Anticancer activity of Aloe vera and Calligonum comosum extracts separetely on hepatocellular carcinoma cells

OBJECTIVE: To investigate the in vitro anticancer effect of Aloe vera (A. vera) and Calligonum comosum (C. comosum) extracts against hepatocellular carcinoma (HepG2) cells. METHODS: HepG2 cells were tested against different doses of A. vera and C. comosum. Viability of the cells was assessed by MTT assay. Evaluation of apoptosis and DNA damage in HepG2 cells were performed using annexin V apoptosis detection kit. The expression of p53 and anti-apoptotic (Bcl-2) were tested by real time-PCR and flow cytometer analyser. Hematoxylin and eosin stained sections from untreated and treated HepG2 cells were observed using light microscopy. RESULTS: The IC

Primary surgery in treatment of stages II and III Wilms' Tumour: a developing countries' experience

Background: Treatment options for Wilms' tumour [WT] are costly and it affects the country's health budget and resources if adopted and implemented at the national level especially in developing countries with low or resource-challenged settings

Aim: The objective of this study is to evaluate the role and effectiveness of primary surgery in the treatment of stage II and III pediatric WT following the schedule indicated in the National Wilms' Tumor Study [NWTS-4] in the institutes of two developing countries

Patients and Methods: The study enrolled 40 children who were primarily diagnosed as stage II and III WT. They were divided into 2 equal groups. Group I [n = 20] included those children who have undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II [n = 20] included those children who have undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 20+/-5 months, clinical and radiological evaluation was performed for all patients

Results: In group I, 15 patients were preoperatively diagnosed as stage II and 5 patients as stage III while in group II, 16 patients were proved to be stage II and 4 patients were stage III. After a follow up period, clinical and radiological evaluation using CT was performed on all patients. In patients with stage II, evidence of recurrence was noted in 4 patients of group I whereas no patient showed any evidence of recurrence in group II. In patients with stage III, rebound increase in size was seen in 2 patients in group I and only one patient in group II

Conclusion: Primary surgery with appropriate adjuvant therapy improves the treatment results compared to the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III WT. It may be used as a safe and effective tool in treating WT patients with relatively no changes from the long administration schedules. This will have a highly positive impact in lowering treatment cost in developing countries

Throat swab culture in chronic plaque type psoriasis

To determine any association between streptococcal throat infection and plaque type psoriasis. A cross-sectional study conducted on 30 psoriatics and 30 household controls at Bangabandhu Sheikh Mujib Medical University, Dhaka. Throat swabs of 60 patients were collected with all aseptic measures and sample were incubated in optimum condition for 3days. After this Streptococcus was identified by examining colonial morphology and sensitivity with bacitracin disc. Streptococcal infection was found in 4 [13%] psoriasis patients and 1 [3%] in control group [p= 1.964]. In our study, we found no association between streptococcal throat infection and chronic plaque type psoriasis

Clinico-mycological correlation in onychomycosis in a tertiary level hospital

To correlate the clinical patterns of onychomycosis with the type of mycological agents in onychomycosis. In this cross-sectional study, 120 patients with onychomycosis, attending outpatient department, were selected by purposive type of sampling technique. They were subjected to thorough clinical examination. Nail material was collected for mycological diagnosis by microscopy and culture on dermatophyte test medium. Microscopy was positive in 47 [39.2%] cases, whereas culture yielded Trichophyton rubrum in 53 [44.2%] and T. mentagrophytes in 2 [1.7%] patients. Common clinical nail changes in mycologically proven cases were thickening of nail plate [68.9%], subungual hyperkeratosis [63.9%], onycholysis [55.7%], roughening of nail plate [29.5%], yellowish discoloration [29.5%] and brownish-yellow discoloration [21.3%]. Only, subungual hyperkeratosis was found significantly more in mycologically positive cases [63.9%] than in mycologically negative cases [37.3%], p<0.05. The validity of microscopic examination for prediction of onychomycosis revealed sensitivity [74.5%], specificity [90.8%], accuracy [83.3%], positive predictive values [87.2%] and negative predictive values [80.8%]. There is an insignificant correlation between clinical pattern and mycological diagnosis. No single clinical feature is suggestive of onychomycosis, hence, direct microscopy must always be coupled with fungal culture for accurate diagnosis.

