Management of liver trauma in Kuwait

The aim of this study was to introduce the concept of non-operative management [NOM] for blunt liver trauma by establishing a protocol and a prospective Liver Trauma Registry in Kuwait. A prospective Liver Trauma Registry was started in 4 hospitals and it included 117 patients who had sustained blunt liver trauma [94 men and 23 women]. Unstable patients were taken to surgery while stable patients were managed conservatively regardless of the grade of liver injury. High-grade [III-VI] liver injuries were managed in collaboration with the liver surgery specialist. The mean age of the 117 patients was 29.02 +/- 11.18 years [range 7-63]. NOM was successful in 94 [96%] patients and failed in 4 [4%] [these 4 then underwent successful surgery]. Nineteen [16.2%] were unstable and underwent surgery immediately; 15 [79%] of them survived [they had had grade III-V injuries] and 4 died [2 with grade V injuries and 2 with grade VI injuries]. Perihepatic packing was necessary in 8/19 [42%] patients. The overall mortality was 3.4% [4/117]. This study showed that NOM was successful in a majority of patients with blunt liver trauma. In addition, it confirmed that the magnitude of liver injury and haemoperitoneum did not preclude NOM as long as the patient was haemodynamically stable

Effects of tramadol versus indomethacin on gastric mucosa in rat model of nociception: a structural, immunohistochemical and hormonal study

Background: Tramadol is centrally acting analgesic that is frequently used clinically but its mechanism of action is still unclear

Aim of work: To evaluate tramadol analgesic activity, and its effect on gastric mucosa and hormones

Material and Methods: Thirty two adult male albino rats were used. Rats were divided into three groups: group [I] was injected with 3 doses of physiological saline [2ml kg[-1] every 12 h, i.p.], served as control; group [II] was injected with 3 doses of indomethacin [10 mg kg[-1] every 12 h, i.p.]; and group [III] was injected with 3 doses of tramadol [10 m kg[-1] every 12 h, i.p.]. 30 min after the first dose of injections, all groups were given 10 ml k[-1] of 1% acetic acid-saline i.p. to induce writhing. After 10 min following acetic acid injection, writhes numbers were counted over 20 min. Gastric mucosa was examined macroscopically and microscopically. Gastrin expression was detected by immunohistochemistry. Serum prostaglandin [PG], E2, ghrelin, and histamine concentrations were measured using ELISA kits

Results: Tramadol has lower analgesic effect compared to indomethacin. The gastric ulcer index was significantly lower in tramadol- versus indomethacin-treated group [P <0.0001]. Immunohistochemistry demonstrated higher gastrin immunoreactivity in indomethacin- and tramadol-treated groups versus control. Ghrelin serum levels were significantly suppressed by tramadol and indomethacin versus control that were coincident with gastric mucosal lesions. No significant changes in serum levels of PGE2 and histamine were obtained

Conclusion: Our results suggested that tramadol-induced gastric lesions are probably mediated by reduction of ghrelin and increase in gastrin expression. The antinociceptive and gastric effects of tramadol suggest that tramadol is relatively safe clinically in pain therapy

Role of thyroxin versus Brewer's yeast supplementation in amelioration of pancreatic alterations induced by hypothyroidism in adult male albino rats

Induction of hypothyroidism by carbimazole could affect many glands including the pancreas. Brewer's yeast, a herbal product, is recently under research for its possible uses. The aim of the study was to study the microscopic, morphometric, and biochemical changes in the pancreas of hypothyroid rats and to evaluate the role of thyroxin versus Brewer's yeast in amelioration of these changes. Sixty adult male albino rats were randomly divided into five groups. Group I rats served as a control group. Group II rats received carbimazole. Group III rats received carbimazole followed by thyroxin. Group IV rats received carbimazole followed by Brewer's yeast. Group V rats received only Brewer's yeast. At the end of the experimental period, specimens from the pancreas were processed for light and transmission electron microscopic examinations and immunostaining for Ki-67. Biochemical analysis for T3, T4, and insulin was performed. In addition, body mass gain and pancreatic mass were measured. All parameters were statistically analyzed. Group II specimens revealed congestion of blood vessels and cellular infiltration. Acinar cells showed pyknotic nuclei, hyalinization, and vacuolation of the cytoplasm, with few zymogen granules. beta Cells of the islets of Langerhans revealed depletion of organelles and small granules without their characteristic halo. Immunostaining revealed significant decrease in the percentage of Ki-67-positive nuclei. In group III, the acini revealed numerous secretory granules, few vacuoles, and euchromatic nuclei. beta Cells showed secretory granules with the characteristic halo. Group IV revealed less improvement in the histopathological changes as compared with group III. T3, T4, and insulin levels were significantly lower in hypothyroid rats in comparison with the control group, whereas administration of thyroxin showed restoration of these levels to near control values. Hypothyroidism showed a deleterious effect on the histological structure of rat's pancreas. Administration of thyroxin minimized these effects more than administration of Brewer's yeast

