Molecular detection, risk factors, and phylogenetic analysis of tick-borne pathogens in dogs from northern Vietnam

@#In tropical regions, numerous tick-borne pathogens (TBPs) play a crucial role as causative agents of infectious diseases in humans and animals. Recently, the population of companion and pet dogs has significantly increased in Vietnam; however, information on the occurrence of TBPs is still limited. The objectives of this investigation were to determine the occurrence rate, risk factors, and phylogenetic characteristics of TBPs in dogs from northern Vietnam. Of 341 blood samples tested by PCR, the total infection of TBPs was 73.9% (252/341). Babesia vogeli (18SrRNA gene – 30.5%) was detected most frequently in studied dogs followed by Rickettsia spp. (OmpA gene – 27%), Anaplasma platys (groEL gene – 22%), Bartonella spp. (16SrRNA – 18.8%), Mycoplasma haemocanis (16SrRNA – 9.4%) and Hepatozoon canis (18SrRNA gene – 1.2%), respectively. All samples were negative for Ehrlichia canis and Anaplasma phagocytophylum. Co-infection was detected in 31.4% of the samples (107/341) of which, A. platys/Bartonella spp. (34/94,10%), Rickettsia spp./B. vogeli (19/94, 5.6%), and M. haemocanis/B. vogeli (19/94, 5.6%) were recorded as the three most frequent two species of co-infection types. Statistical analysis revealed a significant correlation between TBP infection and several host variables regarding age, breed, and living area in the current study. The recent findings reported herein, for the first time in Vietnam, are essential for local veterinarians when considering the appropriate approaches for diagnosing these diseases. Furthermore, this data can be used to establish control measures for future surveillance and prevention strategies against canine TBPs in Vietnam.

Effect of NPK, Bio and Organic Fertilizers on Growth, Herb Yield, Oil Production and Anatomical Structure of (Cymbopogon citratus, Stapf) Plant

This study was carried out at the Department of Ornamental Horticulture, Faculty of Agriculture, Cairo University, in Egypt during the two successive seasons of 2015 and 2016. The experiment was designed using a complete randomized blocks design. Eco-friendly agriculture has its priority for safe products, so the objective of this study was to investigate the effect of bio fertilizers (Nitrobien and Phosphorien) at 1, 2 and 4 g/plant, compost and poultry manure at the rates of 5, 10 and 15 ton/ feddan (feddan= 4200 m2) as alternative to NPK (recommended dose), on growth and anatomical characters of Cymbopogon citratusplants. The results showed that the highest number of tillers per plant (49.07) and leaf area (83.99 cm2) obtained by the high rate of poultry treatment (15 ton/feddan) at the second cut in the second season. Thus the result obtained showed that the organic fertilizers had a better effect on total herb fresh and dry weights per plant than bio fertilizer treatments. The poultry manure at the rate of 10 ton/feddan resulted in the maximum total herb fresh yield with value 56.53 ton per feddan and total herb dry yield with value 16.94 ton per feddan, in the second season. The essential oil production per feddan at the first cut (in August) was more than at the second cut (in October) in both seasons. The highest oil yield per feddan was recorded in the second season by the poultry manure at the rate of 10 ton/feddan with values 82.26 and 51.85 l/feddan at the first and second cut, respectively. The anatomical study showed that the best thickness of the leaf sheath at the midrib region was due to treating the lemongrass plants by poultry at the rate of 10 ton/feddan. The increasing ratio was 16.7% compared to control. This treatment showed the best results in the total number of vascular bundles, in addition to the No. of large bundles and their dimensions. From these results, it could be recommended that poultry manure was the best treatment for lemongrass growth and getting highly clean yield.

