Early detection of left atrial dysfunction by speckle tracking echocardiography in hypertensive patients with normal left atrial size

Background: Arterial hypertension adversely affects LA size and function, effect on function may precede effect on size. This effect is reflected on patient's morbidity and mortality risks. Many techniques were used to assess LA function but with many pitfalls

The objectives: early detection of left atrial dysfunction with speckle tracking echocardiography in hypertensive patients with normal left atrial size

Patients And Methods: The study was conducted on 50 hypertensive patients and 50 age matched normotensive controls, all with normal LA size and free from any other cardiovascular disease that may affect the LA size or function. They were all subjected to history taking, clinical examination and echocardiographic study, both the conventional measures and speckle tracking then both groups were compared regarding LA strain representing LA function

Results: Our study found that hypertensive patients had significantly reduced LA function as measured by speckle tracking when compared to normotensive controls [P-value < 0.001]. Also, many factors were associated with worse LA function in hypertensive patients as old age, high BMI, DM, LV diastolic dysfunction, high LV mass index, larger LA size, lower LA expansion index and higher systolic BP

Conclusion: Speckle tracking echocardiography is a useful novel technique in detecting LA dysfunction in hypertension even before LA enlargement occurs

Potential Zoonotic Trematodes Recovered in Stray Cats from Kuwait Municipality, Kuwait

Stray cats are a common feature roaming the streets and alleys of Kuwait; they could be a source of parasites, including trematodes, that affect humans. A survey was conducted to identify feline trematodes and throw the light on their public health significance in Kuwait. Out of 240 stray cats trapped from different localities of Kuwait from June 2011 to May 2012, 59 (24.6%) were found to be infected with 14 species of trematodes. The most common were trematodes of the genus Heterophyes, particularly H. heterophyes and H. dispar that were found in respectively 15.8% and 10.8% of the cats examined. Other trematodes recorded, with lower prevalences, were Heterophyes nocens (2.9%), Haplorchis taichui (3.8%), Stictodora sawakinensis (2.1%), Stellantchasmus falcatus (1.6%), Echinochasmus japonicus (1.6%), and Mesostephanus dottrensi (1.3%). Centrocestus cuspidatus, Galactosomum fregatae, Ascocotyle sp., Mesostephanus appendiculatus, Haplorchis yokogawai, and Pygidiopsis genata showed the lowest prevalence (0.4%) and intensity. The majority of the trematodes are recorded for the first time in Kuwait and even in the Gulf region. The study reveals that stray cats are good indicators of fish-borne trematodes in the environment. As all trematodes recovered are zoonotic, their significance to public health should be considred.

Mechanisms of hepatotoxicity of chloroacetonitrile: an end product of water chlorination

Chloroacetonitrile is a disinfectant by-product of chlorination of drinking water and is considered as a directacting mutagenic and carcinogenic agent. Time-course and dose-response studies were performed to examine the mechanism of chloroacetonitrile-induced hepatotoxicity. In the time-course study, animals were scarified at 2, 4, 6 and 12 h after a single oral dose of chloroacetonitrile [38 mg/kg, p.o.]. In the dose-response study, rats were scarified at 2 h after a single oral dose of chloroacetonitrile [9, 19, 38, and 76 mg/kg]. In the time-course study chloroacetonitrile induced a significant decrease of hepatic glutathione, and activities of glutathione-S-transferase, glutathione proxidase and superoxide dismutase accompanied with an increase of hepatic malondialdehyde, plasma cytokines [IL-6 and 10 and TNF-alpha], serum aminotransferases and total bilirubin after 2 h of administration. Maximal alteration of the estimated parameters was observed at 4 h and returned to normal value at 6 h and/or 12 h after chloroacetonitrile treatment. Moreover, the alterations in oxidant, antioxidant parameters, inflammatory cytokines and the liver function tests were dose dependant. Histopathological findings supported the biochemical results. These data indicate that the mechanism of chloroacetonitrile-induced hepatotoxicity may be mediated through depletion of antioxidants, induction of oxidative stress and inflammatory cytokines

Evaluation of polysaccharide extracted from Spirulina sp as hepatoprotective agent against malignant cells