possible therapeutic effect of 'chaetomium globosum' fungal extract on experimentally induced rheumatoid arthritis

Rheumatoid arthritis [RA] is an autoimmune disease that leads to chronic inflammation in the joints with subsequent cartilage and bone destruction. RA induces a massive burden on health services worldwide. This study was designed to evaluate the possible therapeutic effect of 'Chaetomium globosum' extract in the treatment of RA in a rat model. Forty male Wistar albino rats aged 8-10 weeks were divided into four groups of 10 rats each. The control group [group I] was injected subcutaneously with 0.1 ml of saline. RA was induced in the other three groups [groups II, III, and IV] by single subcutaneous injection of 0.1 ml of complete Freund's adjuvant in the footpad of the right hind paw. Group II was induced with arthritis and left untreated. Rats in groups III and IV were treated by administering either C. globosum 10 micro g/kg or methotrexate [MTX] 0.3 mg/kg subcutaneously twice weekly for 2 weeks from day 12 after induction of arthritis. Animals of all groups were sacrificed on day 28 from the start of the experiment. The ankle joints were processed and stained with H and E, Masson's trichrome, and immunohistochemical stain for inducible nitric oxide synthase. Specimens were also processed for transmission electron microscopic study. Untreated arthritic rats revealed paw swelling, synovial hyperplasia, inflammatory infiltration, collagen accumulation, cartilage degradation, bone destruction, and significant increase in inducible nitric oxide synthase-positive chondrocytes. Transmission electron microscopic examination confirmed these results. The present study demonstrated for the first time that C. globosum significantly reduced all the clinical and histopathological changes of arthritis similar to MTX. C. globosum extract had therapeutic effects similar to the well-established drug MTX and could be devoid of its serious side effects.

Laryngeal cancer: sociodemographic, life style and clinical risk factors among patients underwent total laryngectomy

Laryngeal cancer [LC] is an important health problem. It is one of the most common respiratory cancers. The prevalence of this cancer is increasing all over the world. The aim of the present study is to determine the clinical features of the laryngeal cancer patients underwent total laryngectomty [TL]; to define the characteristic features of surgery in these patients; and to define the life style, health behavioral, sociodemographic and clinical risk factors of the patients. A total of 90 laryngeal cancer patients and a control group of the same number were enrolled in the study. A case-control, hospital based study design was used. The most important clinical features of the studied laryngeal cancer cases underwent TL were; most lesions site was glottis [56.7%], presented with hoarseness of voice [85.6%] and most of the patients were in stage III [63.3%]. Also, the most important characteristics of the surgery in these cases were 64.4% had TL and primary tracheoesophageal puncture, 88.9% underwent thyroidectomy and 25.6% had preoperative tracheostomy. The +ve reflux symptoms index was significant clinical risk factor [OR=6.77]. Factory worker occupation was significant risk factor [OR=4.65]. The most important sociodemographic risk factors for laryngeal cancer were male sex, urban residence, old age, low social level and low occupational level [ORs= 52.59, 2.43, 2.43, 1.99 and 1.97; respectively]. Further, the most important significant health behavioral risk factors were cigarette smoking, goza smoking and no healthy food intake [ORs= 4.44, 4.25 and 2.74; respectively]. Population based studies are needed in different areas in Egypt and on large numbers of patients to understand the full epidemiology of the laryngeal cancer and quality of life of these patients

