Subclinical involvement of cardiovascular system in juvenile collagen diseases

Cardiovascular lesions are commonly found in children and adolescence with different collagen diseases with relevant implication in mortality and morbidity. The purpose of the study was to verify whether there is any sign of cardiovascular involvement in juvenile collagen diseases using electrocardiography [ECG] and echocardiography [ECHO]. The study was carried out on 77 patients, 52 juvenile idiopathic arthritis [JIA], 20 systemic lupus erythematosus [SLE], 3 spondylarthropathy [SPA] and 2 juvenile dermatomyositis [JDM]. They were free of any clinically evident of cardiac manifestations. Thirty six healthy children were enrolled as control group All subjects underwent complete history and physical examinations, x ray chest, ECG and two dimensional, M mode, continuous wave [CW], pulse wave [PW] and color flow Doppler examinations. The following investigations were done erythrocyte sedimentation. rate[ESR], antistreptolysin O titre [ASOT], C reactive protein[CRP], rheumatoid factor[RF], antinuclear antibodies[ANA] and anti double stranded DNA[anti ds DNA]. Minor ECG changes were detected in 3 SLE and 2 JDM. ECHO showed pericardial effusion in 2 [3.3%] JIA and 3[15%] SLE. Aortic insufficiency was detected in 5[9.6%] JIA, 4 [20%] SLE. Mitral regurge was found in 7[13.4%] JIA, 5 [25%] SLE. Mild tricuspid regurge was detected in 3[15%] SLE. Mild pulmonary hypertension was found in 4[20%] SLE. Significant systolic dysfunction was elicited in JIA in form of increased left ventricular end diastolic diameter [LVEDD], left ventricular end systolic diameter[LVESD], left ventricular end diastolic volume[LVEDV] and left ventricular end systolic volume[LVESV] and reduction of ejection fraction [EF] and fractional shortening [FS]. In SLE .there was significant reduction, of EF and FS. Significant diastolic dysfunction was manifested in JIA by decreased peak early [E], E acceleration time [Eat], E duration [Edur], Total duration [Tdur], [E/A] ratio and A acceleration time [Aat] and increased peak atrial filling velocity [A], E deceleration time [Edt], isovolumic relaxation time [IVRT] and A deceleration time [Adt] and in SLE by decreased [E] and [E/A] ratio and increased [Edt] and in JDM by decreased [E] and [E/A] ratio and increased [IVRT]. In JIA, there was a positive correlation between age and [LVEDD] and disease duration with both [LVEDD] and [LVESD] and negative correlation between disease duration and EF. Cardiovascular involvement in juvenile collagen diseases is common. Regular cardiac evaluation using [ECG] and [ECHO] is recommended for early diagnosis of cardiac involvement. Key words: Cardiovascular-juvenile-collagen diseases

Prevalence, risk factors and impacts of schistosomal and intestinal parasitic infections among rural school children in Sohag governorate

Parasitic diseases represent a major cause of morbidity and mortality in childhood in most parts of the world. Hygiene and play habits make children especially vulnerable to schistosomal and parasitic infections. The aim of this study is to define the prevalence of different types of parasitic infections, to define their risk factors and to determine their impacts on health and scholastic absenteeism and achievement of rural school students in Sohag Governorate, Egypt. A cross-section, analytical study design was chosen to perform this research on 960 rural school students. All the students were interviewed and examined clinically and laboratory. The study showed that 38.5% of the students were infected by parasites. Entaemoeba histolytica, Enterobius vermicularis and Giardia lamblia had the highest percentages, 20.4%, 16.6% and 15.2%, respectively. Male sex, last birth order, poor personal hygiene, low socioeconomic level, >/=3 infected siblings, previous parasitic infections and no early consultation for therapy were important risk factors [ORs=1.41, 2.32, 2.63, 2.86, 4.17, 9.80 and 10.83, respectively]. Also, 29.2% and 31.6% of infected students were below the 5th percentiles as regard weight-for-age and height-for-age, respectively. Anemia was present among 52.4% of infected students. Further, 3.2% of them had hepatomegaly. Also, 37.8% and 41.1% of infected students had 0-3 and 4-6 days/month absent, respectively, while, 34.3% of infected students had a scholastic achievement <50.0%. Improving personal and environmental hygiene and regular screening, treatment and health education for students as regard parasitic infections in Egypt is recommended

