Detection of Helicobacter pylori infection in Egyptian patients with chronic calcular cholecystitis.

Reports of Helicobacter pylori in biliary tract diseases in humans are very fragmentary, and therefore there is a need for further investigations. This study aims to detect H. pylori in the bile and gall bladder (GB) of patients with chronic calcular cholecystitis (CCC), and to determine the association of H. pylori infection with gallstone type. Thirty patients with CCC admitted for laparoscopic cholecystectomy were investigated, including upper gastro-endoscopy before cholecystectomy. Rapid urease test and histopathological examination were performed on gastric biopsies. The GB specimens were investigated for the presence of H. pylori by immunohistochemistry (IHC). H. pylori antigen in bile was detected by enzyme immunoassay. Chemical analysis of gallstones was performed to determine type. Immunohistochemistry testing showed 73.3% and 66.7% positivity among GB neck and body biopsies, respectively, demonstrating high sensitivity and specificity. A significant association was found between gastric and GB H. pylori positivity (P < 0.01). H. pylori antigen was detected in bile from three CCC cases. The greatest number of stones were of the calcium bilirubinate type. Gall bladder positivity for H. pylori was accompanied by chronic quiescent gastritis (40.9%). In conclusion, H. pylori infection may be an aetiological factor leading to cholecystitis. Gastric colonisation with H. pylori could be a source for GB infection, and the organism may act as a lithogenic component, especially in the context of pure pigmented gallstones.

HAV and HEV infection in hospitalised hepatitis patients in Alexandria, Egypt.

A total of 202 serum and stool samples from acute hepatitis patients attending the Fever Hospital of Alexandria, Egypt, have been studied to reveal markers of hepatitis virus infection. Anti-HAV IgM were detected in 21 out of 202 sera (10.4%), whereas 201 sera (99.5%) had anti-HAV IgG. The first age attack was in the class-age 0-9 years with 64.7% of anti-HAV IgM positive sera. Among 202 patients, anti-hepatitis E IgG (sample/over cut off > 1.0) was identified in 90 patients (44.5%). The anti-HEV seropositivity ranged from 17.6% to 60.0% in the different age groups, with the highest level in the class-age 20 29 years. Anti-hepatitis E IgM were identified in 49 patients with the first age attack in the class-age 10-19 years (39.4%). HAV RNA was identified by nested PCR in 7 samples out of 15, whereas HEV RNA was present in 4 out of 75 stool samples. Direct DNA sequence of the latter PCR products confirmed the presence of the HEV genome; comparison of the sequences of the isolates from Egypt with those in data banks revealed the highest homology to the Burma strain. Our data confirm that HAV and HEV are common causes of acute sporadic hepatitis in Alexandria but with different peak age positivity. Occasionally, but not infrequently, dual infections (HAV-HEV and HEV-enteric viruses) were also found. The risk analysis indicates that patients living in rural areas are exposed to a higher risk of hepatitis E infection compared to the urban population, whereas the presence of anti-HEV IgG was significantly associated with consumption of common village water and use of indoor dry pit and oral therapy for schistosomiasis.

Serum antibodies to polioviruses in Alexandria, Egypt.

Random sera, in a total of 192, were collected in the Fever Hospital of Alexandria, Egypt, and analysed for the presence of antibodies against polioviruses. The results show good antibody levels, only three sera (1.5%) were negative for poliovirus type 1, 5 (2.6%) for poliovirus type 2 and 10 (5.2%) for poliovirus type 3; one subject was completely negative.

Evidence of hepatitis E virus replication on cell cultures.

Several human and animal cell lines have been used to grow hepatitis E virus. The strain SAR-55 was adapted only on PLF/PLC/5 cell line without any visible cytopathic effect. The growth of the SAR-55 was monitored by examining the positive and the negative strands of HEV-RNA. Stool samples, obtained from hospitalised acute hepatitis patients at the Fever Hospital of Alexandria (Egypt), were used to confirm the susceptibility of PLF/PLC/5 cells. After more than one-week's cultivation, three stool samples out of 17 IgM anti-HEV positive and 1 from 52 IgG anti-HEV positive patients showed a specific RT-PCR amplification product. The nucleotide sequences of the methyltransferase region of the genome in the isolates revealed the maximum homology with Burma strain with several point mutations.

Microbiological quality of coastal sea water of Alexandria, Egypt.

The aim of the present study was to evaluate the quality of the seawater in Alexandria, Egypt. Samples were collected in 6 different points: Kayet Bay, El Shatby, Camp Cesar, Sporting, Beir Massoud and El Max. In total, 24 samples were analyzed. For each point the analysis included estimation of the following parameters: Esherichia coli, total coliform and fecal streptococci, Yersinia, Shigella, Salmonella, bacteriophages and enteric viruses. Just one sample (El Max) was positive for the presence of Salmonella, neither Shigella or Yersinia were isolated from any of the analyzed points. E. coli was identified in 10 samples while the ratio between total coliform and fecal streptococci showed variable results with the exception of El Max that resulted constantly high. Three samples were positive for the presence of enteric viruses: El Shatby, Beir Massoud and Sporting. The analysis of phages showed a variable pollution values.