Effect of sildenafil citrate on the outcome of in vitro fertilization after multiple IVF failures attributed to poor endometrial development: a randomized controlled trial

Aim of the work: this study aimed to evaluate the effect of sildenafil citrate on endometrial development in women with history of recurrent implantation failure after IVF

Setting: this study was conducted in obstetrics and gynecology department of Ain Shams University

Patients and methods: this is a randomized controlled trial on 80 women with previous two or more failed IVF. Women in group A [N=40] took oral sildenafil citrate at dose 25mg tab /6h daily from day six of induction of ovulation until day of HCG administration; while those in group B [N=40] took placebo tablets

Outcome measuers: the primary outcome was change in endometrial thickness before and after intervention

Results: endometrial thickness in both groups was statistically insignificant between the two groups when measured in day 6 with p-value 0.070.Endometrial thickness on day of HMG injection measured and found that it was higher in group A[Sildenafil Group] than group B[Placebo Group] with significantly increased statistically difference between the two groups with p-value <0.001

Conclusion: sildenafil citrate leads to smooth muscle relaxation and vasodilation. This may enhance endometrial development and increased pregnancy rate in females undergoing IVF which may be attributed to the increase in the endometrial thickness

In vitro antiviral and antimicrobial activities of Spirulina platensis extract.

Spirulina platensis are filamentous, undifferentiated, non-toxigenic cyanobacteria that have been used as food since ancient times. There have been numerous studies on its antioxidant and antimicrobial actions. In this study antibacterial and antiviral effect of ethanol extract of Spirulina platensis were tested. The reduction of infectious viral units after treatment with ethanol extract of Spirulina platensis was tested. Non toxic doses of Spirulina platensis revealed 53.3%, 66.7%, 76.7%, 56.7%, and 50% reductions in vitro for infectious units of adenovirus type 7, Coxsackievirus B4, astrovirus type 1, rotavirus Wa strain, and adenovirus type 40 respectively. Using disc diffusion method to show the antibacterial effect of ethanol extract of Spirulina platensis against different bacterial strains (Escherichia coli, Staphylococcus aureus, Salmonella typhi, and Enterococcus faecalis) in addition to Candida albicans, inhibition zones were observed with Enterococcus faecalis and Candida albicans.

Isolation and identification of main mastitis pathogens in Mexico / Isolação e identificação dos micróbios patogênicos principais da mastite em México

The present work is a large epidemiological study aiming to detect the prevalence of subclinical mastitis and to investigate the major udder pathogens in Jalisco State, western Mexico. For this purpose, 2205 dairy cows, representing 33 Mexican dairy herds, were involved. Of 2205 cows, 752 mastitic animals were diagnosed and only 2,979 milk samples could be obtained for further investigation. All 2979 milk samples were subjected to California Mastitis Test (CMT) to differentiate clinical cases from subclinical ones where 1996 samples (67 %) reacted positively. Of these, 1087 samples (54.5%) came from cows suffering from clinical cases of mastitis. Bacteriological identification of the causative agents revealed the presence of a major group of pathogens including the Coagulase negative staphylococci (CNS), S.aureus, S.agalactiae, Corynebacterium spp. and Coliform bacteria which were detected in 464 (15.6%), 175 (5.9%), 200 (6.8%), 417 (14%) and 123 (4.1%) of the 2927 investigated quarters, 295 (15.4%), 118 (15.7%), 111 (14.8%), 227 (30.2%) and 109 (14.5%) of the 752 examined cows and in 33 (100%), 22 (66.7%), 19 (57.6%), 30 (90.1%) and 27 (81.8%) of the 33 herds involved, respectively. Other pathogens could be detected in the investigated milk samples such as S. dysgalactiae (0.4%), S.uberis (0.37%), Bacillus spp. (1%), Nocardia spp. (0.6%) und Candida spp. (0.1%). Meanwhile, others were present in a negligible ratio; including the Aerococcus viridans, and Enterococcus spp., Lactococcus lactis, S. bovis.