Laryngeal cancer:quality of life among patients underwent total laryngectomy

Laryngeal cancer is an important health problem causing negative effects on patients' quality of life [QOL]. The aim of this research is to study QOL of the patients with laryngeal cancer who underwent TL, laryngectomees, and to study impact of early speech restoration on QOL of these patients. A case-control, hospital-based study design was used. A total number of 90 laryngectomees and a control group of the same number were enrolled in this research. The laryngectomees had a significantly poorer self-reported health-related QOL domain scores than the controls on all eight Short Form [SF]-36 domains [P=0.000]. Also, the laryngectomees with primary/secondary tracheoesophageal puncture [TEP] had significantly poorer self-reported health-related QOL domain scores than the controls on all eight SF-36 domains [P=0.000]. Further, patients with primary TEP had significantly higher self-reported health-related QOL domain scores than the patients with secondary TEP on the social functioning, emotional limitation and mental health domain scores of SF-36 QOL with statistically significant differences [P=0.003, 0.006 and 0.019; respectively]. Voice restoration is an important essentiality for the laryngectomees. Primary TEP is preferred over secondary TEP. More studies are needed on large number of patients to understand the impact of the laryngeal cancer and consequent of its therapy on QOL of these patients on short and long term

Histological changes in the endometrium of women suffering from recurrent pregnancy loss: light and electron microscopic study

Recurrent Pregnancy Loss [RPL] is defined as the occurrence of three or more consecutive spontaneous abortions before 20 weeks gestation.In human, natural killer cells [NK] are present in abundance in the endometrial stroma and appear to play an important role in early pregnancy. This study was designed to investigate the histological changes which occurred in the human endometrium in women suffering from RPL compared to fertile controls. This study was performed on 20 non-pregnant healthy women. Fifteen of them had a history of three or more spontaneous consecutive first trimester abortions and represented as [RPL group]. Five women had at least one successful child birth and considered as control group. Endometrial biopsies were obtained and were processed for haematoxylin and eosin, immunohistochemical stain for CD 56, transmission and scanning electron microscopic study. Compared with control group, RPL group showed that some cells of epithelial lining revealed vacuolated cytoplasm with karyolytic nuclei and others revealed condensed apoptotic nuclei. The stroma showed apparent increase in the number of positive CD 56 specific for NK cells. Also, in semithin sections the stroma showed apparent increase in the lymphocytes like cells. By TEM, the secretory cells revealed degenerated mitochondria, distorted microvilli, and condensed apoptotic nuclei. The ciliated cells showed disorganization of their cilia, degenerated mitochondria and many cytoplasmic vacuoles. By SEM, the ciliated cells showed short, fused and disorganized cilia while some of the secretory cells appeared degenerated, shrunken and widely separated. No apical secretory cell projections [pinopodes] could be observed. It was concluded that the endometrium of RPL patients showed some histological changes concerning the surface epithelial lining associated with an apparent increased number of NK cells in the stroma. Further studies are needed to explore the role of NK cells in the occurrence of idiopathic RPL

Role of fast-ELISA and western blot in diagnosis of human fascioliasis using crude adult worm and excretory/secretory fasciola antigens

Human fascioliasis is becoming one of the public health problems in Egypt. Because of the similarity of fascioliasis manifestations and other hepatobiiary diseases, the clinical diagnosis of this disease is usually difficult. Diagnosis of human fascioliasis using different worm antigens [crude worm antigen [CW] and excretory/secretory antigen [EIS]] and different methods [Falcon assay screening test enzyme linked immunosorbent assay [FAST-ELISA] and immnoelectrotransfer blot [Western Blot]]. The second objective is to compare between FAST-ELISA and Western Blot using the same antigen, also to compare between the use of [CW] antigen and [E/S] antigen in each method aiming to evaluate the immunodiagnostic potential of both techniques and both antigens. The third objective is to detect the most specific and sensitive immunoreactive bands in both CW and E/S Fasciola antigens by western blot technique. One hundred and fifteen individuals [40 with chronic fascioliasis, 15 with suspected acute fascioliasis, 40 infected with other parasites and 20 apparently healthy] were included in this study. Sera, urine samples and repeated stool samples were collected from all cases. The stool samples were examined for presence of different parasites and Fasciola eggs were counted by Kato-Katz technique. Fasciola [CW] and [E/S] antigens were prepared. Sera were tested by [FAST-ELISA] and [Western Blot] techniques using [CW] and [E/S] antigens. FAST-ELISA using [E/S] gave better results than that using CW antigen, as the recorded sensitivities and specificities were 97.5% and 98.3% with E/S antigen and 92.5% and 86.7% with crude antigen respectively. By using each of CW antigen and E/S antigen, Western blot was more sensitive and specific than FAST-ELISA in diagnosis of human fascioliasis. After fractionation of both antigens by electrophoresis and immunoblotting, it was found that 27 KDa of Fasciola E/S antigen was the best fraction [100% sensitive and specific]. Immnoelectrotransfer blot [western blot] is more sensitive and specific than FAST-ELISA. In immnoelectrotransfer blot, 27 KDa of E/S antigen was the most specific, sensitive and accurate band that could detect Fasciola antibodies in all Fasciola infected patients

