Comportamiento de la vitamina C en un producto a base de lactosuero y pulpa de mango variedad Magdalena River (Mangífera Indica / ) durante el secado por aspersión / Behavior of vitamin C in a product based on whey and variety Magdalena River mango (Mangífera Indica /) during spray drying

El mango de hilacha y el lactosuero son dos productos perecederos con gran cantidad de nutrientes. El objetivo de esta investigación fue evaluar las condiciones de secado por aspersión de un producto a base de estas materias primas tratando de obtener la máxima recuperación de vitamina C. El producto se secó a temperaturas de entrada del aire caliente entre 120°C - 160°C y salida de 65°C a 74°C, empleando maltodextrina entre un 15% - 35% como agente encapsulante. Se evaluó la concentración en vitamina C (AOAC 967.21/90) y otros parámetros como higroscopicidad, solubilidad y color del producto. Las mejores condiciones de secado se definieron utilizando una concentración de maltodextrina del 27,5%, temperaturas de entrada y salida del aire de 138,2°C y 69,6°C, con una velocidad de aspersión de 24908 rpm, obteniendo una recuperación de vitamina C de 15,60 mg/100 g de producto (58,15%) y por encima del 80% de los demás constituyentes estudiados.

The mango of hilacha and whey are two perishables with a lot of nutrients. The objective of this research was to evaluate the conditions of spray drying of a product based on these raw materials trying to get the maximum recovery of vitamin C. The product was dried at inlet temperatures of hot air between 120°C - 160°C and outlet 65°C to 74°C using maltodextrin between 15% - 35%. The concentration of vitamin C (AOAC 967.21/90) and otherparameters such as hygroscopicity, solubility and color of the product was evaluated. The best drying conditions were defined using a concentration of 27,5% maltodextrin, inlet and outlet temperatures of the air of 138,2°C and 69,6°C with a speed of24908 rpm spraying, obtaining a recovery of vitamin C 15,60 mg/100 g of product (58,15%) and over 80% of the other constituents studied.

finite element study on stress distribution of two different attachment designs under implant supported overdenture

Objective: This study aimed to evaluate stress patterns generated within implantsupported mandibular overdentures retained by two different attachment types: ball and socket and locator attachments

Materials and methods: Commercial CAD/CAM and finite element analysis software packages were utilized to construct two 3D finite element models for the two attachment types. Unilateral masticatory compressive loads of 50, 100, and 150 N were applied vertically to the overdentures, parallel to the longitudinal axes of the implants. Loads were directed toward the central fossa in the molar region of each overdenture, that linear static analysis was carried out to find the generated stresses and deformation on each part of the studied model

Results: According to FEA results the ball attachment neck is highly stressed in comparison to the locator one. On the other hand mucosa and cortical bone received less stresses under ball and socket attachment

Conclusions: Locator and ball and socket attachments induce equivalent stresses on bone surrounding implants. Locator attachment performance was superior to that of the ball and socket attachment in the implants, nylon caps, and overdenture. Locator attachments are highly recommended and can increase the interval between successive maintenance sessions

Liver cirrhosis and splenomegaly associated with Schistosoma mansoni in a Sudanese woman in Malaysia: A case report

We report a case of a patient with Schistosoma mansoni infection who presented with liver cirrhosis and splenomegaly. She was diagnosed by a serological test and Kato-Katz thick smear stool examination. The patient was a 52-year-old woman from Sudan who came to Malaysia for a week to visit her sons. The patient lives in the middle of Rabak region, Sudan, a highly endemic area for schistosomiasis where her daily routine includes rearing of cows and farming. The site of toilet and sources of drinking water are canals and wells; both infested with snails. Patient had a long history of exposure and coming into contact with water from these canals and wells.

