Analysis of the aetiology of epilepsy in 3,216 adult patients attending a tertiary referral center enabled by an electronic patient record.

PURPOSE: The aim of this study was to review the causes of the epilepsies in our institution, an adult tertiary referral center for neurology and neurosurgery in Dublin, Ireland. Data was obtained from a bespoke epilepsy electronic patient record (EPR). METHODS: Predetermined search parameters of well-established broad categories of epilepsy aetiology were used to identify patients with a diagnosis of epilepsy attending Beaumont Hospital, Dublin. There were 3216 patients that met the inclusion criteria for this study. We included living patients with epilepsy attending our institution. We then excluded patients with a diagnosis of pure non-epileptic attack disorder and patients found to have idiopathic generalised epilepsy (IGE) (n = 382) from our final cohort. We excluded IGE due to the complex polygenic basis underlying this patient group. RESULTS: An aetiology was identified in 54.3 % (n = 1747) of the total number of patients studied. Of the symptomatic epilepsies, 41.08 % (n = 1321) were acquired and 13.3 % (n = 426) were predominantly of genetic or developmental aetiology. The most common causes of the acquired epilepsies were hippocampal sclerosis (n = 380; 28.75 %), cerebral tumor (n = 279; 21.06 %), traumatic brain injury (n = 248; 18.77 %), stroke and cerebrovascular disease (n = 151; 11.43 %) and perinatal causes (n = 138; 10.45 %). The leading causes in the genetic / developmental category included cavernous haemangiomas (n = 62, 22.22 %), arteriovenous malformations (n = 59; 21.15 %) and cortical dysplasia (n = 55; 19.71 %). The aetiology of a patient's epilepsy was undetermined in 45.68 % (n = 1469) of individuals. CONCLUSION: This study emphasizes the clinical utility of the ILAE's 2017 revised classification of the epilepsies and highlights the evolving dynamic nature of attributing causality in epilepsy. This is the largest single centre analysis of the aetiology of the epilepsies described in the literature. It is also the first large scale study examining aetiology utilising a bespoke electronic patient record in epilepsy.

Characteristics of systemic lupus erythematosus in a sample of the Egyptian population: a retrospective cohort of 1109 patients from a single center.

Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can vary among different ethnic and racial groups. Objective The objective of this paper is to study the prevalence of various manifestations of SLE in a sample of the Egyptian population. Patients and methods Information in this study was derived from the medical records of SLE patients who sought medical advice at a private clinic in Cairo from January 1980 to June 2016. Results This study included 1109 SLE patients, of whom 114 (10.3%) were males and 995 were females (89.7%). Mean age of onset was 25.89 ± 10.81 years, while the median of disease duration from the onset of the disease till the last recorded visit was 26 months. The most common cumulative manifestations were arthritis (76.7%), malar rash (48.5%), leukopenia (45.7%), and photosensitivity (45.6%). A total of 33.1% of the patients had nephritis, and neuropsychiatric lupus was present in 6.4% of the patients. Secondary antiphospholipid syndrome was present in 11.5% of the patients. Antinuclear antibody and anti-double-stranded deoxyribonucleic acid were present in 1060/1094 (96.9%) and 842/1062 (79.3%) of the patients, respectively. Antiphospholipid antibodies were present in 266/636 (41.8%) of the patients, anti-Smith in 54/240 (22.5%), anti-SSA/Ro in 61/229 (20.4%), and anti-SSB/La in 32/277 (11.6%) of the patients. Male patients had a statistically higher prevalence of nephritis ( p = 0.01), whereas arthritis and alopecia were statistically higher in females ( p = 0.012 and p = 0.006, respectively). Patients with juvenile onset had a statistically higher prevalence of nephritis and seizures ( p < 0.001 and p = 0.012, respectively). Conclusions Arthritis and malar rash represented the most common clinical manifestations. Male and juvenile-onset patients had a predilection toward a more severe disease. These results are in agreement with many studies conducted in the Middle East and worldwide. On the other hand, major organ involvement was exceptionally low, which is contradictory to several reports from the Middle East and across the globe.

Introduction and enzootic of A/H5N1 in Egypt: Virus evolution, pathogenicity and vaccine efficacy ten years on.

