Predictors of renal replacement therapy and mortality in children with chronic kidney disease

To study the epidemiology of chronic kidney disease [CKD] in children, and to look for risk factors to predict renal replacement therapy [RRT] and mortality. This is a retrospective cohort study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 2006 and 2014, where the files of 1,000 children with CKD were reviewed. We determined the effect of consanguinity and hypertension, and being a Saudi indigene on mortality and RRT. We compared children with congenital versus non-congenital causes of CKD. The mean +/- standard deviation age at presentation was 4.9 +/- 4.3 years. The median duration of follow up was 1.5 [interquartile range [IQR]: 0.4-4.0] years. Only 9.7% of children received RRT, and 8.3% died. The underlying etiology for CKD was congenital in 537 children. The congenital CKD group presented at a younger age group [3.5 +/- 4.0 versus 6.6 +/- 3.9 years, p<0.0001], had more advanced stages of CKD [p<0.0001], higher rates of consanguinity [75.4% versus 47.1%, p<0.0001], and RRT [p<0.004] than children with non-congenital CKD. Risk factors for RRT among children with CKD include being a Saudi indigene [relative risk [RR]=1.49, 95% confidence interval [CI]: 1.01-2.21], and hypertensive [RR=5.29, 95% CI: 3.54-7.91]. The risk factor for mortality was hypertension [RR=2.46, 95% CI: 1.66-3.65]. Congenital causes of CKD represent the main etiology of CKD in children living in the western province of Saudi Arabia. Significant risk factors for RRT include congenital CKD, Saudi nationality, and hypertension. Hypertension is also a predictor of mortality in children with CKD

Morbidity and mortality in icu patients with end stage liver disease

Acute or chronic liver failure is associated with numerous complications which may occur in combination and patients may require intensive care unit [ICU] treatment; many do not survive. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. To estimate the frequency of different morbidity changes and to evaluate risk factors responsible for mortality among patients with end stage liver disease [ESLD] admitted to the ICU. A total of 120 patients with ESLD were enrolled [102 males [85%] and 18 females [15%]. All were consecutively admitted to the ICU at the Tropical Medicine and Gastroenterology Department, Assiut University Hospital from May 1[st] to August 31[st], 2013. Full history taking, thorough clinical examination, full investigations and assessment of patients accordinglo C-hild-Turcotte-Pugh [CTP] class and Model for End-stage Liver Disease [MELD] score were done with close monitoring and follow up. The mean age of patients was [56.23 +/- 11.21] years. Regarding clinical presentation, hepatic cncephalopathy [HE] was found in 87.5%, jaundice in 60%, hematemesis in 41.7%. hepatorenal syndrome [MRS] in 35.8% and spontaneous bacterial peritonitis [SBP] in 20.8%. The majority of patients [86.7%] were CTP class C. Mortality rate was 57.5%; the main causes of death were HRS [10.8%], HE[21.7], aspiration pneumonia [10%], septic shock [2.5%] and irreversible shock in only.7%. There was a significant correlation between mortality and old age, CTP and MELD scores and a longer stay at the ICU. We found six risk factors independently affecting the outcome of ESLD patients in the ICU. Those were HE, jaundice, HRS, increased white blood cell count, increased hemoglobin and decreased prothrombin concentrations. Among ESLD patients having more risk factors, mortality rates were higher, 86.2% with 5-6 risk factors and 21.7% with 1-2 risk factors. Rates of improvement were highest with 1-2 risk factors [78.3%] and worst with 5-6 risk factors [13.8%]. The mortality rate in of ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP and MELD scores as well as HE, HRS and jaundice were significant predictors of mortality in ESLD patients in the ICU. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin and prothrombin concentrations were indepejident risk factors affecting the outcome of ESLD patients in the ICU