Different surgical modalities in management of paediatric abdominal lymphoma

The abdomen is one of the most frequent sites for lymphoma in children. The role of surgery has been limited to intra-abdominal resectable tumours or as a diagnostic procedure in case of disseminated disease. Laparotomy without total excision of the tumour does not improve survival; moreover, it may cause complications and delays initiation of chemotherapy. This study was undertaken to assess the role of surgery in the management of children and adolescents presenting with intra-abdominal lymphoma in order to create certain criteria to select the proper surgical modality for managing those patients. This case-series, retrospective study was done on 33 patients of abdominal lymphoma over a period of seven years from 2000 to 2007. Patients' files were reviewed regarding the full clinical examinations, laboratory and radiological investigations as well as surgical and diagnostic procedures. Collected data were tabulated and statistically analyzed using SPSS program package. Eleven patients [33.3%] presented with huge pelvi-abdominal mass and eleven [33.3%] had generalized lymphadenopathy beside their abdominal affection. The remaining 11 [33.3%] patients presented with symptoms of an acute abdomen. A total of 15 laparotomies were done. 11 patients underwent emergency laparotomy for acute abdomen and 4 patients had elective abdominal exploration. Lymph node biopsies were taken in 7 patients and laparoscopy procedures were performed in 3 patients as a diagnostic tool. Out of the total 33, the remaining 8 patients underwent true cut needle biopsy for diagnosis of their disease. Surgery still has a role in treatment of lymphoma whether non Hodgkin or Hodgkin's. However, in disseminated metastatic disease, aggressive debulking of the tumour should be avoided as chemotherapy is to be instituted primarily. Surgical resection does not cause significant change in morbidity or mortality

Parasitic infestation in pediatric and adolescent appendicitis: a local experience

The relationship between parasites and pediatric appendicitis is a highly debatable issue. This study aims to investigate the role of parasitic infestation in the etiology of acute pediatric appendicitis. A retrospective study including 1600 pediatric and adolescent patients who had undergone surgical therapy for a diagnosis of acute appendicitis over a period of ten years from Jan 2001 to Dec 2010. Demographic data were retrieved including the patient's age, sex, clinical data, clinical presentations, laboratory investigations, operative data and pathological findings to identify the presence and type of parasites. Patients were divided into two groups according to the presence or absence of parasites in the appendix lumen. In group I [n: 88], parasitic infestation was observed, whereas in group II [n: 1502], no parasitic infestation was present. Parasites were present in 5.5% [88 patients], and of those 88 parasitic infestations, 45 [51.1%] were Enterobaisis, 8 [9.1%] were Schistosomiasis, 23 [26.1%] were Ascariasis, 7 [8%] Trichuriasis, and 5 [5.7%] were Teania Saginata. The percentage of patients with suppurative, gangrenous or perforated appendicitis was similar in both groups with no statistical significance, irrespective of the presence or absence of parasitic infestation. The low prevalence of parasites among the appendectomy specimens did not support the notion that parasites were a major cause of appendicitis in pediatric patients

Role of BAL cellularity in assessment of severity of idiopathic pulmonary fibrosis

Study the role of BAL cellularity in assessment of the degree of severity of IPF. Forty IPF patients underwent, history taking, clinical examination, HRCT chest, ABGs, 6MWT, spirometry, echocardiography, FOB and BAL. Neutrophils were present in 28 patients, mean value 57.25 and SD +/- 31.27. The second predominant cell was Alveolar Macrophages with mean value 24.25 and SD +/- 27.828.HRCT pattern and BAL cellularity, showed the most predominant cell neutrophils in the ground glass and Honey combing on HRCT. There was no statistical significance between the sex and the BAL cellularity, the most predominant cell was neutrophils in both sexes. Corticosteroids did not have an effect on BAL cellularity and the predominant cell was neutrophils in IPF patients using steroids and those not. BAL cellularity in relation to treatment by azathioprine and/or acetlycysteine showed no statistical significance between patients using those drugs and those not, the most predominant cell was neutrophils in both groups.Correlation between BAL cellularity and age, showed no statistical significance but there was a negative correlation between age to neutrophils and lymphocytes. There was a negative correlation between neutrophils and PaCO2, PaO2, SO2, FVC%, FEV1 and 6MWT with no statistical significance but with significance to FEF25-75%.Macrophages showed a positive correlation with age, PaO2, 6MWT, FVC%, FEV1% with no statistical significance but with significance to SO2 and FEF25-75% and a negative correlation with PaCO2 and PASP. There was a positive correlation between neutrophils and severity of the disease and a negative correlation between Macrophages and severity of the disease. Most commonly used drugs did not show any effect on BAL cellularity