The aim of this investigation was insight the potential health effects of Spirulina and its extracts, especially its effect on the treatment of cancer. The anticarcinoma effect induced by polysaccharide was evaluated in vitro using Ehrlich Ascites Carcinoma Cells [EACC] and Hepatic cell line phase G2 [HEPG2]. LC50 for both were 6.1 and 8.93 microg/ml respectively. And in vivo, Polysaccharide exhibited more potent antiproliferation activity against Ehrlich Ascites Carcinoma Cell [EACC] through intraperitoneal injection of five groups of female mice.The 1st group serves as control, the 2[nd] group injected one time by EACC at dose 5xl0[6] cells/body weight, the 3[rd] group injected with polysaccharide three times at dose [50 mg/body weight crude extract] which is equivalent to 6.1 microg/ml for each injection. The 4[th] group was injected firstly by EACC at dose 5xl06 cells/body weight and then polysaccharide was injected three times 2 days apart at dose [50 mg/body weight crude extract] for each injection. The 5[th] group was injected three times with polysaccharide then with EACC one time at the same dose. All animals were sacrificed after 10 days. Biochemical and histopathological. Our study revealed that in both groups of either injection of mice with polysaccharide before and after EACC, the activities of both ALT and AST were normalized. Moreover the dramatic effects on WBCs, RBCs, and Hb were improved, indicating that polysaccharide is hepatoprotectant through the inhibition of the proliferation of EACC. This was confirmed with histopathological investigation which revealed that, most of hepatocytes of female mice injected with polysaccharide three times, then injected with EACC appeared intact with wide central vein. The blood sinusoids between hepatic cords revealed many phagocytic Von Kupffer cells. Many hepatocytes showed division and other appeared normal

Multidrug resistant typhoid fever in Egypt

Typhoid fever is a global health problem, with an estimated 20 million cases and 700.000 deaths annually. In Egypt, since the beginning of the 1980s, there has been an increase prevalence of multidrug resistance to the first line antimirobials, such as chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole [TMP-SMX], shifting the drug of choice for the treatment of typhoid fever to fl uoroquinolones and third generation cephalosporins. Was to detect if multidrug resistant [MDR] typhoid fever is still a problem in Egypt after two decades of its widespread. Also, we studied if resistance had appeared to quinolones and third generation cephalosporins which were widely used for treatment of typhoid fever in the last fi fteen years. In the period between March 2006 and March 2007, thirty seven patients with positive blood culture for Salmonella typhi were included in this study. They were 23 [62%] males and 14 [38%] females with age range from 3 to 45 years [mean 19 +/- 8.2 years]. Drug sensitivity tests showed that 34 [92%] of Salmonella typhi isolates were sensitive to chloramphenicol and 24 [65%] and 23 [62%] isolates were sensitive to ampicillin and TMPSMX, respectively. Only one [3%] isolate was MDR to chloramphenicol, ampicillin and TMP-SMX. All isolates were sensitive to ciprofl oxacin and ceftriaxone. Forteen [38%] patients were treated with chloramphenicol and twenty three [62%] patients were treated with ceftriaxone. All patients were cured. The mean time of defervescence for ceftriaxone and chloramphenicol was 3.7 +/- 1.2 and 5.8 +/- 1.2, respectively. Ceftriaxone was signifi cantly associated with a shorter time of defervescence compared with chloramphenicol. There is marked reduction of prevalence of MDR Salmonella typhi isolates and marked increase of susceptibility of these isolates to chloramphenicol, returning it to be one of the drugs of choice for treatment of acute typhoid fever. No drug resistance to ceftriaxone and ciprofloxacin was reported after many years of using for treatment of acute typhoid fever. Ceftriaxone was significantly associated with short time of defervescence making it the drug of choice for treatment of severe and complicated cases of typhoid fever. Due to high degree of resistance to ampicillin and TMP-SMX they should not be used as first line drugs for treatment of acute typhoid fever