Risk factors and outcome in ICU patients with end-stage liver disease

Acute or chronic liver failure is associated with numerous complications that may occur in combination, and patients may require ICU treatment. Therefore, it seems necessary to identify prognostic clinical parameters and risk factors at the time of ICU admission. The present study aims to estimate the frequency of mortality and evaluate morbidity from cirrhosis in patients with end-stage liver disease [ESLD] admitted to the ICU and evaluate the relationship between the demographic, clinical, and laboratory data [potential risk factors] of those patients and mortality. A total of 120 patients with ESLD were enrolled [102 [85%] male and 18 [15%] female patients]. History taking, clinical examination, and other laboratory investigations were carried out, and patients were classifi ed according to the Child-Turcotte-Pugh [CTP] and the model for endstage liver disease [MELD] scores. Regarding the clinical presentation, hepatic encephalopathy [HE] was found in 87.5% of patients, jaundice in 60%, hematemesis in 41.7%, hepatorenal syndrome [HRS] in 35.8%, and spontaneous bacterial peritonitis in 20.8% of patients. The mortality rate was 57.5%; the main causes of death were HRS [40.8%], HE [21.7%], aspiration pneumonia [10%], septic shock [2.5%], and irreversible shock [1.7%]. There was a significant relationship between mortality and old age, CTP and MELD scores, and a longer stay at the ICU. Increased white blood cell count, increased hemoglobin and decreased prothrombin concentration, and elevated creatinine were independent risk factors of mortality in ESLD patients in the ICU. Mortality rates were higher in patients with 5-6 risk factors [86.2%] than in those with 1-2 risk factors [21.7%]. Mortality rate in ESLD patients admitted to the ICU was 57.5% and the most common cause of death was HRS. CTP, MELD score, HE, HRS, and jaundice were significant predictors of mortality in ESLD patients. Mortality increased with increased number of risk factors. Creatinine level, white blood cell count, hemoglobin, and prothrombin concentration were independent risk factors of mortality in ESLD patients

pharmaceutical study on antifungal drugs for topical application

The objective of the present study was to design and develop topical pharmaceutically acceptable nonionic surfactant systems for poorly water-soluble triazole antifungal agents such as Fluconazole [flu.] and Terconazole [ter.]. Several systems have been developed using selected ingredients of oils with penetration enhancing properties and antimicrobial activity, surfactants and co-surfactants. All ingredients were able to form clear microemulsione that differ in their domain area according to the types and ratios of the ingredients used. The developed formulae were evaluated with respect to their physic-chemical characteristics like electrical-conductivity, particle size, rheological behavior and apparent viscosity as well as in vitro drug release in acetate buffer pH 5.5. Accelerated physical stability studies were achieved for all systems to confirm the inherent high stability characteristics of the microemulsion. Microbiological efficacy of medicated and nonmedicated formulae have been studied and compared with each other and with some of the available commercial products against Aspergillus niger, Candida albicans, and Trichophyton mentagrophytes. Finally, the chosen formulae were conducted to [21-day cumulative irritancy patch] irritation test followed by a clinical study. The clinical results revealed that most of patients were improved affirming the results of microbiological activity especially against dermatophytic infections. Variations in curative or improvement time were related to the difference in case severity, adherence to the treatment, prevention tips that were dispensed to patients and some other individual variations e.g. skin type, life style, age, gender, etc

Results of endoscopic sclerotherapy with n-butyl-2-cyanoacrylate versus ethanolamine oleate in treatment of bleeding gastric varices

Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension. Gastric variceal injection of N-butyl-2-cyanoacrylate has been shown to be effective however: rare serious side effects have been reported as pulmonary embolism and portal vein thrombosis. Also, the optimal treatment of bleeding gastroesophageal varices is not yet fully determined and whether to use ethanolamine oleale or N-butyI-2-cyanoaCrYlate for sclerotherapy is not yet clear. Aim of the work: To compare between N-butyl-2-cyanoacrylate [NBC] and ethanolamine oleate [EAO] injection in patients with bleeding gastric varices. This study included 157 patients with bleeding gastric varices underwent sclerotherapy in 4ssuit University Hospital Endoscopy Unit. Fifty two patients with bleeding isolated gastric varices [IGV] underwent sclerotherapy with a mean of 2 mL NBC. One hundred and five patients with bleeding gastro-oesophageal varices [GOV] were randomally divided into 2 groups. The first group included 36 patients were subjected to endoscopic variceal obturation using NBC. The second group included 69 patients were subjected to endoscopic sclerotherapy using EAO. Outcome parameters were primary haemostasis [bleeding control within the first 48 hs.], and recurrent bleeding [after 48 hs. of oesophago-gastro-duOdefl0Sc0PY]. All those patients were followed up for one week after sclerotherapy to detect rebleeding or any intervention related complications. Primary haemostasis was significantly higher in patients treated with NBC than those treated with EAO [96.6% vs. 82.6%; p< 0.005]. Re-bleeding within one week after initial sclerotherapy was significantly lower in patients treated with NBC than those treated with EAO [5.9% vs. 19.3%; p< 0.05]. In patients with gastroesophageal varices type 1, there was no statistically significant d4fference between NBC and EAO sclerotherapy regarding primary haemostasis [100% vs. 91.5%, p>0.05] and rebleeding [no cases vs. 9.3% p>0.05]. in patients with gastroesophageal varices type 2, there was high statistically significant difference between NBC and EAO sclerotherapy regarding primary haemostasis [100% vs. 63.3%; p<0.005] and rebleeding [no cases vs. 50% p<0.005]. No significant difference was present between NBC and EAO sclerotherapy regarding the occurrence of intervention related complications. Secondary haemostasis was achieved with NBC sclerotherapy in 100% of cases presented with failure of primary haemostasis or rebleeding. No mortality cases reported during the first week of follow up in both groups. N-butyl2-cyanoaCrYlate is safe and statistically significantly more effective than ethanolamine oleate in controlling GV bleeding. Ethanolamine oleate sclerotherapy still have a role in treatment of bleeding gastroesophageal varices type one only

HLA-DRB1 alleles in Egyptian children with systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is an autoimmune disease characterized by multisystem organ damage due to autoantibody production. Polymorphism in genes at the Major histocompatibility complex [MHC] region represents an important susceptibility factor for SLE, especially HLA-DRBI and HLA-DQB1. Moreover; it was noted that ethnicity has a significant role in both disease susceptibility and disease expression. This work was planned out to study HLA-DRBI alleles association with SLE susceptibility and clinical presentations in Egyptian children with juvenile onset SLE. HLA-DRBI allele typing was done using polymerase chain reaction-sequence-specific oligonucleotide probe for 65 juvenile SLE patients and compared to 150 healthy controls of the same ethnic group. P values were corrected for the number of the alleles tested [Pc]. HLADRB1 asterisk 15 allele was significantly increased in SLE children Vs controls [OR=3.44; 95%CI=1.51-7,83; P=0.004 and Pc=0.048]. No HLA-DRB1 allele was found to be statistically significantly associated with renal, musculoskeletal, cutaneous, hematologic, cardiac or neuropsychiatric manifestations in children with SLE [P>0.05]. Although HLADRB1 asterisk 15 [15g] allele may be a susceptibility allele in Egyptian children with juvenile SLE; however HLA-DRB1 alleles do not contribute to SLE clinical presentations in these children