It is almost a decade since the highly pathogenic H5N1 avian influenza virus (A/H5N1) of clade 2.2.1 was introduced to Egypt in 2005, most likely, via wild birds; marking the longest endemic status of influenza viruses in poultry outside Asia. The endemic A/H5N1 in Egypt still compromises the poultry industry, poses serious hazards to public health and threatens to become potentially pandemic. The control strategies adopted for A/H5N1 in Egyptian poultry using diverse vaccines in commercialized poultry neither eliminated the virus nor did they decrease its evolutionary rate. Several virus clades have evolved, a few of them disappeared and others prevailed. Disparate evolutionary traits in both birds and humans were manifested by accumulation of clade-specific mutations across viral genomes driven by a variety of selection pressures. Viruses in vaccinated poultry populations displayed higher mutation rates at the immunogenic epitopes, promoting viral escape and reducing vaccine efficiency. On the other hand, viruses isolated from humans displayed changes in the receptor binding domain, which increased the viral affinity to bind to human-type glycan receptors. Moreover, viral pathogenicity exhibited several patterns in different hosts. This review aims to provide an overview of the viral evolution, pathogenicity and vaccine efficacy of A/H5N1 in Egypt during the last ten years.

A study on Trichomoniasis vaginalis and female infertility.

A total of 280 patients, 240 infertile and 40 pregnant were subjected to thorough history taking, general and local examination for exclusion of organic lesion, laboratory investigations to exclude parasitic, bacterial and fungal infections. Sterile vaginal swab from the posterior fornix was taken, and examined by wet smear preparation, Giemsa staining and cultivation on C.P.L.M. medium for trichomoniasis infection. The mean age of the infertile group was 25.75+/-3.92, and of the control group was 21.6+/-2.38 (in years). The mean duration of infertility was 2.81+/-1.51 (years). Out of 240 infertile women, 18.75% complained of discharge, 17.5% itching, 15.42% dysuria, 14.58% dyspareunia, and 10% had cervical lesion. Of the 40 controls, 5% complained of discharge, 2.5% complained of itching, dysuria, dyspareunia, but none had cervical lesion. Of the total cases (280), 36 (12.9%) had T. vaginalis. The clinical data observed were significantly higher among the infertile group than the control group. Cultures were positive in 14.58% of the infertile group and 2.5% in the control group. The difference between the 2 groups was statistically significant. No doubt, T. vaginalis plays an important role in female infertility.

Experimental evidence for a torus breakdown in a glow discharge plasma.

A global bifurcation scenario for a two-frequency torus breakdown depicted by Baptista and Caldas [Physica D 132, 325 (1999)] is observed on a glow-discharge experiment. The torus is broken through a crisis with an unstable periodic orbit. The torus section before the bifurcation is a sided polygon that has a number of edges equal to the period of the unstable orbit. Since the discharge is an extended system the two-frequency torus breakdown is shown to be a possible way to space-time chaos.

Evaluation of five stains in diagnosing human intestinal coccidiosis.

Three hundreds cases over the year 1998 complaining of diarrhoea were examined. The stools were examined by the traditional diagnostic methods and confirmed to be free from intestinal parasites. Cryptosporidium parvum, Isospora belli and Cyclospora cayetanensis were detected by using different types of faecal stains namely modified Ziehl-Neelsen, Kinyoun acid-fast, Auramine-rhodamine, Gomori's trichrome and Giemsa. The number of positive cases were 87 C. parvum (29%), 5 cases L. belli (1.7%) and 12 cases C. cayetanensis (4%). This study showed that the sensitivity of modified Ziehl-Neelsen and Kinyoun Acid-fast were very high (100%) in comparison with the other stains.

Quantitative inhibition ELISA for diagnosis of schistosomiasis using human IgG labeled with fluorescein and anti-fluorescein/peroxidase.

Usually mouse monoclonal antibodies are used in inhibition assays for antibody determination. Interference may occur in these inhibition assays due to presence of naturally occurring anti-mouse antibodies in some human serum samples. To avoid such interference, human IgG isolated from a pool of serum samples of S. mansoni patients and highly positive for IgG against S. mansoni soluble egg antigen (SEA) was used in inhibition ELISA for diagnosis of S. mansoni infection. The assay was based on inhibition of binding of human IgG labeled with fluorescein to S. mansoni SEA coating microtitration plates by tested serum samples. Plates were washed and labeled human IgG reacted with SEA was linked to peroxidase enzyme by incubation with anti-fluorescein/peroxidase conjugate. The assay showed 90% sensitivity and 96.3% specificity. The level of inhibition in ELISA showed highly significant positive correlation with stool egg output (Kandall's tau b = 0.512, P < 0.001). To make the assay quantitative, serial dilutions of the highly positive human serum pool, used for preparation of human IgG, were applied in each plate and concentration of anti-SEA antibodies in serum samples tested was calculated from a 4-parameters logistic curve equation. The highly positive serum pool used as a standard was considered to contain one million arbitrary units of immunoglobulins against S. mansoni SEA. Human IgG is expected to be more practical in inhibition assays than mouse monoclonal antibodies due to elimination of interference caused by naturally occurring human anti-mouse antibodies. Also, large amount of human IgG could be purfied from remnants of serum samples highly positive for the proposed antibodies. A higher specificity and sensitivity could be obtained if IgG is isolated by affinity purification instead of ammonium sulphate precipitation. In conclusion, human IgG isolated from highly positive serum samples could be used in sensitive and specific diagnostic antibody determination inhibition assays for diagnosis of infectious and autoimmune diseases.