O trabalho atual é um estudo epidemiológico que objetiva detectar a predominância da mastite subclínica e investigar os micróbios patogênicos principais do úbere no México ocidental. Com esta finalidade, foram utilizadas 2205 vacas leiteiras, representando 33 rebanhos de leiteiras mexicanas. Além dessas 2205 vacas, 752 animais com mastite foram diagnosticados, considerando-se que somente 2979 amostras do leite poderiam ser obtidas para a posterior investigação. Todas as 2979 amostras do leite foram submetidas ao teste da mastite de Califórnia (CMT) para diferenciar casos clínicos dos subclínicos, visto que 1996 amostras (67%) reagiram positivamente. Além dessas, 1087 amostras (54.5%) vieram das vacas que sofrem de casos clínicos de mastite. A identificação bacteriológica dos agentes causais revelou a presença dos Staphylococcus negativos para coagulase (CNS), S. aureus, S. agalactiae, outros spp. Streptococcal, Corynebacterium spp., e as bactérias de coliformes foram detectadas em 464 (15.6%), 175 (5.9%), 200 (6.8%), 109 (3.9%), 417 (14%) e em 123 (4.1%) dos 2927 quartos investigados; em 295 (15.4%), 118 (15.7%), 111 (14.8%), 95 (12.6%), 227 (30.2%) e em 109 (14.5%) das 752 vacas examinadas e, finalmente, em 33 (100%), 22 (66.7%), 19 (57.6%), 30 (90.1%), 30 (90.1%) e em 27 (81.8%) dos 33 rebanhos envolvidos, respectivamente.

Clinical and biomechanical evaluation of three bioscaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys [Equus asinus]: An experimental study

The present study was designed to carry out an in vivo and in vitro comparative evaluation of three bio-scaffold augmentation devices used for superficial digital flexor tenorrhaphy in donkeys. Twenty-four clinically healthy donkeys were assigned for three treatment trials [n = 8] using one of three bioscaffold materials [glycerolized bovine pericardium xenograft, tendon allograft and allograft shielding with glycerolized by bovine pericardium]. In addition, eight clinically healthy donkeys were selected to serve as control. Clinical signs of each animal were scored and the sum of all clinical indexes was calculated at each time point of the experiment. Four donkeys from each group were euthanized at 45 and 90 days postoperatively, respectively, for biomechanical and histopathological evaluation of treated superficial digital flexor tendon [SDFT]. The failure stress in allograft shielding group significantly increased compared to the corresponding values of the other groups at 45 [62.7 +/- 6.5 N mm[-2] and 90 [88.8 +/- 3.5 N mm[-2] days postoperatively. The fetlock angle in the allograft shielding group at both 45 [112.8[degree] +/- 4.4] and 90 [123.8[degree] +/- 1.1] days postoperatively showed a significant increase [p < 0.05] relative to the values of the other groups and a significant decrease [p < 0.05] when compared to normal angle [125[degree] +/- 0]. However, the histomorphological finding srevealed no remarkable changes between the treatment groups. In conclusion, the failure stress, fetlock angle and histomorphological findings may provide useful information about the healing characteristics of SDFT tenorrhaphy. The bio-scaffold augmentation devices, either xenogenic or allogenic, provide good alternative techniques accelerating SDFT healing with minimal adhesions in donkeys

Some optimal culture conditions for production of cyclosporin a by Fusarium roseum

A suitable chemically defined culture medium was selected and some optimal conditions for the production of the highly immunosuppressive compound, cyclosporin A (Cyc A) are reported. Medium of the following composition was favorable for the production of Cyc A by Fusarium roseum: glucose, 30; NaNO3, 2; KH2PO4, 1; MgSO4.7H2O, 0.5 and KCL, 0.5 (g/l). Maximum productivity of Cyc A was achieved at pH 6.0 when 50 ml of the fermentation medium/250 ml flask, inoculated with five fungal agar discs (6 mm, diameter) of 7-days old F. roseum culture after incubation at 30 ºC at 120 rpm for 7 days.

Development and utility of a questionnaire to evaluate the quality of PBL problems.