Liver cirrhosis and splenomegaly associated with Schistosoma mansoni in a Sudanese woman in Malaysia: A case report

We report a case of a patient with Schistosoma mansoni infection who presented with liver cirrhosis and splenomegaly. She was diagnosed by a serological test and Kato-Katz thick smear stool examination. The patient was a 52-year-old woman from Sudan who came to Malaysia for a week to visit her sons. The patient lives in the middle of Rabak region, Sudan, a highly endemic area for schistosomiasis where her daily routine includes rearing of cows and farming. The site of toilet and sources of drinking water are canals and wells; both infested with snails. Patient had a long history of exposure and coming into contact with water from these canals and wells.

Dynamics of brain natriuretic peptide in critically ill patients with severe sepsis and septic shock

Changes of B-type natriuretic peptide [BNP] in sepsis and its utility in predicting intensive care unit outcomes remains a conflicting issue. To investigate the changes in plasma levels of BNP in patients with severe sepsis/septic shock and to study the association of BNP levels with the severity of the disease and prognosis of those patients. Thirty patients with severe sepsis or septic shock were enrolled in our study. BNP measurements and echocardiography were carried out on admission and on 4[th] and 7[th] days. Blood concentrations of BNP were measured by commercially available assays [Abbott methods]. In-hospital mortality and length of stay were recorded multivariate analyses adjusted for acute physiology and chronic health evaluation score II [APACHE II score] was used for mortality prediction. Twenty patients admitted with the diagnosis of severe sepsis and 10 patients with septic shock. The in-hospital mortality was 23.3% [7 patients]. Admission BNP was significantly higher in the non-survivors 1123 +/- 236.08 versus 592.7 +/- 347.1 [P<0.001]. By doing multivariate logestic regression, the predicatable variables for mortality was APACHE II score, BNP, and then EF. BNP concentrations were increased in patients with severe sepsis or septic shock and poor outcome was associated with high BNP levels; thus, it may serve as a useful laboratory marker to predict survival in these patients

Attitudes of cairo university medical students toward smoking: the need for tobacco control programs in medical education

Tobacco smoking rates are increasing in developing countries and so are tobacco-related chronic diseases. Reported figures from the WHO show rates of smoking in Egypt as high as 20% but limited information is available about smoking specifically among physicians and medical students. Final-year medical students of Cairo University were surveyed regarding their tobacco behavior and attitudes using a modified Global Health Professions Student Survey. We approached 220 students by randomly selecting clinical units into which they were assigned and requested completion of the survey. Ever users of some form of tobacco comprised 46.7% of students sampled, current users of cigarettes comprised 17.4%, and current users of water pipe 'sheesha' comprised 17.6%. The vast majority [87.7%] of students believed that smoking is a public health problem in Cairo and supported restriction of tobacco. Yet, only 58.5% stated that they were taught it is important for physicians to provide tobacco education materials to patients. Among ever users of cigarettes, 54.4% believed health professionals do not serve as health role models for patients, and only a small percentage of all students [34.2%] stated that they had received some form of training on smoking cessation in their medical curriculum to be able to instruct patients. A high rate of smoking was revealed among medical students in Cairo. Overall, approximately 23.4% of students were currently smoking cigarettes and/or sheesha, and 46.7% were ever users of some form of tobacc o. A formal antitobacco program for medical students should be incorporated into their medical curriculum to change the attitudes of medical students and overcome the anticipated increase in chronic diseases in Egypt

Reported survival with severe mixed acidosis and hyperlactemia after toluene poisoning

Lactic acidosis is a recognized complication of the inhalant abuse such as toluene, especially in patients with renal insufficiency. We report a case of severe metabolic acidosis and hyperlactemia due to toluene sniffing. The favorable outcome, despite extremely poor clinical symptoms, signs, laboratory and radiological findings, was unexpected. Specific aspects of the clinical course are addressed. Toluene sniffing should be considered in evaluating sever metabolic acidosis. Favorable outcome could be achieved with early diagnosis and proper interventions

Relationship between HCV infection and Insulin resistance in non-obese non-diabetic patients