Laparoscopic management of malfunctioning peritoneal dialysis catheters

Continuous ambulatory peritoneal dialysis [CAPD] is an established alternative method to hemodialysis for treating endstage renal disease patients. Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis [PD]. Laparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. The purpose of this study is to present our experiences with laparoscopic repair of peritoneal catheter dysfunction Between April 2006 and March 2010, 21 cases of laparoscopic interventions were performed for the salvage of malfunctioning CAPD catheter. Two trocars [5 mm] were used. Recorded data included patient demographics, catheter implantation method, date of malfunction, cause of dysfunction, procedure performed and complications. The primary etiology of dysfunction was omentum and/or small bowel wrapping with adhesions in fifteen cases, malpositioning in four cases, and tunnel infection in the remaining two cases. Adhesiolysis was performed in cases with adhesions. In the cases with malpositioning but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters had to be withdrawn and exchanged because of infection. There were no mechanical or infection problems. The overall success rate of catheter function [>30 days after laparoscopy] was 100%, except for two cases in which the catheters had to be removed. Laparoscopy is a safe, highly effective and successful method for the evaluation and management of peritoneal dialysis catheter dysfunction

Recurrent laryngeal nerve injury in thyroid surgery

Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve [RLNI] is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 [3.2%] cases, and in 1 [0.3%] case, it became permanent [post Rt. Hemithyroidectomy]. Bilateral vocal cord problems occurred in 2 cases [0.58%], but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation [21.7% in secondary vs. 2.8% in primary, p=0.001], total/near total thyroidectomy [7.2% in total vs. 1.9% in subtotal, p=0.024], non-identification of RLN during surgery [7.6% in non-identification vs. 2.6% in identification, p=0.039] and in malignant disease [12.8% in malignant vs. 2.9% in benign, p=0.004]. However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender [4.1% in male vs 3.8% in female, p=0.849]. The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury

Spinal cord injury without radiological abnormality [SCIWORA]. A diagnosis that is missed in unconscious children

Spinal cord injury without radiographic abnormality [SCIWORA] usually occurs in the hypermobile, immature cervical spine of young children. In a comatose child, a normal spine x-ray, and CT scan exclude most cases of gross fracture and dislocation, but not SCIWORA. We present 2 children that sustained a polytrauma, which rendered each of them unconscious at the outset. In both, cervical spine x-ray excluded bony injuries, however, CT scan raised the suspicious of spinal cord injury in one, and MRI demonstrated significant cord injury in both. The first patient died from severe head and cervical spinal cord injury. The second patient recovered with mild Brown-Sequard syndrome. A high index of suspicious of SCIWORA is necessary in injured comatose children in whom movement of all limbs is not seen. Therefore, spine MRI should be considered if they are expected to remain ventilated for an unknown time

Management function and managerial skills for nurse interns at mansoura university hospitals