Central obesity among adults in Egypt: prevalence and associated morbidity

Through a home-based survey, all people aged 18 years and over [n = 1800] in the catchment areas of 12 primary health care centres in 4 Egyptian governorates were subjected to standardized waist and hip measurements. Central obesity was determined based on the waist circumference [WC] and waist-to-hip ratio [WHR] indicators. The age-adjusted prevalence of central obesity among adults was 24.1% and 28.7% based on the WC and WHR indicators respectively. After adjustment for sex and other confounding factors, WC was significantly associated with the risk of diabetes and hypertension, while WHR was not significantly associated with either diabetes or hypertension. No significant association was seen between body mass index and diabetes or hypertension

protective effect of L-tryptophan versus alpha lipoic acid against L-arginine-induced experimental acute pancreatitis in albino rats

This study was conducted to investigate the possible protective effects of L- treptophan "a precursor of melatonin" and alpha lipoic acid against L- arginine-induced experimental acute pancreatitis in albino rats. Fourty adult male albino rats [200- 250g] were randomized into 4 groups [n= 10]. Group I, the control group was given 0.9% saline intraperitoneally [i.p]. Group II, was given 500 mg/lOOg L-arginine [i.p] as a single dose to induce acute pancreatitis. Group III: was given 250mg/kg L-tiyptophan [i.p] 30 mm prior to L- arginine injection. Group IV: was given 50mg/kg alpha lipioc acid [i.p] 30 mm prior to L-arginine. Before scarifice, blood samples were obtained from all groups to assay serum amylase and interleukin 6. Animals were sacrificed after 6 hours. For the histopathological study, pancreatic tissue was prepared for histological [H and E, PAS] histochemical [Tween stain for lipases] and immunohistoehemical [Bax stain for apoptosis] techniques. Both qualitative and quantitative analyses were done to assess the degree of acinar cells affection. It was revealed that serum amylase and interleukin 6 in group II rose rapidly. Microscopically, severe acinar cells degeneration, interstitial edema, diffuse bleeding and inflammatory infiltration were demonstrated. These changes were markedly improved with the administration of both L- tryptophan and alpha lipoic acid. It was concluded that both L- tryptophan and alpha lipoic acid reduced the effects of L-arginine-induced acute pancreatitis with better protection achieved by L-tryptophan administration

Light and electron microscopic study on the protective role of corneal epithelium against the effect of "UVB" radiation on rabbit cornea

The human eye might be subjected to repeated exposure to ultraviolet radiation [UVR] either during a single day or over a longer period of time. It is known that the cortical epithelium strongly absorbs UVR. The aim of this study was to evaluate the protective role of corneal epithelium against the effect of UVB radiation on corneas of albino rabbits in comparison with that on de-epithelialized corneas. Sixteen adult female New Zealand albino rabbits [3-3.5 Kg] were divided into 4 groups, 4 rabbits each. Group I served as control. Group II served also as control, but their corneas underwent manual de-. In group III, corneas were exposed to UVB irradiation, peaked at 3l2nm as a single dose [3.12J/cm2] for 30 minutes. In group IV corneas underwent manual de-epithelialization. 5 minutes prior to UVB exposure. All animals were sacrificed after 48 hours, and the corneas were removed and processed for histological and transmission electron microscopic study. The histological results of group III revealed that the corneas had slight edema and the keratocytes in the outer stroma appeared to be affected. Ultrastructural evaluation of this group showed affected epithelial cells and the keratocytes revealed early apoptotic changes like chromatin condensation. Results of group IV showed that the stromal damage was deeper and more extensive. The keratocytes had been markedly affected in the entire thickness and there was thinning out of Descemet's membrane. Ultrastructurally, the keratocytes showed chromatin condensation, fragmentation and cell shrinkage. Disorganized collagen lamellae were also seen. It was concluded that the removal of the corneal epithelium makes the underlying ocular structures-more susceptible to damage by UVB in the 312nm range. Further studies are needed to investigate whether the corneal epithelium has protective properties against UVB at other wavelengths