Hepatitis C is a major cause of liver-related morbidity and mortality and represents a major public health problem in Egypt and worldwide. There is growing evidence as regard to the association between hepatitis C virus [HCV] infection and type 2 diabetes mellitus. However, the mutual link and related virological implication have not been fully clarified. Insulin resistance [IR] plays a primary role in the development of type 2 DM. This is supported by the results of prospective longitudinal studies showing that IR is the best predictor of the development of type 2 DM, preceding its onset by 10-20 years. To assess the correlation between HCV morbidity and Insulin resistance [IR] detected by HOMA test in none diabetic none obese HCV patients. The study participants were subcategorized into two groups,Group [I]: included 867 healthy subjects [negative HCV RNA] as a control group. Group [II]: included 277 patients with chronic HCV as a study group. The 2 groups were subjected to thorough history taking, full clinical examination, Anthropometric study,ultrasonographic examination and laboratory investigations including liver functions, viral markers, and qualitative PCR for HCV RNA ,lipid profile, glucose profile and HOMA test. This study revealed higher insulin resistance in the HCV study group than the control group

Progressive multifocal leukoencephalopathy limited to the posterior fossa

Progressive multifocal leukoencephalopathy (PML) is a rapidly progressive demyelinating disease caused by the reactivation of JC papova virus usually in immunocompromised hosts.1 The disease is a chronic viral infection resulting in mortality within a year.2 The condition characterized by white matter changes in multiple locations of the brain is caused by destruction of the oligodendrogliocytes.2 We report a case of AIDS associated PML presenting with progressive cerebellar symptoms, with the unusual feature of imaging abnormalities limited to the posterior fossa.

Carcterización fisicoquimica y reologica de la pulpa de guayaba (Psidium guajava L. ) variedades hibrido de klom Sali, Puerto Rico D14 y Red / Physicochemical and rheological characterization of guava pulp (Psidium guajava L. ) varieties hybrid Klom Sali, Puerto Rico, D14 and Red

Las propiedades reológicas de los jugos de fruta dependen de su variedad, estado de madurez, concentración de jugo/pulpa y variación de temperatura; los valores de índice de comportamiento al flujo e índice de consistencia son limitados, considerando la cantidad de variedades de guayaba. En este trabajo se caracteriza reológicamente la pulpa de guayaba (Psidium guajava L.) en las variedades Híbrido de Klom Sali, Puerto Rico, D14 y Red, cultivadas en el departamento de Córdoba (Colombia); las pulpas son obtenidas mediante refinadora con malla 1.5mm de abertura. Las medidas reológicas se realizan en un viscosímetro Brookfield modelo DV-II+ Pro, utilizando la aguja Nº 5 para las variedades Klom Salí, Puerto Rico y Red, y Nº 6 para la variedad D14. Las pulpas de guayaba presentan pH entre 3.9–4.6, ºBrix entre 9-10, acidez titulable expresada como porcentaje de ácido cítrico entre 0.56–0.96%, e índice de madurez entre 9.38–17.94; su comportamiento reológico se ajusta adecuadamente al modelo de Oswald de Waele o ley de potencia (R2 ≥ 0.989), comportándose como un fluido seudoplástico (n ≤ 0.307) y presentando tixotropía las variedades Puerto Rico (14.16%), Red (18.54%) y D14 (18.48%).

prognostic significance of proliferative factors, angiogenesis and matrix metalloproteinase in non small cell lung carcinoma