value of clinical and pathological profiles of gastric cancer in Egypt

Stomach cancer is the 4[th] common cancer but the 2[nd] cause of cancer related death. This prospective study has been completed on 25 patients with invasive gastric cancer at Bab-Elsharea University Hospital and Beni-Suef University Hospital. Fifteen of them were males and 10 were females, their ages ranged from 31 to 68 years with an average of 57 years. All cases were clinically laboratory and radiologically assessed. Subtotal gastrectomy was performed for 17 patients [68%], while total gastrectomy was done for 8 patients [32%].In this study we reevaluate the surgical management of stomach cancer, the extent of gastric resection and the lymphadenectomy, hoping to answer the following questions is 4 cm safety margin applicable to all stomach cancer patients? is D3 gastrectomy should be done for every stomach cancer patient? And what is the clinicopathological factors affecting PN stage and infiltration length of the tumour?. The inclusion criteria includes differentiated gastric tumours, T2, local or locoregional disease with no ascites or peritoneal deposits, radical gastrectomy is done [total, proximal or lower] according to the site of the primary tumour, with lymphadenectomy one level beyond the level of palpable lymph node [D2 or D3]. Patients are classified according to the pathological lymph node stage [Japanese classification] "PN" into PNI when LN metastasis is confined to NI, PNII when LN metastases is confined to N2 and the patient are classified PNIII when LN metastasis are present in the N3. From all clinicopathological criteria studied; sex, smoking, tumour morphology, tumour grade, serosal invasion, T-stage and tumour size have significaht relation to the lymph node metastasis and PN stage other factors as age of the patient, presentation, histopathological type of the tumour, gastric mucosal abnormalities as presence of peptic ulcer, gastritis or metaplasia and the site of the tumour show no significant relation to the PN stage. The studied group are also classified according to the microscopic infilteration length into patient with infilteration length less than 2 cm and patient with infilteration length between 2 and 4 cm and the last group of patient have infiltration length more than 4 cm. The clinicopathological factors are compared in the above groups. Age of the patient, tumour morphology tumour grade, Laurence tumour classification, tumour size, lymphatic vessel invasion and serosal invasion, all these factors are significantly correlated to the microscopic infiltration length while patient sex. presentation, tumour size tumour histopathological type, gastric mucosal abnormality and other organ infiltration, all these factors are not significantly correlated to the microscopic infiltration length

1[st] line antimicrobial therapy for febrile neutropenic cancer patients

Empiric antibiotic regimens used in febrile neutropenic patients often include an extended spectrum cephalosporin, but the response of therapy in Gram positive coccal bacteremia has been unsatisfactory, thus new antibiotic with better activity against Gram positive bacteria should be tested. Antipseudomonal penicillins including piperacillin are effective against many Gram positive and Gram negative organisms. The aim of this work is to compare combination therapy with piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as first line in treatment of febrile neutropenic cancer patients. This study is a single center, prospective and randomized trial performed in pediatric branch wards, of the National Cancer Institute, Cairo University. All patients were subjected to full clinical and laboratory evaluation including microbiological study. Doses were given according to the International Antimicrobial Therapy Cooperative Group [IATCG] of the European Organization for the Research and Treatment of Cancer [EORTC]. 164 febrile neutropenic episodes were enrolled on this study. 82 patients with 105 [64%] high risk febrile granulocytopenic episodes were considered eligible. 53 were treated with piperacillin-tazobactam plus amikacin [group A], and 52 were treated with ceftazidime plus amikacin [group B]. The overall success in group A was higher than group B, yet, the difference was statistically insignificant with a p value=0.2. Time of defervecence was significantly shorter in piperacillin-tazobactam group [p=0.001]. There was no infection related mortality in this study. Side effects were encountered in 3 [5.6%] cases receiving piperacillin-tazobactam in the form of mild skin reaction. 55.7% of positive cultures yielded Gram positive organisms. Staphylococcus species were the most common organism in both groups. Both Gram positive and negative organisms showed higher sensitivity to pipercillin-tazobactam compared to ceftazidime with a significant p value=0.05. Piperacillin-tazobactam is safe and more effective than ceftazidime in febrile neutropenia in pediatric cancer patients

Haemophilus influenzae meningitis at the Abbassia Fever Hospital 1982 to 2001

The aim of this work was to study the prevalence, clinical presentation, outcome of patients with H. influenza meningitis and to determine the efficacy and safety of new therapeutic regimens that could be used in the treatment of the disease and test the susceptibility of the isolates to different antibiotics. During the period from January 1982 to December 2001, 472 children with H. influenza meningitis were admitted to El-Abbassia Fever Hospital, Meningitis Ward in Cairo. The study indicated that H. influenzae is the main causative organism in Egypt accompanied high morality and morbidity rates. Although there has been no increase in the number of cases over the year, a steady increase in the resistance to the traditional drugs has occurred. Thus, it was recommended to use third generation cephalosporins for treatment and Hib vaccines in children

Lactic acid as a predictor for erythrocyte transfusion in healthy preterm infants with anemia of prematurity

Up till now there is no guidelines for blood transfusion in healthy preterm infants. In this study we try to show if blood lactate measurement may be used as in index for transfusion in those preterms. The present study included 33 healthy preterm infants, received no medications except for theophyline and prophylactic antibiotics, required no intravenous fluids or oxygen therapy. They were divided into two groups, [group I] included 23 babies, given once transfusion according to the decision of physician in charge. The main indications for transfusion were Hb below 8 gm/dl, Hct value below 30% and poor weight gain. The remaining 10 babies were not transfused [group II] and used as a control to measure normal blood lactate. The infants in the two groups were subjected to thorough history, clinical examination and selective laboratory investigations including CBC and blood lactate measurement. The results of group I were compared with each other before and after transfusion and with that obtained from group II. Comparing data of group I with that of group II, significant increase in blood lactate and decrease in Hb, Hct and body weight were detected in group I before blood transfusion. Pre and post transfusion data were compared in group I, there were significant decrease in blood lactate levels and significant increase in Hb, Hct and body weight, after transfusion. Blood lactate had a high specificity 100% and sensitivity 91.3%. We can conclude that measurement of blood lactate level as an indicator of early tissue hypoxia could identify otherwise healthy preterm infants who might benefit from blood transfusion. Thus, it may prevent unnecessary transfusion