Non-Tensile Tunica Albuginea Plication for the Correction of Penile Curvature

Objective: To evaluate the efficacy of non-tensile tunica albuginea plication (NTTAP) using nonabsorbable sutures for the correction of congenital and acquired penile curvature and to determine the key points for a successful outcome of this procedure. Patients and Methods: From June 2004 to July 2007; 43 patients with penile curvature (35 congenital and 8 secondary to Peyronie's disease) underwent surgical correction by NTTAP. The indications were difficult or impossible vaginal penetration; and a cosmetically unacceptable penis. For tunica albuginea plication (TAP) we applied the 16 dot procedure using non-absorbable sutures (Tycronr 2/0 polyester fiber). Results: After a mean follow-up period of 18 months; successful results with respect to penile straightening; normal erection; penetration and sensation; confirmed both subjectively and objectively; were achieved in all patients. Post-operative penile shortening of less than 1.5 cm was present in 50of the cases; but did not affect intercourse. Post-operative complications were mild and reversible; they consisted of penile skin necrosis after circumcising incisions and post-operative pain upon nocturnal erection that subsided after a few weeks with the frequent use of ice compresses. The overall satisfaction rate was nearly 100(35/43 very satisfied and 8/43 satisfied). Conclusion:NTTAP is a simple and effective method for the correction of congenital and acquired penile curvature. The key points for successful appropriate expectations; and careful discussion of the location of the suture sites. There is no need for mobilization of the urethra or neurovascular bundle; which adds a great advantage to this easy and simple technique. Cutting through the tunica albuginea; which may prevent postoperative erectile dysfunction; is not necessary. A disadvantage of this procedure is that it cannot correct hour-glass deformity

Anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis and their clinical significance

One of the characteristics of rheumatoid arthritis [RA] is the presence of several autoantibodies in the serum of the patient. However, most of these antibodies have failed to demonstrate adequate diagnostic and prognostic value so far. There is growing evidence that therapeutic intervention early in the course of RA leads to earlier disease control less joint damage, and a better prognosis. A new serological test, the anti-cyclic citrollinated peptide [anti-CCP] was developed. Anti-CCP was reported to have a high specificity for the diagnosis of RA, especially in patients with early disease and its presence before disease presentation is suggestive of its role in disease pathogenesis .The aim of this study is to estimate the level of anti-CCP antibodies in the serum of RA patients and to correlate them with RF isotypes [IgG and IgM] and clinical findings as disease activity and severity. This study comprised 68 RA patients [64 female and 4 males] diagnosed according to the revised criteria described by ACR [1987], in addition to 15 healthy control subjects. Clinical assessment of RA disease activity and severity, radiological investigations, and laboratory investigations [complete blood picture, ESR, CRP, determination of anti-CCP, IgG-RF and IgM-RF antibodies by ELISA technique] were done for all subjects.Highly significant increase in the levels of anti-CCP, IgG-RF and IgM-RF antibodies were found in RA patients compared to control group [P<0.001 for each]. Anti-CCP antibodies showed the highest diagnostic specificity [100%] than both RF IgM and IgG [93.33% for each].The anti-CCP and IgG-RF tests had excellent sensitivity [95.59% and 98.53% respectively] while IgM-RF had relatively lower sensitivity than both tests [86.76%]. Anti-CCP level was significant positively correlated with duration of the disease [P=0.024].Also,there was positive correlation between anti-CCP levels and all disease activity parameters which include the number of active joints [P=0.007], duration of morning stiffness [P<0.001], ESR [P<0.001] and CRP values [P=0.024]. Anti-CCP test had the best correlation with disease activity grades .disease severity, and radiological score [P=<0.001, P=<0.001 and P=0.000 respectively]. The level of anti-CCP in patients receiving methotrexate either alone or with lefwnomide is lower than other patients receiving methotrexate with corticosteroids [56.5 +/- 41.33,112 +/- 95.04 lU/ml respectively]. In conclusion, anti-CCP antibodies could be regarded as a new diagnostic marker for RA as they have 100% specificity and 95.8% sensitivity and it could predict erosive development early in the disease, and it could be used in evaluation of disease activity, severity and therapeutic response

role of multi-detector computerized tomography in the evaluation and diagnosis of acute bowel ischemia