The outcome of surgical treatment of non small cell lung carcinoma [NSCLC] remains poor. In many patients the biological behavior of NSCLC does not follow a definite pattern, and can not be accurately predicted before treatment. Thus, the proliferative potential of tumor cells, angiogenesis and matrix metalloproteinase [MMP] are an important prognostic factors. In the present study, expression of cyclin D1, CD34, MMP-2 and AgNORs count was estimated in a group of 80 surgically resected NSCLC using immunohistochemistry. The results were compared with clinicopathological parameters including patients' survival 41 cases [51.3%] revealed positive immunoreactivity for cyclin D1. Cyclin D1 overexpression is significantly higher [<0.05] in patients with lymph node metastasis [63.3% versus 15%], and with advanced pathological stages [stage I, 12.5%, II 37.5%, III 60% and IV 86.7%]. Patients with cyclin D1 positive immanoreactivity revealed a significantly shorter overall survival than patients with negativity. There is no significant correlation [p > 0.05] between CD34 score and histological type and grade, while there is significant positive correlation [p < 0.05] between high CD34 score and lymph node metastasis, distant metastasis, tumor stage and shorter over survival. No significant correlations [p > 0.05] were found between MMP-2 expression and histological type, grade and lymph node metastasis. In contrast the intensity of MMP-2 staining in tumor cells correlated significantly [p < 0.05] with tumor stage, and distant metastasis. Overall survival was shorter in patient with MMP-2 expression, although the difference does not reach statistical significant AgNORs count was found to correlate significantly [p < 0.05] with tumor grade, and the size, shape and distribution pattern was found to show a characteristic difference between non-neoplastic and neoplastic lesions. In conclusion, an overexpression of cyclin D1, angiogenesis, expression of MMP-2 and high AgNORs count are a poor prognostic factors for NSCLC, also MMP-2 and AgNORs can be used to differentiate between non-neoplastic and neoplastic lung lesions

Abstracts of award-winning posters, 14th annual health sciences poster conference, Faculty of medicine, Health Sciences Centre, Kuwait University, Kuwait, April 21-23, 2009

It has been shown in the rat that insulin affects expression of the rat equilibrative nucleoside transporter [rENT] 2 and rat concentrative nucleoside transporter [rCNT] 1 and 2 in cardiac fibroblasts and adenosine uptake by cardiac myocytes. The aim of this study was to explore the effects of streptozotocin [STZ]-induced diabetes in the rat heart on the expression of rENTl and 2 and rCNTl, 2 and 3. Diabetes was induced in Sprague-Dawley rats by an i.p. injection of STZ [60 mg/kg]; controls were treated with vehicle. Diabetes was confirmed by plasma glucose >17 mM. Rats were sacrificed after 4 weeks, and cardiac muscle samples were frozen in liquid N[2]. Real-time PCR was used to estimate the threshold cycles for target amplification [Ct] values. The differences between the Ct values for ENTs and CNTs and the Ct values for the housekeeping gene [3-actin were calculated [Act], and the difference between diabetic and control rats was tested for significance. Data are presented as mean +/- SD from 3 samples. Results: The Ct value of [3-actin did not differ significantly between the groups [p > 0. 05], so this gene was used as the endogenous control. In the control group, the mRNA for rCNT2, rENT2, rENTl and rCNTl were detected with the Act 2.4 +/- 0.4, 4. 3 +/- 0.3, 7.4 +/- 0.6 and 8.1 +/- 0.1, respectively. The mRNA for rCNT3 was apparently absent. Four-week diabetes caused a significant decrease in the amount of mRNA for rCNTl [p < 0.05 vs. control], while the amount of mRNA for other transporters did not change significantly. The observed changes in the amount of rCNTl mRNA may indicate a decrease in the amount of this pyrimidine-selective transporter in the membrane, which in turn could reduce the cellular uptake of py-rimidines in diabetes

Non invasive predictors for decision making in acute exacerbation of chronic obstructive pulmonary disease [AECOPD]