Histological and immunohistochemical analysis of BCL-2 and P 53 experession in relation to apoptosis in normal, benign and malignant human female mammary gland epithelium

Apoptosis is a genetically regulated form of programmed cell death. It occurs in response to physiological stimuli and secondary to cell injury and stress. It has a role in the regulation of cell population density during embryogenesis, aging and in many diseases. This work was performed to study the expression of the apoptosis -related proteins [Bcl-2 and P53] in normal human female mammary gland epithelium at different physiological stages [puberty, lactation and involution] and in breast fibroadenoma and invasive breast carcinoma. Breast specimens were processed for histological, immunohistochemical and statistical studies, Histologicaly, most of the apoptotic cells showed shrunked cytoplasm and fragmented nuclei and were seen predominantly in the basally located glandular epithelial cells. Different patterns of Immunoreactivity for Bcl-2 and p53 was present throughout the mammary epithelial cells, suggesting different grades of susceptibility towards apoptotic stimuli in individual glandular epithelial cells. However, specific cells showed strong reaction for Bcl-2 and P53. Specific Bcl-2 and p53 expression patterns could reflect particular cell differentiation states. Bcl-2 and P53 expressions are associated with prognostic histopathological features and their evaluation is of value in predicting the clinical course and the programs of treatment of b

Detection of occult cor-Pulmonale using dobutamine stress echocardiography in patients with schistosomal hepatic fibrosis

The presence of early diastolic dip of the ventricular septum has been reported to be able accurately diagnose occult cor-pulmonale during cycle ergo meter exercise test in patients with chronic obstructive pulmonary disease [COPD]. This study was conducted to test the ability of dobutamine stress echocardiognaphy [DSE] to detect cases of occult corpulmonale among patients with hepatosplenic schistosomiasis. The study included 25 patients aged 35.6+/=l2.7 years with hepatosplenic schistosomiasis [group 1, 15 males and 10 females] compared to 25 age- and sex-matched patients with COPD [group II]. M-mode echocardiognaphic ventricular septal motion, left ventricular shape [determined by short-axis 2-dimensional echocandiography], and pulmonary artery [PA] acceleration time [determined by pulsed Doppler echocardiognaphy] were measured at rest and during DSE. The ventricular septal motion and PA acceleration time were normal at rest in all patients. In gnoup 1, 22 patients [88%] reported marked downward ventricular septal motion in early diastole during DSE, indicating distortion of left ventricular shape. In group II, only 11 patients [44%] showed the same change during DSE. There is significant decrease in PA acceleration time in patients who showed septal dip in both groups from rest to DSE. It could be concluded that occult cor pulmonale can be diagnosed by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during DSE in patients with hepatosplenic schistosomiasis. This method may be useful in selecting cases for medical treatment for early cor-pulmonale

Effect of some opioids on plasma glucose and liver glycogen in STZ-induced diabetic rats

Opioid analgesics are used widely to control various types of pain. Several studies reported that opioid analgesics may produce lowering plasma glucose. The present work aims to investigate the effect of both tramadol and fentanyl on the plasma glucose and liver glycogen of streptozotocin [STZ] induced diabetic rats and declares the possible mechanism of this effect. IV administration of either tramadol or fentanyl for 4 successive days in STZ-induced diabetic rats produced significant reduction in fasting and random plasma glucose in comparison with non-treated STZ-induced diabetic rats. IV Naloxone [mu opioid [MOP] receptor blocker] 30 min. before administration of either tramadol or fentanyl blocked the effect of both tramadol and fentanyl on fasting and random plasma glucose. IV injection of both tramadol and fentanyl in STZ-induced diabetic rats for 4 successive days, produced significant recovery [increase] of glycogen content of the liver in diabetic rats compared with diabetic non-treated group. This effect was also blocked by IV naloxone administration 30 min before administration of either tramadol or fentanyl. The histochemical examination of PAS stained sections of the liver, prepared from rats used during this work, confirmed the results obtained by chemical detection of glycogen content of the liver homogenate. I.V injection of either tramadol or fentanyl produced significant increase in pain tolerance. I.V naloxone 30 min. before adminstration of either tramadol or fentanyl partially blocked the analgesic effect of tramadol, while the analgesic effect of fentanyl was completely blocked. These results suggested that both tramadol and fentanyl have a significant anti-hyperglycemic effect. This effect could be through activation of MOP receptors which may be mediated through increased glycogen deposition in the liver