Acute bowel ischemia [ABI] is a complicated disorder that occurs when blood flow to the intestines is compromised. Multi-detector row CT combines multiple rows of detectors and faster gantry rotation with narrow collimation. Thus, it offers advantages over classic spiral CT for imaging the mesenteric vasculature and small bowel. The aim of this study was to evaluate the sensitivity and specificity of Multi-Detector Row Computerized Tomography technique in patients with suspected mesenteric ischemia. In this study, 72 consecutive patients were prospectively followed and examined at Aseer. Central Hospital [ACH] with clinical suspicion of ABI or having a CT diagnosis of ABI during the period between March 2003 and October 2004. CT scans were evaluated for evidence of criteria suggestive of ABI. Finally, CT findings and radiological diagnoses were compared to the final pathological diagnoses to measure its sensitivity, specificity, predictive value positive and negative predictive values. Acute bowel ischemia was documented in 56 patients. Their ages ranged between 23 and 85 years with the mean age is 62.5 +/- 15.5 years. Patients were divided to two groups [A and B]. From our study, combining the most sensitive and specific criteria; bowel wall thickening, mesenteric stranding, focal lack of bowel wall enhancement and ascities, increased the overall sensitivity of our technique and interpretation to 97% and the overall specificity to 100%. These finding should be considered in the management of acute bowel ischemia. The mortality rate in our study was 26.8% [15/56 patient] regarding patient proved to have ABI during laparotomy. We concluded that biphasic CT with mesenteric CT angiography is a valuable method of diagnosing ABI, with an overall sensitivity of97% and a specificity of 100%. Inspite of the advances and early intervention, the mortality rate of acute bowel ischemia is still high. Moreover, combining diagnostic criteria predicts high mortality rates

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. This study was carried out in the Departments of General Surgery and Pathology, King Fahad Hospital, Hofuf, Kingdom of Saudi Arabia, from June 2001 through to July 2002. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma, 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading

Proinflammatory cytokines [IL-12 and IL-18] in immune rheumatic diseases: relation with disease activity and autoantibodies production

lnterleukin-18 [IL-18] and its inducer IL-12 have multiple biological activities that are important in generating Th1 responses and inflammatory tissue damage. We investigated serum concentration of the novel pro-inflammatory Th1 cytokine; IL-18, and its inducer IL-12 in patients with immune rheumatic diseases. Group I comprised 32 patients of systemic lupus erythmatosus [SLE], Group II comprised 36 patients of rheumatoid arthritis [RA]. Group III comprised 9 patients [2 patients of Behcet, 2 patients of Dermatomyositis, 2 patients of Sicca syndrome, one patient of Scleroderma, and 2 patients of Mixed connective tissue disease]. Group IV is a control group consists of 21 sex and age matched healthy subjects and correlated their levels with autoantibody concentration [ANA and ds-DNA], clinical grades and SLE disease activity index [SLEDAI]. Serum IL-18, IL-12 ,ANA and ds-DNA were measured by enzyme immune sorbent assay. IL-18, IL-12 and ANA were significantly higher in the three studied groups than in the control group [IL-18; P<0.001 in the three groups, IL-12; P=0.019, P=0.002, and P= 0.006, and ANA; PO.001, P=0.002,and P=0.006, respectively].ds-DNA was significantly higher in SLE patients than in control group [P<0.001].There were significant positive correlations between; A] levels of IL-18,and both ANA and ds-DNA in SLE patient [r=0.41,P=0.001, r= 0.58 and P=0.001 respectively]; and B] IL-18 and ANA in both RA and group III patients [r= 0.32, P=0.005,r=0.61 and P= 0.022 respectively]. Also, there were significant positive correlation between the levels of IL-18 and clinical grades of the three groups [r=0.60, P=0.001, r=0.79, P=0.001, r=0.78 and P= 0.001 respectively]. In SLE patients ,IL-18 concentration shows significant positive correlation with SLEDAI score [r= 0.76 ,P=0.001]. In conclusion, the elevation of proinflammatory cytokines [IL-18 and IL-12] may trigger the inflammatory process in immune rheumatic diseases and IL-18 is correlated with disease activity