Objective: High quality problems are crucial for successful learning in Problem Based Learning (PBL). Many criteria have been described in literature about the quality of PBL problems. The aim of this study was to develop a questionnaire to evaluate the quality of PBL problems and to test its utility. Method: The questionnaire was developed based on literature review. Both students and tutors used the questionnaire to evaluate PBL problems. It was applied at King Fahad Medical City, Faculty of Medicine in the first block of three consecutive years in the academic year 2008. A total of 12 problems were evaluated by students and the tutors. Results: A total of 12 tutors and 36 students applied the questionnaire to evaluate 12 PBL problems. At the overall level, the questionnaire gives an impression on the strong and weak aspects of all PBL problems evaluated. The strongest aspect identified by both students and tutors is that the PBL problems rated in this study have a realistic context. The weakest aspect is that the problems do not adapt to students level of prior knowledge. At a more specific level the instrument can be used to identify strong and weak problems and give suggestions for improvement. Conclusions: It can be concluded that the instrument that has been developed to evaluate the quality of PBL problems provides useful information about strong and weak aspects of PBL problems.

Involvement of chlamydia pneumoniae in atherosclerosis: Importance of methodology in determination the relation between them

Detection of Chlamydia pneumoniae [C. pneumoniae] in atherosclerotic vascular tissue to assess their role in atherogenesis, and also the choice of the best methodology for detection. Immunohistochemistry staining [IHC] for vascular tissue specimens were done on 34 atherosclerotic vascular tissues and 54 normal vascular tissues as controls [34 internal control specimens and 20 external control specimens from healthy individuals]. Using 2 monoclonal antibodies: the species specific and the Chlamydia genus-specific antibody. Three PCR assays are used for detection of C. pneumoniae DNA: Single-step PCR with different DNA polymerases enzymes, the nested PCR, and real-time quantitative PCR. C. pneumoniae DNA was detected in 58. 8% of atherosclerotic vascular tissues by single-step PCR which used Tag DNA polymerase and detection by hybridization with specific probe, no detection by other methods and also no detection in healthy vascular tissues. C. pneumoniae DNA was detected in atherosclerotic vascular tissues and no detection in healthy vascular tissues indicating that C. pneumoniae is playing a role in atherogenesis. Detection of C. pneumoniae is method dependent, so, the choice of assay I is of major importance when evaluating a relationship between C. pneumoniae and atherosclerosis

Chronic hepatitis C virus infection: Enhanced expression of suppressor of cytokine signalling-1 in hepatic cells and its role in response to interferon therapy

Expression of Suppressor of Cytokine Signalling-1 [SOCS-1] in liver tissues of chronic hepatitis C patients [CMC] and to assess whether SOCS-1 had any relationship to resistance to interferon-a [INF-alpha] therapy. RT-PCR was done on hepatic tissues obtained from 42 CMC patients before starting of INF-alpha therapy and 26 controls without CMC with normal livers for detection of SOCS-1 mRNA. And also, on serum samples collected from CMC patients at the end of treatment by INF-alpha to assess respond to therapy. SOCS-1 expression in hepatic tissues of CMC patients in a significant higher incidences than controls [p<0.0001]. The response to INF- alpha therapy was found in [30.9%] of CMC patients. There is over-expression of SOCS-1 in hepatic tissues from non-responders to INF- alpha therapy [96.6%]. SOCS-1 expression is enhanced in the livers of CMC patients and involved in resistance to INF- alpha therapy

Mycobacterium tuberculosis infection of the lungs: CD[+4] T cells and CD[+8] T cells in peripheral blood and their relation to disease outcome