Ischemia modified albumin in patients with acute cardiac ischemia

Differentiating transient myocardial ischemia or angina from non-cardiac causes of chest pain is a major diagnostic challenge. Cardiac troponin I [cTnI] is sensitive and specific for the detection of myocardial damage but may not rise during reversible myocardial ischemia. Ischemia Modified Albumin [IMA] has recently been shown to be a sensitive and early biochemical marker of ischemia. We studied eighty-five patients presenting to the emergency department [ED] within 3 hours of acute chest pain. Blood samples were taken for IMA and cardiac troponin I, at presentation and then after 12 hours. Patients underwent standardized diagnostic procedures, and treatment. Results of IMA, cTnI were correlated with final diagnoses of non-ischaemic chest pain [NICP], unstable angina [UA] and acute myocardial infarction [AMI]. The sensitivity and specificity of IMA for the detection of myocardial ischemia were evaluated by ROC curve analysis. The mean absorbance value [ABSU] of IMA was significantly higher in patients with UA [0.6610.14 and 0.70 +/- 0.18] and those with AMI [0.70 +/- 0.19 and 0.74 +/- 0.22] when compared to individuals with NICP [0.48 +/- 0.11 and 0.50 +/- 0.13] [p < 0.001], both at admission and at the late 12 hours samples respectively. However, the mean ABSU value of IMA showed no significant difference between patients with UA and AMI [P > 0.05] both at admission and after 12 hours. When ROC curve was constructed to evaluate IMA-ABSU in NICP patients compared to all acute coronary syndrome [ACS] patients, the area under the curve was 0.85 [95% confidence interval [CI], 0.76-0.94], immediately after admission, and at cutoff value of 0.51 ABSU, sensitivity and specificity were 86% and 64% respectively. Nearly, the same results were obtained when NICP patients was compared with AMI patients and UA patients separately. While when we compared UA and AMI groups, the area under the curve was 0.6 [95% confidence interval [CI], 0.45-0.74], indicating a poor discrimination between these two groups. CTnI values showed a non-significant difference between patients with UA [1.6 +/- 0.7mnicrog/L] and NICP [1.3 +/- 0.3 microg/L], [P>0.05] at the time of admission, but after 12 hours, cTnI values were significantly higher in patients with UA [1.8 +/- 0.6microg/L] than NICP [1.3 +/- 0.5 microg/L], [P < 0.05]. On the other hand, patients with AMI showed significant increase of cTnI both at admission [1.8 +/- 0.8 microg/L] and 12 hours later [2.9 +/- 0.9 microg/L] when compared to NICP group [p < 0.01 and 0.001 respectively]. IMA is highly sensitive for the early diagnosis of myocardial ischemia in patients presenting with symptoms of acute chest pain

Women health in poor urban settings in Alexandria

The aim of this paper is to investigate women health and status as well as to study gender gap in three poor urban settings in Alexandria. Poor families were identified and invited to participate in the study through the help of local informants. The study included 172 families, 53 from Abu- Kir, 57 from El-Dahreya and 62 from Wadi El-Kamar area. An interviewing questionnaire was used to collect data form the wives as well as their husbands about household family members. Wives and husbands who participated in the study were clinically examined. Their weight and height were measured. For those who accepted to participate, stool, urine and blood analyses were performed. Female to male comparison as well as sex ratio of some parameters were used to investigate gender gap. Results showed that females were the head of the family in 19.8% of the families. In 18% of the families, wives participated in the family income. Illiteracy represented 94.2% among females aged 45+ years, and unemployment was 97.4%. The rate of ill health increased with age from 36% for girls to 90% among older women [45+] compared to 71% among older males. Cardiovascular and orthopedic disorders represented the most reported problems among older females and males. Diarrhea and ARI episodes were rather more frequent among females than among males. About 60% of examined women suffered from obesity, 45% had gynecological problems, 38% had parasitic infections in stool, and 45% had anemia. Female to male sex ratio was low for <6 and 60+ years old. In conclusion, poor women suffer from high burden of socio-economic disadvantage, gender inequality and ill-health