PIP: The bacteriological virological parameters were evaluated on seawater samples taken at different points on the coast of Alexandria, Egypt. Samples were collected at 6 different points: Kayet Bay, El Shatby, Camp Cesar, Sporting, Beir Massoud, and El Max. A total of 24 samples were analyzed by estimation of the following parameters: Escherichia coli, total coliform and fecal streptococci, Yersinia, Shigella, Salmonella, bacteriophages, and enteric viruses. The virological analysis included the isolation and identification of cytopathogenic enteroviruses and three phages: somatic coliphage, F-specific, and B 40-8. The bacteriophage analysis was performed by the plaque assay method using the double-layer method, whereas the membrane filtration method was used to estimate bacterial populations in the samples. During the summer period no E. coli could be isolated from any point during the study, whereas in autumn E. coli were identified in all the points except for Sporting. E. coli was identified in 65% of the qualitative analyses. The limit was exceeded in 12 samples out of 24; for fecal streptococci, in 15 samples out of 24. The ratio over 4.4 relating to fecal coli and fecal streptococci indicated human fecal pollution. The El Max sample was positive for the presence of Salmonella; neither Shigella nor Yersinia were isolated from any of the analyzed points. In the El Max sample (autumn period), total coliform and fecal streptococci exceeded the European Community (EC) limit, whereas the ratio was 10, confirming human fecal pollution. E. coli was identified in 10 samples, while the ratio between total coliform and fecal streptococci showed variable results with the exception of El Max, which was constantly high. Three samples were positive for the presence of enteric viruses: El Shatby, Beir Massoud, and Sporting. The enteric viruses were confirmed by a secondary passage on cell culture. The analysis of phages showed variable pollution values.

Seroprevalence of HIV and HCV infections in Alexandria, Egypt.

During the years 1992-1994, we tested 948 individuals from different population groups for HIV-1 and HIV-2 infections by ELISA and WB and for HCV infection by ELISA. Repeated ELISA reactivity for HIV was found in 2.12% of blood donors, 2.95% of fire brigade personnel and 1.61% of prisoners. Western blotting studies, however, showed that these samples were non-reactive or indeterminate to either HIV-1 or HIV-2. In contrast, anti-HCV antibodies were detected in 39% of fire brigade personnel, 31.4% of prisoners and 20.8% of blood donors. The analysis of risk factors for acquiring HCV infection showed a strong association between a past history of parenteral therapy for schistosomiasis and anti-HCV seropositivity (p < 0.0001). The implementation of preventive strategies is at the moment the mandatory choice to stop a further spread of the HCV infection. Meanwhile the same preventive measures could avoid spreading of the HIV disease.

Intravenous drug addicts: a high risk group for infection with human immunodeficiency virus, hepatitis viruses, cytomegalo virus and bacterial infections in Alexandria Egypt.

In this work the seroprevalence of HIV, HBV, HCV and CMV were studied among two groups of population; IVDA (intravenous drug addicts) (100) and control group (40). Syphilis and other bacterial infections which may be encountered among IVDA were also investigated. It was found that all serum samples (of both groups) were negative for anti-HIV. Regarding HBV markers, the prevalence of HBc antibodies was significantly higher among IVDA (62%) than the control group (27.5%). Also HBsAg was detected in 16% of IVDA while it was 75% among the control group. Prevalence of anti-HCV was significantly higher among IVDA (63%) than the control group (27.5%). The prevalence of co-infection with HBV and HCV was significantly higher in IVDA (40%) than the control group (15%). Sharing of needles and duration of drug use were positively associated with the presence of both HBV markers and anti-HCV. CMV seroprevalence was high in both groups. Antibodies to Syphilis were found in sera of 3 IVDA and one control using MHA-TP test. Although HIV infection has not yet been sufficiently introduced among IVDA in Alexandria but potentials for its spread among addicts are high as supported by observation that other infections with similar mode of transmission are common among addicts.

Low prevalence of antibodies to HIV-1 and HTLV-I in Alexandria, Egypt.

PIP: Sera from 1029 subjects from Alexandria, Egypt were tested for antibodies to HTLV-1 and HIV-1 by ELISA and confirmatory immunoprecipitation assay. The sera were from 866 blood donors, 71 prisoners, 54 hospital patients, and 38 intravenous drug addicts. 2.8% of the sera were positive for HTLV-1 by ELISA, 1 of which (0.1%) was confirmed by radioimmuno-precipitation (RIPA). 1.6% were positive for HIV-1 by ELISA, none of which were confirmed. Thus the prevalence of HIV-1 is low in Egypt compared to Europe and the U.S.^ieng

Effect of prostaglandins E2 and 15-methyl F2 alpha on human pregnant and non-pregnant cervix.