To determine the frequency of CD[+4] and CD[+8] T-cells in peripheral blood [Pb] in the patients with Mycobacterium tuberculosis infection of the lungs and to assess their roles in disease recovery. Flow cytometric analysis of the Pb from 41 patients with active pulmonary tuberculosis and 20 healthy individuals as controls for determination the frequency of CD[+4] and CD[+8] T-cells in Pb. the frequency of CD[+4] and CD[+8] T-cells in Pb from patients with pulmonary tuberculosis was higher than controls [p<0.001 and 0.05 respectively]. The frequency of CD[+4] T-cells was higher than CD[+8] T-cells in Pb of pulmonary tuberculosis patients. The rate of recovery from active pulmonary tuberculosis was inversely related to the frequency of CD[+4] and CD[+8] T-cells being higher in SR, but less in RR and IR. More CD[+8] T-cells producing IFN-y, while more CD[+4] T-cells producing IL-10. there was a higher frequency of CD[+4] T cells in Pb of active pulmonary tuberculosis. The recovery from this disease requires fine balance between CD[+4] c CD[+8] T cells in Pb

Midazolam deep sedation versus metoclopramide to prevent nausea and vomiting during small dose bupivacaine spinal anesthesia for cesarean section

Nausea and vomiting during regional anesthesia for Cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include psychological [anxiety] factor, arterial hypotension, and hypo perfusion of the central nervous system. The trials for prevention and treatment of IONV still not definite. In the present study we evaluate the efficacy of hypnotic doses of midazolam in comparison with metoclopramide to prevent nausea and vomiting during spinal anesthesia for elective Cesarean section. One hundred [100] pregnant females were divided to two groups. Group [A] receives [midazolam, n=50], Group [B] receives [metoclopramide, n= 50], the two groups received spinal anesthesia with 8 mg of bupivacaine to avoid sever hypotension and decrease incidence of nausea and vomiting. Nausea and vomiting occurred in 5% of the total cases. IONV was absent in 97% in the midazolam group, 96% in metoclopramida group [p <0.001] for both group, no significant difference between two groups. The results showed a significant lower incidence of IONV in the deep sedation with midazolam and metoclopramide, without significant difference between two groups. The results confirmed and explained that, IONV during spinal anesthesia for Cesarean Section can be caused by psychological [anxiety] factors

Brachial plexus block [axillary block] for emergency orthopedic pediatric surgery versus deep sedation

Our study was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary [brachial plexus] block regional anesthesia [ABRA] [32 children] or deep sedation with ketamine and midazolam [30 children]. This was a prospective randomized unmasked controlled comparative trial conducted in hospital emergency department. The 2 groups were similar in age [older than 4 years], fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation. The primary outcome measure was procedural distress during manipulation as measured with the Children's Hospital of Eastern Ontario Pain Scale [CHEOPS]. The mean CHEOPS score was 6.4 +/- 2.8 in the group with axillary block and 7.5 +/- 1.6 in those receiving deep sedation; the difference between the CHEOPS scores in the 2 groups was not statistically significant [P = 0.126, 95% CI: 2.5, 0.3]. Axillary block was used successfully in 26[90%] of the 32 children. No patient in either group experienced any adverse events

Effect of exercise therapy on pulmonary functions in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is a major health problem because of its high prevalence, morbidity and mortality and its economic impact. The patients experience a progressive deterioration and disability, which lead to a worsening in their health related quality of life. Physical training is an important component of management and can increase exercise capacity and improve health status while reducing breathlessness. The purpose of this study was to investigate the effect of moderate intensity aerobic exercise on pulmonary functions in patients with chronic obstructive pulmonary disease. Thirty patients with COPD were included in this study. They were recruited from patients visiting outpatient clinic of Internal Medicine department, Cairo University Hospitals. Their ages ranged 45-65 years old and had moderate COPD [FEV[1] ranged 50-80%] with partially reversible airway obstruction. All were subjected to full clinical history, examination and electrocardiogaphy. Patients were randomly assigned into one of two groups: group I, who received drug therapy and group II who received drug therapy in addition to a supervised moderate intensity aerobic exercise program performed three times weekly for 12 weeks. Pulmonary functions were assessed before start of treatment and at end of the 12 weeks. Measurements included vital capacity [VC], forced vital capacity [FVC], forced expiratory volume in 1st second [FEV[1]] and maximum voluntary ventilation [MVV]. The mean FVC increased significantly in group 11 following treatment [2.32 to 2.53], while it decreased in group I [2.41 to 2.29]. Similarly FEV[1] increased significantly in group 11 [1.55 to 1.73], while it decreased in group I [1.63 to 1.54]. MVV showed a significant increase in group II [51.37 to 57.78], while it decreased in group I [54.86 to 52.46]. All changes were statistically significant. The number needed to treat to achieve benefit in one more patient was 1.9 [95% CI: 1.3 to 3.6]. In conclusion, exercise training program with moderate intensity for three months improved pulmonary functions as measured by spirometry