Accurate prediction for prognosis is important for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease [AECOPD] requiring mechanical ventilation [MV] and for proper assessment of decision making regarding plane of management and ongoing hospital morbidity and mortality. The present study was designed to determine the predictability of non invasive parameters including APACHE II score, arterial blood gases [ABGs] and bedside Echocardiography in management of critically ill patients with COPD exacerbation either invasively or conservatively. The study was conducted on 60 adult patients [50 male and 10 female] with AECOPD, with mean age 60.1 +/- 6.2 were admitted to intensive care unite [ICU]. All patients were subjected to arterial blood gases [ABGs], APACHE II score and bedside Echocardiography study. Patients were divided into two groups according to ventilatory requirement invasive or non invasive into group I [34 patients] with need of MV and group II [26 patients] with success of conservative treatment. We found that APACHE II score, had a high predictive value for MV necessity, it was 19.17 +/- 3.4 in the group I Vs 11.46 +/- 4.4 in the group II also Doppler evidence of pulmonary hypertension had high predictive value for MV necessity. The mean value of PASP was 48.95 +/- 12.44mmHg in group I, Vs 30.71 +/- 6.5mmHg in group II with significant p value. The mean value of PAPm was 42.08 +/- 6.89mmHg in group I Vs 31.50 +/- 7.71 mmHg in group II with significant p value. Increases in the APACHE II score, the mean pulmonary artery pressure [PAPm] and pulmonary artery systolic pressure [PASP] were significantly more in patients who died in comparison to survivors in the group I. APACHE II score, bedside Echocardiography and routine arterial blood gases could be used as a marker to identify patients at the time of admission who are likely to have a poor prognosis, so that such patients can be managed aggressively, either medical conservative treatment or mechanical ventilation [NIPPV or Invasive MV]

Transformation and expression of Na+/H+antiporter vacuolar [AtNHX1] gene in tobacco plants under salt stress

Saline soil is a serious problem worldwide, and it is necessary to improve the salt tolerance of plants to avoid the progressive deterioration of saline soil. Agrobacterium based system was employed to transfer a vacuolar Na[+]/H[+] antiporter [AtNHX1] gene into tobacco leaf discs. Hundred thirty putative transgenic tobacco plants were obtained. The leaf painting assay was applied to select the transformants containing the bar gene [basta herbicide resistance]. In addition, the stable integration of the AtNHX1 gene was confirmed by PCR analysis. The expression of encoding sequence AtNHX1 gene was detected by the accumulation of salt in the transgenic tobacco plants under the salt stress conditions. Transgenic tobacco plants expressing the AtNHX1gene were able to grow in the presence of 150 to 300 mM NaCl and accumulated significantly at high concentrations of sodium ions in the leaves. However, the wild type plants could not tolerate a concentration up to 150 mM NaCl. This remarkable high salt tolerance in transgenic tobacco plants can be helpful in the future for applying important phytoremdiation plants in high saline lands

Diversidad y abundancia ictiofaunística del río Grande de Térraba, sur de Costa Rica

The diversity, abundance and distributional pattern of freshwater fish communities in the Térraba River, south Costa Rica, were investigated from the early dry season of 2004 to early rain season of 2005. There have been no preview studies on the freshwater fish distribution in Térraba. Therefore, the aims of this study were to determine fish species richness, abundance and distribution there. Fish sampling was done using a combination of gears such as gill net, fine mesh net and visual observation. Thirty three species, 26 genera and 14 families were collected in four sampling sites along the river. The number and biomass captured during the entire study was 984 individuals and 147 410.9 g respectively. Most of them are carnivorous species (48%), 33.3% are omnivorous and 12% detritivorous, and only two species are herbivorous. The most important species in relative abundance (56.5%) and biomass (53.7%) in the study area was the machaca (Brycon behreae). It should be clear that although the list of fish species that occur in Térraba River is reasonably complete, knowledge of their ichthyogeographic history patterns is superficial. The main community component was secondary freshwater species; with 17 invading brackish water species and one introduced species (tilapia O. niloticus). Nine species are reported for the first time in this river. The diversity index H` varied from 2.32 (El Brujo) to 1.67 (Coto), a similar pattern was also showed for the other indexes. Most of our results were similar to those of previous studies on freshwater fish distribution elsewhere, however no significant correlation between species distribution and environmental variables was found, and we hypothesized that the depth and water velocity and geomorphological are major environmental variables that influence the fish distribution. Our findings are opposed to the tendency, for species composition, to increase from upstream to the mouth of the river, which is probably due to two major human activities (discharge of waste of pineapple fields and sediments in the main channel). These activities could constitute in the future a real threat for the fish population and other aquatic organisms. Growth rates, competition, predation pressures, community organization, biotic versus physical factors in relation to distribution, and many other aspects of fish biology remain to be studied. Future surveys will involve more quantitative surveys in different seasons and over time to monitor the long-term variation in the diversity and abundance of freshwater fish species in Térraba. Rev. Biol. Trop. 56 (3): 1429-1447. Epub 2008 September 30.