Forty-two women of reproductive age were studied in two equal groups (group I, first-trimester pregnant; group II, non-pregnant). Each group included three equal sub-groups; subgroup A received intra-cervical 15-Me PGF2 alpha gel, B received intracervical PGE2 gel and C received intra-cervical gel alone as placebo. Three different staining techniques were employed to study the histological picture and histochemical alterations of cervical biopsies. These showed that PG-treated cervices presented significant changes compared to placebo in terms of more widely dissociated connective tissue bundles that are separated by clear spaces and an increase in the amount of ground substance. Moreover, the observed changes in pregnant sub-groups were more evident than in the corresponding non-pregnant cases.

Effect of subdermal levonorgestrel contraceptive implants on vaginal candidiasis.

A total of 150 women in 3 equal groups, each using a different contraceptive method (group I used Norplant, group II used the IUD and group III used combined OC pills) were investigated for the presence of vaginal candidiasis before and at various time intervals (3, 6 and 12 months) after starting to use the particular contraceptive method. The incidence of vaginal Candida albicans infection increased significantly among pill and IUD users, but with a much lower intensity among the latter cases. In Norplant users the increase was slight and insignificant. The explanation of these findings within the context of changes in local vaginal milieu is discussed.

Transmission and scanning electron microscopic studies of rhinoscleroma.

Using both types of electron microscope, combined transmission and scanning electron microscopic studies were done on 6 patients with rhinoscleroma. The present work suggests the possibility of two types of organisms causing the disease: one type--being in the majority--was a rod-shaped bacillus measuring about 3 micrometers; the other type was a short, stout bacillus with terminal spiral cilia. The ultrastructure of these bacilli has been described. The advantages and limitations of each type of electron microscopy in the investigation of rhinoscleroma have been discussed.

The ceruminous glands in chronic suppurative otitis media. A histological and histochemical study.

The ceruminous glands have been studied histologically and histochemically in twenty patients suffering from chronic suppurative otitis media with discharging ears, and in ten patients with dry central perforations, in comparison with normal ears. The present study revealed hyperactivity of the glands initially; later on, atrophy and fibrosis took place. Thus the diminution of wax may be due to: (1) The washing effect of the discharge. (2) Atrophy of the glandular structures. (3) Periglandular fibrosis. As the discharge stops, regeneration of the glands occurs.

Statistico epidemiological study of changes in the vaginal flora of contraceptive pill users in Alexandria.

PIP: A stratified random sample of 1000 women with proportionate allocation according to district of residence was taken from normal females living in Alexandria, Egypt, and attending family planning centers in order to understand social-pathological changes in the vaginal flora of oral contraceptive (OC) users. Cases were examined over 18 months, and all cases were given a combined OC. Bacteriology and pH changes in vaginal flora were determined after 18 months. Results of the bacteriological examination revealed a positive correlation between those having a vaginal discharge and pH above 5, mixed infection, and illiteracy. As the duration of pill use increased, so did the incidence of monilla, staphylococcus aureus, anaerobic streptococci, gram negative bacilli, trichomonas vaginalis, and hemophilus vaginalis, whereas lactobacilli decreased. Duration of pill use also corresponded to increase in vaginal pH. Longer duration of OC use, practice of bad hygiene, and illiteracy were factors associated with an alkaline pH, changed pattern of vaginal flora, and greater susceptibility to infection by staph aureus and E. coli.^ieng

Electron microscopic study of previously irradiated scleroma.

Nasal biopsies from 2 scleroma patients who had received previous X-ray therapy were investigated under the electron microscope. In the lamina propria, the majority of Mikulicz cells contained numerous small vacuoles. This was attributed to the effect of X-ray therapy causing temporary suppression of the inflammatory process followed by new granuloma formation. The vacuoles of the Mikulicz cells contained some fine granular and fibrillar material of unknown origin. Rounded electron-dense bodies with microprojections on their surface were present near some Mikulicz cells. These structures were considered to be Russell bodies. Occasional small lymph vessels with obstructed lumina were seen. This might indicate the rare spread of Klebsiella rhinoscleromatis bacilli to regional lymph nodes.

The leprous testis.

A clinical investigative study of 148 male leprous patients demonstrated the presence of testicular lesions in 35 cases. Semen analysis revealed marked oligo-athenozoospermia in 10 cases and azoospermia in 25 cases. Testicular biopsies from leprous testes showed different histologic patterns ranging from spermatogenic arrest to complete hyalinization of both seminiferous tubules and interstitial tissue. Histochemical staining for neurovascular supply revealed degenerative nerve change in addition to altered permeability of the testicular capillaries. There was good correlation between the results of semen analysis and histological and histochemical examination of testicular biopsies.