Prognostic indicators in cirrhotic patients with bleeding oesophageal varices

The aim of this study was to identify the risk factors that affect the prognosis in patients with liver cirrhosis presented with acute variceal bleeding through clinical and laboratory assessment. It included 200 cirrhotic patients presented with bleeding esophageal varices with a mean age of 48.9 +/- 11.4 years. They were enrolled in prospective study and followed up for six weeks after bleeding attack. The patients were assessed using clinical, ultrasonographic, endoscopic and laboratory examinations. It was concluded that the main factors that can independently affect the prognosis of cirrhotic patients with bleeding esophageal varices are ascites, hepatocellular carcinoma on top of liver cirrhosis and prothrombin time. Furthermore, Child Pugh grade is an important prognostic factor

Psychiatric aspects in hepatitis C infection

Psychiatric symptoms and emotional distress appear to be more common in chronic hepatitis C [CHC] patients than in the general population. The aim of this study was to assess the psychiatric disorders in hepatitis C infection in cases not receiving anti-viral therapy in a rural community of Upper Egypt [Sallam village]. In a cross- sectional study, 86 positive anti-HCV cases, aged 15-65 years old and 60 control subjects of matched age and sex participated in this study. Assessment was done using standardized questionnaires including Hamilton anxiety rating scale [HARS], Hamilton checklist of symptoms of depressive illness, symptom checklist -90 [SCL-90] and social scale assessment. In addition to clinical, physical, ultrasonographic examinations and laboratory assessment including urinalysis, blood sugar, hepatitis B surface antigen [HBsAg], HCV antibody and HCV RNA by polymerase chain reaction [PCR]. The mean age was 40.29 + 15. 75. Fifty cases [58.1%] were HCV RNA positive, whereas 36 cases [41.9%] were negative. The mean score of the nine subscales of SCL-90 were significantly higher in HCV antibody positive cases than in controls and the mean score of the nine subscales of SCL-90 were significantly higher in positive HCV-RNA cases than in controls except for those with paranoia. Moreover, the mean scores of the nine subscales were significantly higher in negative HCV-RNA cases than controls except for those with anxiety and phobia. The previous parameters were higher in HCV RNA positive than in negative cases but without significant difference. The frequencies of depressive cases [> 18 degrees] and severe cases [> 26 degrees] were significantly higher in HCV antibody cases [25 [29.1%] and 6[7%]] than in controls [3[5%] and 0%] [P < 0.001 and P < 0.05 respectively]. The frequencies of mild and moderate depressive cases were significantly higher in HCV RNA positive cases than in controls [P <0.01 and P < 0.05 respectively but only in mild cases for those with HCV RNA negative cases. However, the frequency of depressive cases [> 18 degrees] was significantly higher in both positive [16[32%]] and negative [9[25%]] HCV RNA than in controls [3[5%]] [P < 0.001 and P < 0.01 respectively]. There was a significant difference between mild anxiety cases [15-28 degree] and also anxiety cases > 15 degrees in HCV antibody positive cases [41.9%] than in controls 03.3%] [P < 0.001 and P < 0.001 respectively]. The same previous results were obtained on comparison of positive HCV RNA and negative cases versus controls [P <0.01 and P < 0.001 respectively]. Although the frequency of severe anxiety cases [> 29 degree] was higher in positive HCV RNA cases [4 [8%]] than in controls [1 [1.7%]] but without significant difference [P = 0.056]. No significant association was found between ALT levels and depressive as well as anxiety cases in HCV RNA positive cases and also, no significant correlation was found between the score of the nine SCL 90 subscales and the level of ALT in HCV RNA positive cases. Psychiatric disorders as anxiety and depression and also, the nine SCL-90 subscales were significantly higher in HCV RNA positive or negative cases than in controls. Although, the previous parameters were higher in HCV RNA positive than in negative cases but without significant difference. These results may be due to the patients concern about the potentially serious health consequence of CHC infection