Light and electron microscopic study on the possible protective effect of taurine against thioacetamide induced liver damage in albino rats

Thioacetamide [TAA] is used as a fungicide and one of the human carcinogens which induces multiorgan failure including hepatotoxicity. The aim of this study was to evaluate the protective effect of taurine [2- amino-ethane sulfonic acid], against [TAA] induced hepatotoxicity in albino rats. Twenty adult male albino rats [150-200g] were divided into 4 groups, 5 rats each. Group I served as control, received [1ml/100g] 0.9% saline intraperitoneally [i p] for 4 days. Group II received [TAA] [300mg/kg] [i.p] for two consecutive days. Group III received taurine [400mg/kg] [i.p] for two consecutive days prior to the [TAA]. Group IV received the same dose of taurine only. All animals were sacrificed on the 5th day after the beginning of the experiment. For histological studies, liver sections were stained with H and E, PAS and Masson's trichrome stains. Other minute specimens from the liver were processed for transmission electron microscopic study. The histological results of [TAA] injected rats revealed loss of normal hepatic architecture, most of the hepatocytes of centrilobular region showed necrosis and vacuolated cytoplasm,, marked decrease of PAS positive material and minimal increase of collagen fibers inbetween blood sinusoids were noticed. The ultrastructural findings showed that hepatocytes contained polymorphic mitochondria with apparent loss of their cristea, numerous cytoplasmic vacuoles, loss of short microvilli and apparent decrease of the glycogen granules.These changes were improved markedly, both histologically and ultrastructurally with taurine administration. It is concluded that [TAA] induces severe hepatic alterations. These alterations were less prominent in animals treated with taurine indicating that taurine can be used as a possible hepatoprotector agent against [TAA] induced toxicity

Persistence of the vinyl phosphate insecticide 14C-dichlorvos in stored soybeans and its toxicological significance to experimental animals

Soybeans were treated with the recommended dose of dichlorvos insecticide [12.0mg pesticide/kg seeds] and its duplicate [24 mg pesticide / kg seeds] and stored for 7 months under normal local storage conditions. The rate of penetration of the pesticide through the seeds and the percentage of bound residues were apparently not dose dependent. The amount of surface residues decreased with time to 18% of the applied dose while the amount of extracted and bound residues inside the seeds showed a slow but definite increase with time of storage and reached more than 61% and 9%, respectively, at the end of the experiment. The incomplete recovery of the applied radioactivity by extraction and combustion may be attributed at least to volatilization of the parent substance. Toxicity of the total internal residues of dichlorvos in stored soybeans was studied in mice through a subchronic feeding experiment for three months. The maximum inhibition in plasma and erythrocyte cholinesterase activity was 60% and 52% after the first month, respectively. Blood picture showed a slight decrease in hemoglobin concentration [18%] and red blood cell counts [19%] and a significant decrease [55%] in white blood cell-counts at the end of experimental period. Treated mice suffered from deterioration of hepatic and renal functions as indicated by the obtained results. Percentage increase in alanine aminotransferase [ALT], aspartate aminotransferase [AST] and alkaline phosphatase [ALP] reached to about 93, 61, and 20%, respectively as compared with control animals at the end of feeding period. A significant increase in blood urea [65%] was observed whereas creatinine concentration showed only a slight increase [17%] as compared with control group

protective effects of vitamin E versus vitamin C against cisplatin ototoxicity in guinea pigs [histological and audiological study]

