominal girth, abdominal length and uterine height/abdominal length ratio in predicting low birthweight for gestation was 25%, 31.3% and 50% respectively. Careful measurement of uterine height using a simple measuring tape in reference to standard charts appears to be an efficient and reliable mehtod for screening pregnancis for low birthweight for gestation

plasmin inhibitors alpha-2-macroglobulin and alpha-1-antitrypsin before and after the development of pre-eclampsia

Maternal serum levels of alpha-2-macroglobulin [alpha-2-M] and alpha-I- antitrypsin [alpha-I-AT] determined by single radial immunodiffusion were found to be slightly raised in 41 primigravid patients with proteinuric pre-eclampsia compared with those in 41 primigravid normotensive women matched for age and gestation. As alpha-2- M and alpha-I- AT are established plasmin inhibitors, our results suggest that in pre-eclampsia there is an exaggeration of the depression in fibrinolytic activity found in normal pregnancy. The inhibition of fibrinolytic activity is also related to the severity of the pre-eclamptic process. Alpha-2- M and apha-I- AT were also determined in serial serum samples obtained from 13 women who had a high weight - gain between 20 30 weeks of pregnancy. Seven of these pregnancies were subsequently complicated with pre-eclampsia while the remaining six continued to be normotensive. Neither alpha-2- M nor alpha-I- AT were found to rise prior to the development of the clinical signs of pre-eclampsia suggesting that the depression of the fibrinolytic activity associated with this syndrome is a secondary effect and not a primary cause