Interdigitating dendritic cell tumor

Interdigitating dendritic cell tumor is an extremely rare neoplasm that mainly occurs in lymph nodes. In this case report, we describe the histopathological and clinical features of a typical interdigitating dendritic cell case in a 30-year-old Saudi female who presented with a painless unilateral left neck mass. Microscopically, the lesional tissue in the affected lymph node showed whorls and fascicles of spindle cells intermingling with small lymphocytes. The neoplastic cells were strongly and diffusely positive for S-100 protein, vimentin and alpha 1-antichemotrypsin and focally for macrophages marker [CD68]. The combined morphological features and immunohistochemical results were diagnostic of interdigitating dendritic cell tumor

Comparative study of primary and secondary prevention of bleeding oesophgeal varices

This study included 302 patients with liver cirrhosis and esophageal varices who were classified into five groups; two groups of primary prophylaxis and three groups of secondary prophylaxis. The first group was under propranolol therapy [88 patients] and the second group was the control group [62 patients] with a mean age of 49 years and the mean follow up period was 2.97 +/- 1.88 years for the former and 2.35 +/- 1.1 years for the latter. It was concluded that propranolol is an effective treatment in primary prophylaxis as it decreases the rate of bleeding while increases the need for and the amount of blood transfusion. Also, this study supported the long-term use of propranolol plus endoscopic sclerotherapy for secondary prevention of bleeding esophageal varices

use of three Ascarid antigens in serodiagnosis of visceral larva migrans in clinically suspected patients

The syndrome of visceral larva migrans [VLM] is a zoonotic disease caused by migration of nematode larvae especially ascarids in human tissues. In the present study serum samples of 40 clinically suspected patients of VLM with persistent unexplained eosinophilia were tested by ELISA IgG and Western-immunoblotting assays for antibodies of three ascarids [Parascaris equorum, Toxocara vitulorum and Toxascaris leonina]. Embryonated egg extract antigens of these ascarids were used for serodiagnosis. By ELISA test the percentage of positivity was 42.5 percent with P.equorum, 40 percent with T.vitulorum and 30 percent with T.leonina antigens. By Western-blot assay, the seropositivity was 42.5 percent with P.equorum and 25 percent with T.vitulorum antigens. 27.5 percent of tested sera reacted with T.leonina antigen and showed single band at 65 KDa. This band was previously proven to be specific for Toxocara canis infection only. Some cases showed seropositivity for two or three species of ascarid antigens. The relationship between the seropositivity, clinical symptoms, eosinophilia and age groups was discussed. The use of two immunological assays and three types of ascarid antigens in the present study revealed for the first time the role of P.equorum and Toxocara vitulorum as causative agents of human VLM in Upper Egypt

Medical-surgical supplies consumption and nurses' attitude towards cost-effectiveness in two health care sectors: a comparative study

A correlation study was carried out to estimate retrospectively the consumption rate of the frequently used medical-surgical supplies over a year, examine nurses' attitude toward cost-effectiveness, explore the effect of selected sociodemographic variables on nurses attitude toward cost-effectiveness and compare between selected intensive cue units [ICUs] affiliated to private and governmental health care sectors in relation to the previously mentioned variables. Eighty baccalaureate nurses were randomly selected, 40 from each sector to constitute the study sample. Blaney/Hobson attitude scale [1988], auditing sheet and brief socio-demographic data sheet were utilized to collect data pertinent to the study. The findings revealed that private ICU nurses showed a tendency to have higher mean age, years of experience and less years in current job. Also, the majority of them [72.5%] possessed more positive attitudes toward cost effectiveness compared with 42.5% of the governmental ICU nurses. Private sector nurses' attitude toward cost effectiveness was negatively correlated to years of experience and years in current job, however their average daily consumption of about two thirds of the frequently used medical- surgical supplies was higher, despite the lower occupancy rate in their units [81% Vs 95%]. The implications of these findings were discussed from the perspectives of developing nursing strategies to deal with nurses attitudes as it relates to cost, services and patient outcomes

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