The internship period is an opportunity for a student to gain practice in a real world setting under the guidance of knowledgeable, experienced and successful supervisors. In Egypt, nurse interns' most frequent complain is the lack of clarity of what specific work is required. The aim of this study was to determine the expected management functions and managerial skills for the nurse interns at Mansoura university hospitals. This cross-sectional analytic study was carried out in different clinical areas of Mansoura University hospitals. The study sample included all nurse interns who succeeded in the academic year 2002-2003 [225 subjects], and two nursing leaders group: 54 academic leaders, and 40 hospital leaders. Data about nurse interns and leaders' perceptions regarding the components of management functions and managerial skills were collected using a questionnaire sheet developed by the researchers, from March to May 2004. Nures leaders had higher scores in planning [p=0.04], whereas nurse interns had higher scores in controlling [p=0.006] functions. Also faculty leaders had higher mean Se- ores in all management functions and managerial skills, compared to hospital leaders, p<0.001. Nurse leaders with less than five years experience had statistically significantly higher scores about the management functions and managerial skills, compared to those with five years experience or more. For nurse interns, the scores were highest among nurse interns aged 21 years, and lowest among those aged 23 years or more, p<0.001. Also previous work was associated with statistically significantly higher scores in all management functions- and managerial skills. Statistically significant positive correlations were found among the scores of the elements of management functions among nurse leaders and nurse interns, p<0.01. Experience years of nurse leaders had negative statistically significant correlations with the scores of management functions and managerial skills. Among nurse interns, age had statistically significant negative correlations with management functions and managerial skills scores, r=-0.50 and r=-0.47, respectively. It was concluded that the expected management functions and managerial skills for the nurse interns at Mansoura university hospitals are differently perceived by nurse leaders and nurse interns. It is recommended to frequently conduct staff development programs to nurse i1tems to refresh and develop their competences regarding managerial skills, with more training programs focusing on management skills such as leadership and communication

Assessment of ground reaction force components in parkinsonian patients

The purpose of this study was to evaluate the ground reaction force components in Parkinsonian patients and to compare them with that of age matched normal subjects. Twenty Parkinsonian patients and ten normal subjects participated in this study. This study calculated kinetic quantities of human gait, by using all components of the ground reaction force [vertical load, horizontal shear forces in the fore-aft and mediolateral directions], both in normal subjects and Parkinsonian patients by using force plate form. The results of this study showed a highly significant reduction of ground reaction force in all parameters of ground reaction force of Parkinsonian patients when compared with control group, except the reduction of the mediolateral component of the first peak which was non significant. So assessment of ground reaction force should be considered as a valuable tool in diagnosis, rehabilitation and prognosis of Parkinsonian patients

Assessment of combustion products of medical waste incinerators in Alexandria

The emissions and ashes from medical waste incinerators might perform a threat to the environment and the public health. The aim of the present work is to evaluate the emissions and ashes of six medical wastes incinerators in six hospitals in Alexandria. Five air pollutants were sampled and analyzed in the emissions comprising smoke, lead, carbon monoxide, sulphur dioxide and nitrogen dioxide.Ash samples were analyzed for bacterial count, volatile substances, lead and cadmium. Shape and color of ash were observed visually. The results of the present study have revealed that all the average values of gases in the six incinerators were within the limits stated in Egyptian environmental law, where as carbonaceous particulate [smoke] averages of the six incinerators have exceeded the maximum allowable limit in the law. On the other hand, lead concentration in emissions were far below the maximum allowable limit in the law. Incinerator No6 emissions have been significantly higher in CO, NO 2, SO 2 and smoke concentration than the other five incinerators P<0.001, P<0.0006, P<0.0001, and P<0.002 respectively. There was no significant variation in bacterial count of ash samples at 20°C and 37°C between the six studied incinerators. Volatile substance percentage of ash samples in the six incinerators were much higher than the recommended percentage. There was a highly significant variation between the six incinerators [p<0.005]. Lead and cadmium concentrations in ash samples were much higher than those in developed countries, meanwhile, more or less as those in developing countries. It is recommended to state specific realistic emissions limits for medical waste incinerators and to substitute sporadic incinerators in hospitals by two central incinerators in proper places outside the city