Evaluation of slide agglutination and widal agglutination tests in the diagnosis of acute enteric fever in Cairo

This study we compared the sensitivity, specificity, positive predictive and negative predictive values of Widal tube agglutination test and slide agglutination test, which was used in many fever hospitals for diagnosis of acute typhoid fever because of its simplicity and cheapness. This study included 25 normal controls, 153 diseased control patients [non-typhoidal] and 36 acute typhoid fever patients. The sensitivity, specificity, positive and negative predictive values for Widal tube agglutination test were 91.7%, 100% and 98% and for slide agglutination test were 86%, 83%, 55.4% and 97.7%, respectively. It was concluded from this study that Widal agglutination test is a valid test for diagnosis of acute typhoid fever in Egypt and that slide agglutination test is a rough screening test for suspected typhoid diagnosis which is valuable for exclusion and not for diagnosis

Bone mineralization in hemiplegic patients

This study aimed at comparing bone mineral density [BMD] and bone mineral content [BMC] of the distal radius in the paralyzed upper limb to that of non-paralyzed one in hemiplegic patients. There is a significant decrease in BMD [BMC/ cm[2]] of the distal radius in paralyzed upper limb compared to the non paralyzed. In addition to comparing hand function in the hemiplegic side, there is asignificant positive correlation between BMD [BMC/ cm[2]] of the distal radius and hand grip strength, but not the Barthel index scores, in the hemiplegic side

Pneumococcal meningitis: drug resistance and prognostic factors

Sixty-seven patients with cerebrospinal fluid [CSF] culture positive for Streptococcus pneumoniae were included in this study. Out of the sixty-seven S. pneumoniae isolates, thirty-three were penicillin resistant, four were chloramphenicol resistant, three were resistant to penicillin and chloramphenicol and twenty-seven were sensitive to both penicillin and chloramphenicol. In patients with penicillin resistance to S. pneumoniae strains, chloramphenicol was used in the treatment of seventeen patients with a mortality rate of 12%. The poor prognostic factors in patients with pneumococcal meningitis depended on patients age, duration of illness [two days or more prior to hospital admission], coma on hospital admission and associated diabetes mellitus

Study of penile sensitity in patients with primary premature ejaculation

We have evaluated penile sensory levels in patients with primary premature ejaculation to determine whether there is an etiological basis for this disorder and whether there is a sensory difference among these patients Penile biothesiometry was performed in 78 patients with primary premature ejaculation and in 20 men with normal satisfactory ejaculation as a control group. Both patients and control men selected from the same age group [30-40 years]. Vibratory thresholds were recorded at the glans penis and both lateral aspects of mid penile shaft. Vibratory thresholds of the three location sites [glans penis and right and left mid penile shaft] in the patients group were significantly lower than those in the normal control group, Based on the glanular vibratory threshold, the patients were classified into three subgroups. The average of thresholds of the three location sites was used as an indicator for the penile sensitivity as a whole in each patient and it was termed by us as penile sensitivity index [PSI]. significant differences in PSI were detected between the three subgroups of patients. Patients with primary premature ejaculation have penile hypersensitivity with different grades. This may provide further implications for an organic basis of primary premature ejaculation. Penile sensitivity index [PSI] may provide a quantitative evaluation of premature ejaculation and may aid in the selection of therapy and evaluation of its outcome

KAP study of hepatitis B virus infection among Egyptian primary health care physicians

Hepatitis B infection is an unpredictable disease that may incapacitate a person for weeks or months and lead to complications; most patients recover. However, 5 to 10 percent of persons who become infected with hepatitis B virus become chronic carriers capable of spreading the disease to others for an indefinite period of time. Accurate information about Hepatitis B infection [HBI] is important for prevention. This work presents a KAP study among primary health care physicians as regards hepatitis B infection and provides recommendations to policy makers on activities to be taken in relation to health providers. The results pointed out that the majority of the studied group [91.5%] understand the significance of the problem, but only [38.5%] identify that HB vaccine is efficient in disease prevention. Again one third [33.5%] of the studied group reported that they were vaccinated or have been immune to HBI