The protective effects of both vitamin E and C against cisplatin induced ototoxicity were assessed histologically and audiogically. This was done by quantifying the extent of cochlear damage with the light microscope, scanning electron microscope and with measurement of the Distortion Product Otoacoustic Emissions [DPOAEs]. Twenty-five adult male guinea pigs were used in this study. They were divided into control group, cisplatin group that was injected 8 mg/kg cisplatin intra-peritoneally [i.p.], vitamin E group that was injected 500 mg/kg of vitamin E i.p.30 mm prior to cisplatin injection, and vitamin C group which was given 200 mg/kg of vitamin C i.p. 30 min before cisplatin administration. When administered alone, cisplatin induced loss and vacuolation of outer hair cells [OHCs] as seen by LM examination. Scanning EM revealed fusion, disarrangement and loss of some stereocilia in the remaining OHCs especially in the basal turn. In contrast, inner hair cells resisted cisplatin ototoxicity. Audiological assessment demonstrated reduction in DPOAEs amplitudes and S/N values in all frequencies. Both vitamin E and C reduced cisplatin ototoxicity, with better protection achieved by vitamin C administration. Scanning EM examination showed that OHCs were similar to the control configuration after vitamin C administration while after protection with vitamin E, OHCs of the third row showed fusion and absorption of the stereocilia in some parts. In addition, both DPOAEs amplitudes and S/N ratio were near the control values up to 4 KHz. However, above 4 KHz both vitamins failed to achieve the full protection, with vitamin C showing better performance in these high frequencies. We conclude that both vitamins had protective effects against cisplatin induced ototoxicity, with vitamin C inducing more protection in the used regimen

Construction of an arabic reading test for assessment of dyslexic children

Dyslexia is a specific language-based disorder of constitutional origin, characterized by difficulties in phonological processing. The Arabic language differs in many aspects from foreign languages and the few previously designed Arabic tests for assessment of dyslexia did not pay attention to phonological awareness problems. This necessitates the design of an Arabic test which could properly assign specific difficulties among Arabic reading dyslexic children, including phonological awareness as a major contributing factor for dyslexia. The study was carried out in Assiut City, Egypt, during the period from September 1999 to the end of January 2001. The newly designed Arabic Reading Test [ART] in this work passed through many stages. Firstly, test construction by 11 Arabic teachers [specific judges]. Secondly it was applied, in a pilot study, to 50 normal students [9-10 years old] to ascertain clarity of the test. Then test standardization was proven through application on a second sample [n=252 students], and third sample [n=58 dyslexics]. The reliability of the ART was proven by the test-retest method [r=0.913, p<0.01]. Validity was proven by judgment validity, internal consistency validity [ranged from 0.238 for auditory perception to 0.940 for phonological awareness and spelling], contrasted group validity, and criterion related validity [in relation to Schonell r=0.859, Awaad reading r=0.817, Awaad comprehension r=671, mid-term Arabic scores r=0.686]. The ART was thus proven to be highly reliable, and valid for assessment of dyslexia among Arabic reading children. It has great value in predicting dyslexia even among preschool age Arabic speaking children, through assessment of their phonological awareness skills, and thus, remediation programs can be properly and early directed

Surgical treatment of thoracic and lumbar tuberculosis by anterior interbody fusion and posterior instrumentation

To evaluate the efficacy and clinical outcome of simultaneous or sequential anterior and posterior surgical approaches in the management of spinal tuberculosis in the form of anterior extirpation of the tuberculous lesion, strut bone grafting of the defect produced and posterior instrumentation for spinal fixation. Subjects and Twenty-two patients who had tuberculosis of the thoracic and lumbar spine with moderate to severe localized kyphosis and variable degrees of neurological deficits were treated at Al Razi Hospital [Kuwait] in the period from 1998 to 2000 by anterior debridement and autogenous strut bone grafting with simultaneous or staged posterior spinal fixation using either USS or SOCON spinal instrumentation. Appropriate antituberculosis treatment was given to all patients for 9-12 months. The postoperative follow-up period was 18 months. Of the 22 cases the average of preoperative kyphosis was 42°. The average of immediate postoperative correction was 27°. At the last follow-up the average correction was 24° and the loss of correction did not exceed 3°. Average fusion times were 5 months for one-segment fusions and 8 months for two-segment fusions. There was no recurrence of the disease in any of the cases. Posterior instrumental stabilization and anterior interbody fusion were found to be effective in arresting the disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion

Outcome of critically ill cirrhotic patients: an evaluation of the different scoring systems