Desde el inicio de la estación seca del 2004 hasta la estación lluviosa de 2005, se llevó a cabo una investigación, con el objetivo de determinar la diversidad, abundancia y patrones de distribución de las comunidades de peces de agua dulce del río Grande de Térraba. El muestreo de peces se llevó a cabo utilizando una combinación de artes de pesca, entre ellas las redes agalleras, redes finas y observaciones visuales. Fueron recolectadas 33 especies, 14 familias y 26 géneros en las cuatro estaciones. Se capturaron 984 ejemplares para una biomasa de 147 410.9 g. La mayoría de las especies son carnívoras (48%), 33.3% son omnívoras y 12% detritívoras y sólo dos especies son herbívoras. La especie con mayor abundancia relativa (56.5%) y biomasa (53.7) fue la machaca (Brycon behreae). Aunque la lista de especies de peces en el río Térraba parece razonablemente completa, el conocimiento sobre los patrones ictiogegráficos es superficial. El principal componente comunitario son los peces de agua dulce secundarios con 17 especies estuarinas y una especie introducida (tilapia O. niloticus). Nueve especies son registradas por primera vez. El índice de diversidad H´ varió de 2.32 (El Brujo) a 1.67 (Coto), un patrón similar se encontró para los otros índices aplicados. Muchos de nuestros resultados fueron similares a los de previos estudios sobre distribución de peces de agua dulce en otras zonas, sin embargo no se encontró correlación significativa entre la distribución de especies y las variables ambientales. Se hipotetiza que la profundidad, velocidad del agua y atributos geomorfológicos son las variables físicas que influencian la distribución de peces. Los resultados de este estudio difieren de la tendencia de que la riqueza de especies se incrementa desde la parte alta hacia la boca del río, esta condición se atribuye a dos actividades humanas (descarga al canal principal de desechos de los cultivos de piña y sedimentos contaminados). Estas actividades podrían ser, en el futuro, una amenaza real sobre los peces y otros organismos acuáticos. Se deben estudiar otros aspectos de la historia natural de los peces de la zona, tales como crecimiento, competencia, depredación, organización comunitaria y los factores físicos y/o bióticos relacionados con la distribución ictiofaunística.

Post-traumatic refractory intracranial hypertension and decompressive craniectomy

Decompressive craniectomy [DC] removes the rigid confines of the bony skull, increasing the potential volume of the intracranial contents and circumventing the Monroe Kellie doctrine. To study the effect of early decompressive craniectomy [DC] <24 hours versus conservative treatment on the outcome of severe traumatic brain injury. Retrospective study, on 20 consecutive patients treated between 2005 2007 for severe intracranial hypertension without intracranial mass lesion, was done. In all patients, treatment included sedation, paralysis, aggressive temperature control, mild hyperventilation PCO2 35 40 mmHg, intracranial pressure [ICP] monitoring and head elevation 30 degrees. Early DC with early flap replacement was carried out in 9 patients [45%] where 11 patients were managed with non operative treatment, outcome was followed over 12 months by Glasgow outcome score [GOS]. 8 patients [89%] in the craniectomy group survived, one of them had persistent vegetative state [PVS]. On the other group, 7 patients survived [63%], two of them had PVS, ICP was significantly lower in the DC group P<0.05. Early decompressive craniectomy [DC] may be effective in reducing the mortality and prevention of early irreversible ischemic changes which may be effective in treatment of secondary deterioration that may lead to death or severe neurological deficit

Effect of training programs on some pulmonary functions and physical work capacity of students of faculty of physical education of Assiut University