Parasitic infections and malnutrition in rural pre-school children in a northern Nile Delta area, Egypt

This cross sectional study was performed in a rural area in the Northern Part of Nile Delta, Egypt to assess the parasitic infections and malnutrition in preschool children. A complete data set was analyzed for 150 preschool children with an age ranging from 2 to 7 years. The parasitic infection was studied by the examination of the stool samples using a modified Kato technique and the formol-ether concentration technique. The nutritional status was assessed by blood hemoglobin estimation and by anthropometric measurements. The results of the study were presented and discussed

Current status of S. mansoni infection in El-prince village, Alexandria governorate

The present work was implemented to determine the current status of Schistosorna mansoni infection in "El-Prince" village, near Alexandria, which was studied before as a Control village between 1985 and 1990. Stool examination was performed on 571 of the inhabitants by Kato thick smear technique and intensity of infection was determined. Prevalence was found to be 15.4% with a percentage decrease of 53% from the 1990 survey. The geometric mean egg count [GMEC] ranged from 19.05 eggs/gram of stools in children aged five years or less to 81.86 in the oldest group greater than 50 years of age and averaged 42.26. Age stratified prevalence of infection peaked at 31.4% in the [20 to 25]-year-old age group. High prevalence of 23.6% was also observed in the age group from 36 to 50 years. Infection in males was higher than females [17.8% vs.13.5%]. However the difference was not statistically significant [x2 = 2.2, P=0.0086]. Risk factors significantly associated with the infection were an age more than 5 years, male gender, males with water contact activities and having done a previous lab oratory analysis for schistosomiasis. The community category of the village changed from high prevalence in 1990 to moderate prevalence in 2002. Most of the infected individuals [85%] had light intensity of infection [less than 99 eggs lg stools]. Active screening and treatment programs should be maintained in the area. More control measures should be directed towards older people who should be included in evaluation of control programs

Evaluation of renal arterial blood flow in patients with various stages of schistosomal hepatic fibrosis by duplex ultrasonography

Studies of renal perfusion when kidney function tests are still normal could be useful to understand the pathophysiology of renal impairment in schistosomal hepatic fibrosis; currently, this requires invasive methodology. Duplex Doppler ultrasonography allows noninvasive evaluation of intrarenal arterial resistances. In 40 patients with schistosomal hepatic fibrosis [10 with hepatomegaly, 10 with hepatosplenomegaly, 10 with shrunken liver and splenomegaly, and 10 with shrunken liver, splenomegaly and ascites] with normal kidney function [normal serum creatinine and urea levels] and in 20 healthy controls, we measured the intrarenal arterial resistivity index [Resistivity index = [Peak systolic velocity - Minimum diastolic velocity]/Peak systolic velocity] and the pulsatility index [Pulsatility index = [Peak systolic velocity - Minimum diastolic velocity]/ Mean velocity] by Duplex Doppler ultrasonography after visualization of interlobar, interlobular or arcuate arteries by color Doppler ultrasonography. The resistivity index and pulsatility index [calculated as the mean of three to five consecutive determinations] were significantly higher in patients with shrunken liver and splenomegaly than in controls or in patients with hepatomegaly only. Also, these indices were significantly higher in patients with shrunken liver, splenomegaly and ascites than in controls or other patients included in this study. On the basis of these results, Duplex ultrasonography is useful in pathophysiology and clinical studies in such patients

Beta radiation in management of Bowen's disease

Two cases of Bowen's disease [carcinoma in situ or intraepithelial epithelioma] were reported. Beta radiation as an armament to prevent recurrence has been applied