Several prognostic scoring systems have been designed in an attempt to assess the prognosis of critically ill cirrhotic patients. For this purpose three different prognostic scores [APACHE III score, Child-Pugh score and ICCO score] were studied in intensive care unit, Tropical Medicine and Gastroenterology Department, Assiut University Hospital. A total of 187 cirrhotic patients [149 males, 38 females; age range 15-82 year] were prospectively enrolled in this study. At the time of admission, 73 cases [39%] had bleeding oesophageal varices and 114 cases [61%] had hepatic encephalopathy. Grading of overall severity of liver cirrhosis according to different prognostic scores were done for all studied patients. In patients with hepatic encephalopathy, APACHE III score had the highest positive predictive value [75%] while ICCO score had the highest specificity [89.3%]. On the other hand in critically ill cirrhotic patients with bleeding oesphageal varices APACHE III and ICCO scores had equal positive predictive value [79%] but ICCO score had the highest specificity [92%]. If specificity is considered as a predictor of mortality, ICCO score was found to be the best predictor of mortality in cirrhotic patients who presented with bleeding oesophageal varices and with hepatic encephalopathy followed by APACHE III score. As regards individual laboratory parameters, serum bilirubin was found to be the best single parameter predicting mortality in cirrhotic patients presenting with bleeding oesophageal varices [specificity 90% and sensitivity 89. 74%]. On the other hand plasma lactate was found to be the best laboratory parameter predicting mortality in cirrhotic patients presenting with hepatic encephalopathy [83% positive predictive value and 85% specificity ICCO score was the best predictor of mortality in cirrhotic patients with bleeding oesophageal varices and hepatic encephalopathy followed by APACHE III score. Serum bilirubin was the single laboratory parameter predicting mortality in patients presented with bleeding oesophageal varices. Plasma lactate predicting mortality in who those with hepatic encephalopathy

Mycoflora of Chicken-Viscera with Aid of RAPD Technique as a Tool for Confirmation

A total of 100 samples of chicken-viscera were collected from different poultry-slaughtering houses in Austria; (20 samples of each of gizzard, heart, intestine, liver and spleen). Intestine and gizzard were heavy contaminated with moulds than other examined visceral organs (4.4x105 and 2.6x104 colonies/1 g of the samples, respectively). Fungal contamination was not detected in all samples of heart and spleen. Eighty-five mould isolates were collected from the examined samples, the majority of isolates belonging to Aspergillus glaucus group (20.0%) and Trichoderma (14.1%). These isolates comprised 15 species belonging to 9 genera. Members of Aspergillus glaucus (telomorph: Eurotium) group and Trichoderma were further confirmed their identification using random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) technique.

Thoracoscopic upper thoracic sympathectomy for upper limb hyperhidrosis

To present a 30-month experience in thoracoscopic upper thoracic sympathectomy [TUTS] in Kuwait in 20 patients with upper limb hyperhidrosis [ULH]. We performed 40 TUTSs in 20 patients with bilateral ULH. The T2-4 or T2-5 sympathetic ganglia were resected in 36 cases. Only the T2-3 ganglia were resected in 4 cases due to difficult localization of the 4th ganglion. Both sides were performed simultaneously. Chest tube drainage was performed at the end of each procedure. The male:female ratio was 9:1, ranging in age from 13 to 43 years [mean age 26.95 years]. Two patients had bilateral dense pleural adhesions, but the procedure was successful. Most patients were discharged on the 2nd postoperative day. Follow-up at 5-30 months [mean 16.3 months] was excellent both for immediate and permanent relief of ULH. Eleven of the 15 patients with pedal hyperhidrosis also had dry feet. Two patients developed transient Horner's eye syndrome. One patient had persistent right pneumothorax that required chest tube drainage for 7 days. Four patients developed compensatory hyperhidrosis of the trunk and upper thighs. Fifteen patients [75%] expressed complete satisfaction. Five patients [25%] reported return of some moisture to their hands and axillae. TUTS is minimally invasive, feasible and effective. It has a low complication rate. We recommend this procedure as the method of choice for the management of ULH

Study of risk factors among acute HBV infected patients.

This study was designed to determine the various risk factors affecting the transmission of acute hepatitis B and to investigate whether the infection is essentially household or community acquired. The study showed that HbsAg-positive individuals were present more in households of HBV acutely infected patients than households of the controls. Also, anti- HBc IgG seropositivity was significantly higher in patients spouses and contacts than controls spouses and contacts. The various risk factors for transmission of HBV were the following in order of frequencies: Shared blades in barber shops, injections, sharing utensils with HbsAg-positive household member, shared machines in barber shops, shared combs or towels with HbsAg-positive household member, dental procedures, operation, sharing room with HbsAg-positive household member, vaccination, stitches, sharing bed, bedding, blades with or kissing of HbsAg-positive household member, neurological examination [pin pricking] and contact with jaundiced patient