Evaluation of occupational hazards in foundries

The working environment of foundries is hazardous and characterized by multiple simultaneous chemical, physical and mechanical hazards exposure, which would lead to injuries of foundry workers. The aim of the present work is to evaluate occupational hazards in four foundries, two in Alexandria: El Nasr and Ramsis, and two in Behira: Misr Spinning and Weaving and Misr Rayon companies. Levels of total and respirable dust, free silica% in total dust and lead concentration in total and respirable dust; NO 2, SO 2 and CO concentrations; noise and heat stress levels have been determined in the present work. Occupational injuries data were analyzed in a three years period from 1998 to 2000. The results of the present work revealed; 1. The levels of total dust and respirable dust exceeded the threshold limit values at knockout and cleaning operations at El Nasr Company. 2. Free silica percentage exceeded permissible levels in all operations except pouring in El Nasr Company. 3. CO levels in Misr Spinning and Weaving Company were higher than threshold levels. 4. Noise levels in knockout and cleaning operations at the four companies were exceeding the threshold limit values. 5. Heat stress levels in melting and pouring operations in El Nasr and in pouring operation in Ramsis Company were higher than the maximum permissible levels. 6. The age group 31-40 years has recorded the highest average incidence rate of injuries of age groups [P<0.01]. 7. Lower extremities and higher extremities have recorded the highest average incidence rate in the four companies [P<0.001-P<0.01 respectively]. 8. Transportation and lifting was the main cause of injury in the four companies [P<0.05]. 9. Faulty action and striking against was the main mean of injury in the four companies [P<0.01]. 10. Ramsis Company has the highest average incidence rate in almost all injuries parameters and indices [frequency rate and severity rate] [P<0.05-P<0.001]. The present work is a massive survey, which highlights the occupational hazards in Egyptian foundries

value of clinical signs in diagnosis of cirrhosis

To document the value of various clinical signs of cirrhosis in its diagnosis. It also reviews the current status of the disease. Observational and descriptive study.Place and duration of study: Medical wards of PNS Shifa, Karachi and Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 2002 to May 2003.Subjects and One hundred and seventy diagnosed adult patients having an unequivocal evidence of cirrhosis on ultrasound examination of abdomen were included in the study. Two trained clinicians examined the cases and their clinical signs were recorded on a format specially designed to record the clinical signs. Age, gender, hepatitis status [hepatitis B, C, or other wise] was also documented. Sixty two percent were males and 38% were females. Patient average age was 53.2 years without gross age difference in the HCV positive and HBsAg positive groups.Twenty eight percent were HCV positive, 22% were HBsAg positive, 10% had no evidence of previous infection of hepatitis B or hepatitis C and 40% had no record of these tests. Males dominated the HBsAg group compared to HCV positive group. Pedal edema was present in 92 percent of patients, ascites in 89 percent, jaundice in 64 percent, clubbing in 25 percent, palmar erythema in 23 percent, Terry's nails in 21 percent, testicular atrophy in 4 percent, gynaecomastia in 4 percent, pectoral area hair loss in 2.4 percent, leuconychia in 2.4 percent and hepatic encephalopathy in different grades in 19 percent. No spider navei, caput medusae and Dupuytren's contracture were noted. We document that in current clinical practice the classical signs of cirrhosis expected to be present in advanced cases are observed quite infrequently and therefore, cannot be relied upon in clinical diagnosis of the disease alone. The diagnosis of cirrhosis should be supported by other means including ultrasound examination of the abdomen etc. Further multicenter studies should be conducted to consolidate our findings

Occupational exposure to selenium among workers in rubber tire repair shops

Selenium concentration was determined in six tire repair shops in Alexandria. Concentrations of selenium were determined in tire damages repair, electric spot heater, and buffing positions. The results obtained revealed that there was a significant difference between the concentration of selenium in tire damages repair position and its concentration in electric spot heater position [t=2.47, 0.003*]. Also, there was a significant difference between the concentrations of selenium in electric spot heater position and its concentration in buffing position [t=2.86, 0.002*]. But, the difference between the concentrations of selenium in tire damages repair and in buffing positions was not significant. Workers at rubber tire repair shops were exposed to concentrations of selenium in the range of 0.7-7.3 micro g/m 3. This range is quietly below TLV of selenium [0.2 mg/m 3], but this concentration is nearly equal to lower end of range of concentration reported to produce slight tracheobronchitis in 9 out of 62 exposed workers in a selenium rectifier plant. The present study determines the levels of selenium in the environment of rubber tire repair shops and recommends that routes of absorption of selenium other than respiratory and unlimited hours of exposure should be considered while health problems is evaluated