Protective effect of vitamin C and beta-carotene against nickel-induced hepatotoxicity in rats

The present study was designed to investigate the effect of nickel sulphate [25 mg/kg diet] and to evaluate the protective effect of vitamin C and beta-carotene [200mg/kg diet] on the liver of male albino rats. Serum alanine aminotransferase [ALT] and aspartate aminotransferase [AST], superoxide dismutase [SOD] activities, lipids peroxidation as malondialdehyde [MDA] and hemoglobin concentration [Hb] were determined. The results showed that nickel sulphate administration for eight weeks induced highly significant [P<0.01] increase of ALT, AST activities and MDA level, highly significant decrease in the activity of SOD and significant [P<0.05] decrease in Hb concentration in rats. The supplementation of vitamin C simultaneously with nickel sulphate showed insignificant reduction in ALT and AST activities, highly significant increase in SOD activity and significant decrease in MDA level, while supplementation of [Beta-carotene with nickel sulphate induced a significant reduction in ALT, AST activities and MDA level with highly significant increase in SOD activity as compared with nickel sulphate treated rats. Supplementation of vitamin C or beta-carotene induced an insignificant increase in Hb concentration in rats comparing with nickel sulphate treated group

Noninvasive markers in monitoring hepatocellular damage: role of natural antioxidants: nigella sativa, honey and silymarin in treatment of hepatocellular damage

Liver fibrosis induced experimentally by using carbontetrachloride [CC14] as a toxic substance. To evaluate the treatment effects of some natural antioxidants such as Nigella sativa [N. sativa], Honey [H.] and Silymarin [S.] in CC14-induced liver fibrosis in rats, some biochemical markers such as glutathione-S-transferase [alpha-GST], Malonedialdehyde [MDA], Nitric oxide [NO] and matrix metalloproteinase [MMP-2] were determined and compared to the liver functions [ALT and AST] and Hemoglobin [Hb]. 100 rats were divided into 20 normal rats served as control, 20 rats injected 1 mg/kg/day CC14 intrapretonially 3 times a week for 8 weeks, 60 rats divided equally into 3 subgroups subjected to the same injection plus oral administration of 50 mg/kg/ day N. sativa, H. and S. daily for another 4 weeks. alpha-GST, MDA, NO and MMP-2 were estimated by enzyme immunoassay and ALT, AST and Hb were estimated by colorimetric assay. Statistical program SPSS, VI2 was used for data analysis. The results showed a significant increase [P<0.05] in alpha-GST, MDA and NO and high significant increase [P<0.01] in MMP-2 in rats group administered CC14 as compared to normal control. The results matched the role of S. in the treatment of hepatic fibrosis and revealed the role of N.sativa as treatment agent by improvement in ALT and AST, enhance antioxidant capacity by significant decrease [P<0.05] in alpha-GST and NO, improvement in general health by high significant increase [P<0.01] in Hb, enhanced antifibrotic response by high significant decrease [P<0.01] in MMP-2 and decrease in lipid peroxidation by significant decrease [P<0.05] in MDA compared to CC14 group. Although H. showed the least effective ability for treatment of liver fibrosis, it appeared to improve liver functions. The histological results were found to be matched with the biochemical results. This work proved that one of the mechanisms involved in the process of liver fibrogenesis induced by CC14 is the development of oxidative stress and fibrotic response, the determined biochemical markers proved to be good markers for the detection of hepatocellular damage and documented also that N. sativa and H. can be used effectively as tools in the treatment of hepatic injury without any fear of complications

value of pulse-wave doppler tissue imaging during dobutamine stress echocardiography in detection of right coronary artery narrowing