This study included 400 students of Faculty of Physical Education of Assuit University of both sexes. It was carried out to study the effect of the Faculty training program on some pulmonary function test, maximum oxygen consumption [VO[2max]], physical work capacity [PWC[170]], ratio and oxygen saturation. The study showed the following: Pulmonary function test values: at the start of the studying year, the mean values of pulmonary function test showed non-significant change in all studied groups after Karpman test on comparing with those before it [males and females]. The values of male and female students significantly increased with training progress [from the start of the training period till the end of twenty week]. The values of the fourth year [male and female] students were significantly higher than that of the first year students. The values of male students were higher than that of the female among all studied grades. Physical work capacity [PWC[170]] and VO[2max]: the mean values of [PWC[170]] and VO[2max] of all students [male and female] were progressively increased with training period from the start of the studying year to the period of ten weeks after the start. After that, no significant changes could be recorded on comparing with that after twenty week. The mean values of the fourth year students were the highest while the first year values are the lowest both in male and female students, The mean values of male were higher than that of the female in all studied groups. The ratio [PWC[170] to the weight]: the mean values of the ratio [PWC[170] to the weight] of both male and female students increased progressively with the training period till the end of the twenty weeks, The mean values of female ratio were higher than that of the male in all studied groups. Oxygen saturation: the mean values of both male and female students were not affected by training progress. The mean values of oxygen saturation of male students were significantly higher than that of female students. There was non-significance decrease in oxygen saturation in both male and female students after Karpman test

Cancer magnitude, challenges and control in the Eastern Mediterranean Region

Cancer is increasingly recognized as a major and growing health concern in the Eastern Mediterranean Region [EMR]. This report outlines the current burden of cancer in the Region and the challenges faced by the countries; these are mainly lack of national cancer surveillance, lack of a model of integrated care for noncommunicable disease prevention in general and cancer in particular, inadequate national capacity-building and lack of programme sustainability. Strategies for cancer prevention, control and care in the Region are discussed, such as: the formulation of evidence-based policies, mobilization and appropriate allocation of resources, active participation of all stakeholders, government commitment to legislation, education and international collaboration

Nosocomial infections caused by klebsiellae species with plasmids carrying bla shv-5 extended-spectrum beta-lactamase gene in Mansoura university hospitals

SHV-5 is a variant of SHV-1 and it is considered now one of the most important ESBL enzymes produced by Klebsiellae species. In this study we aimed to detect the prevalence of plasmid encoded SHV-5 among Klebsiellae strains causing nosocomial infections in Mansoura University Hospitals [MUH]. One hundred and seventy four Klebsiellae strains were isolated from overall 680 cases of nosocomial infections [25.59%] acquired within MUH over 4 months period from July to November 2004. One hundred and thirty six isolates [78.16%] of them were K. pneumoniae and 38 isolates [21.84%] were K. oxytoca. MICs [micro g/ml] of the isolated strains was done for augmentin, cefoperazone and ceftazidime using E test. One hundred and forty one [81.03%] of them were beta- lactamase producer as detected by nitrocefin discs, where 77 isolates from ?-lactamase producing strains were ESBL producers constituting 44.25% of Klebsiellae isolates. Sixty six ESBL producing strains of total 77 were isolated from cases of blood stream infections [85.71%]. Sixty five ESBL producing strains were isolated from neonatal intensive care unit [NICU] [84.42%]. All ESBL producing strains [n=77] posses at least one large plasmid > 23 kbp. SHV-5 gene was amplified by PCR after plasmid isolation from ESBL producing Klebsiellae isolates, reveal that 68 isolates [88.31%] were harbored SHV-5 gene on their large plasmids. In conclusion we found that the SHV-5-producing K. pneumoniae isolates were recovered from different wards of Mansoura University Hospital during the studied period. Thus, it was hypothesized that one clone may have persisted in that hospital. We recommend that infection control measure of endemic ESBL producers should include : the consumption of the broad-spectrum cephalosporins needs to be restricted to reduce the selection pressure which enables the proliferation of ESBL producers in hospital, continuous application of infection control program as; surveillance, hand washing and contact isolation procedure