The importance of right ventricalar function in acute and chronic cardiac affection is well established. Is to assess the value of pulse wave Doppler tissue imaging [PWTDI] during dobutamine stress echocardiography in detection of right coronary artery narrowing. 40 subjects were divided into two groups according to the presence [patient group] or absence [control group] of significant > 70% isolated right coronary artery narrowing proved by coronary angiography. All patients studied had right coronary artery dominance, they were subjected to the following: complete history taking and thorough clinical examination, 12 leads resting surface electrocardiography, resting standard echo Doppler study, coronary angiography, doubtamine-atropine stress echocardiography with pluse-wave Doppler tissue sampling. There was no statistically significant difference between the two groups as regard to early [E] and late diastolic [A] velocity in cm/sec by pulse wave tissue Doppler at rest, low dose and high dose dobutamine. p > 0.05. Regarding the ejection phase velocity in cm/sec. [EJ] by pulse-wave Doppler tissue there was no statistically significant difference between the control and the patient groups at rest and low dose dobutamine p > 0.05., however at higdose dubutamine there was a highly statistically significant difference [p < 0.01] and it was found that a progressive increase of the ejection phase velocity [EJ], expressed by a more than 25% increase from 10 microg/kg/min [low dose] to peak dobutamine stress was predictive of normal or insignificantly narrowed right coronary artery [RCA]. Whereas a blunted increase, expressed by < 25% increase of velocity, was predictive of a significantly narrowed RCA. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of pulse-wave Doppler tissue sampling in detection of right coronary artery narrowing was 80%, 75%, 79.2%, 76.9% and 78% respectively. Analysis of the right ventricular wall was accessible using the pulsed wave tissue Doppler sampling in all cases while visual assessment was not. Pulsed wave tissue Doppler sampling is a valuable tool to detect right coronary artery narrowing when combined with dobuta-mine-atropine stress echocardiography

Bacterial DNA and its consequences in patients with cirrhosis and culture negative, non neutrocytic ascites

The detection of bacterial DNA [BactDNA] in serum and ascitic fluid [AF] from patients with liver cirrhosis and ascites is interpreted as molecular evidence of intestinal bacterial translocation [BT] and considered sufficient to activate the cellular immune response leading to greater cytokine synthesis. In the present work we study whether BactDNA and Tumor necrosis factor-alpha [TNF- alpha] in cirrhotic patients with culture negative, non neutrocytic ascites have been implicated in various complications of cirrhosis such as hepatorenal syndrome [HRS], spontaneous bacterial peritonitis [SBP] and mortality. We studied 34 patients with liver cirrhosis and culture negative, non neutrocytic ascites [22 patients without BactDNA [group I] aged [48.3 +/- 7.85y] and 12 patients with BactDNA [group II], aged [49.7 +/- 6.5y]]. Full history and complete clinical examination were done with the following investigations in the first admission and subsequent admissions during follow up for 24 weeks: complete blood picture, S. creatinine, S. bilirubin, S. albumin, S. transaminases [AIT and AST], AF and plasma TNF-alpha, AF protein and polymorphnuclear leucocytes [PMNL], both blood culture and AF aerobic and anaerobic cultivation, and detection of blood and ascitic fluid BactDNA using PCR. Plasma and ascitic TNF-alpha were significantly higher in cirrhotic patients with compared to those without BactDNA during first admission [54.5 +/- 22.56 vs 35.2 +/- 17.97; 123.2 +/- 49.32 vs 82.6 +/- 29.58 pg/ml respectively, P<0.05]. These changes became highly significant at the end of follow up of both groups [119.3 +/- 27.19 vs 40.2 +/- 16.08; 518.8 +/- 91.11 vs 97.6 +/- 17.81 pg/ml respectively, P<0.001]. There is non significant change of plasma and ascitic TNF-alpha in group I at first admission compared to those at the end of follow up [P>0.05]. However, in group II, there is highly significant increase in both plasma and ascitic TNF-alpha at the end of follow up compared to those at the first admission [P<0.001]. The relative risk of deaths, HRS and SBP were higher in patients with compared to those without BactDNA after follow up for 24 weeks [2.73, 27.37 and 18.18 respectively]. There were significant positive correlation between both plasma and ascitic TNF-alpha and each of serum creatinine and PMNL in the studied patients at the end of follow up. [r= 0.590, p= 0.002 ; r= 0.535, p= 0.005 ; r=0.499, p=0.009 ; r= 0.589, p= 0.002, respectively]. -Patients with BactDNA had more advanced liver disease after 24 weeks follow up compared to patients without BactDNA. We conclude that cirrhotic patients with culture negative, non neutrocytic ascites and BactDNA have significant higher level of AF and plasma TNF-alpha and higher risk of HRS, SBP and morality compared to those without BactDNA during follow up for 24 weeks which could suggest that both BactDNA and TNF-alpha have been implicated in these complications of liver cirrhosis

Mini laparoscopic cholecystectomy: a better outcome

The outcomes after traditional laparoscopic cholecystectomy [LC; one 10 mm port, one 12 mm port and two 5 mm ports] and mini laparoscopic cholecystectomy [MLC; three 3mm ports and one 12mm port] for gall stone disease were compared. The study was a randomized, single blind trial comparing LC with MLC. The randomization period was from February 2003 to December 2004. Two groups of patients underwent the surgery, 48 underwent LC and 47 underwent MLC. Patients were randomized by means of a blind envelop system just before surgery. The groups were matched for age, sex and preoperative characteristics. Median [range] operating times for LC and MLC were similar 45 [20- 120] and 50[20-170] mm. respectively. Intraoperative and postoperative complication rates, the time for the patient to resume walking, eating and passing stools, and median hospital stay were the same in the two groups. The level of post operative pain was lower in the MLC group at 1 h, 3h, 6h, 12h and 24h. Patients who had MLC received fewer injections of analgesic [p=0.036] and more patients in this group expressed satisfaction with the cosmetic result [p= 0.001]. MLC took a similar time to perform and caused less postoperative pain than the standard laparoscopic procedure. Reducing the port size further enhanced the advantages of laparoscopic over open cholecystectomy

cutting seton technique for management of high perianal fistula

Seton technique have been used for treatment of high perianal fistula for thousands of years with successful results. This prospective study reports the results of the cutting seton technique in addition to distal fistulotomy for treatment of high perianal fistula. Twenty two patients, 17 [77.3%] males and 5 [22.7%] females, aged between 20 and 57 years [median 35.5 years] presented with high perianal fistula included in this study. While the patients in the lithotomy position, injection of methylene blue followed by probing was done, care was taken not to do false passage. Subcutaneous track was bayed open till anal sphincter complex, the anoderm and the mucosa overlying the fistula was incised, 2 Nylon No 1 sutures were passed through the fistula and tied over the sphincter complex. The ties were tightened every two weeks in outpatient clinic postoperatively. Thirteen [65%] patients had a normal postoperative continence but 7 patients [35%] had postoperative incontinence [4 patients [20%] incontinent for gases, 2 patients [10%] incontinent for liquid stool and one patient [5%] incontinent for solid stool]. Six patients had been completely recovered and one had permanent incontinence. All fistulae were healed from 10 to 20 weeks [median 14 weeks]. There were two fistulae recurrence during the study period, one was treated successfully by the same procedure