Schistosoma mansoni hepatic fibrosis in Syrian golden hamsters: effect of dose and duration of infection as shown by immunohistopathological studies.

In this work, 180 Syrian golden hamsters were infected with Schistosoma mansoni and 30 cross matched for age and sex served as control. Infected hamsters were divided into six main groups according to the number of infected cercariae (20, 50, 100, 150, 200 and 250 cercariae). Each group was sub-divided into 5 subgroups, according to the duration of infection after which animals were sacrificed (4, 6, 8, 12 and 24 weeks). Control and infected hamsters were subjected to laboratory evaluation of serum albumin, S. globulin and A/G ratio and histopathological examination of the liver and splenic tissues. A significant reduction of albumin was observed in Schistosma infected hamster (50 cercariae or more) but not in the control ones and those infected with 20 cercariae. There was a significant correlation between these changes and the duration of infection and the number of adult worms recovered from the mesenteric circulation at the end of the experiments. Histopathologic evaluation showed appearance of the circulating schistosome antigens, circulating anodic antigen (CAA), and circulating cathodic antigen (CCA) deposits in the liver by the 14th week after infection; liver granuloma, amyloid deposits, fibrosis, Schistosma pigments as well as inflammatory infiltration was observed at 8-12th week and amyloid deposits, CAA & CCA in the spleen was observed nearly at the same time.

Effect of anti-schistosomal treatment on schistosomal hepatic pathology: an experimental study in Syrian golden hamsters.

Thirty Syrian golden hamsters were infected with Schistosoma mansoni and 10 were used as negative controls. Hamsters were infected by 100 cercariae; 15 were treated by praziquantel in doses of 100 mg/kg at 12, 13, 14 and 15 weeks postinfection, and 15 hamsters were left as positive control. Five from each subgroup were sacrificed at 24, 28 and 32 weeks after infection. Animals were subjected to weekly analysis for total plasma protein, serum albumin and urinary total protein excretion. At the end point, animals were sacrificed and the mesenteric venous plexus was explored for adult worms. Liver and splenic specimens were examined by light microscopy, and immunofluorescence microscopy. Complete parasite eradication was achieved in the treated animals. Although, there were significantly higher plasma total protein and albumin in the treated group, there was no significant differences in proteinuria. Histopathological examination of liver specimens showed highly significant reduction of granulomas, CAA and CCA, while amyeloid deposition showed minimal reduction in treated animals. Histopathological examination of splenic specimens showed highly significant reduction of fibrosis, granulomas, CAA and CCA, while follicular hyperplasia and amyeloid deposition showed non significant reduction.

Immunization against experimental trichinosis using T. spiralis larvae and hydatid fluid antigens.

Immunization of mice against T. spiralis infection using T. spiralis larval glycoproteins as homogenous antigen and crude hydatid fluid as heterogenous antigen showed a marked reduction in larvae burden and a significant rise of serum IgE in immunized mice infected with T. spiralis larvae as compared with control group. More reduction was observed with immunization with homogenous T. spiralis larval antigen compared with heterogenous hydatid fluid antigen. The reduction in larval burden with rise of serum IgE begins after the third week of immunization.

Some immunological studies on amoebiasis.

Studies of immunoglobulins pattern in 64 patients with different clinical symptoms of amoebiasis revealed that IgG showed no rise in patients with acute amoebic dysentery and asymptomatic cyst passers, while it was significantly increased in patients with active hepatic amoebiasis. IgM, IgA and IgE were significantly increased in both acute amoebic dysentery and active hepatic amoebiasis, but no significant changes in asymptomatic cyst passers. ELISA (depended on level of IgG) was valid and reliable in diagnosis of active hepatic amoebiasis (100%), IHAT (depended on level of IgM) gave 72.7% and 46.9% in patients with acute amoebic dysentery and active hepatic amoebiasis respectively.

Haematological changes in dogs infected with Ancylostoma duodenale.

A definite relation between the intensity of Ancylostoma duodenale and haematological changes in dogs were studied. There was a relation between the increase in egg count with the haemoglobin percentage. The present study reported haematological data collected during the acute phase of experimental infection with A. duodenale.

Immune response in dogs infected with Ancylostoma duodenale.

The relation between the level of serum immunoglobulins (IgG, IgM, IgA and IgE) percentage of T-lymphocyte and egg counts was studied in dogs infected with Ancylostoma duodenale. The serum IgG levels were significantly high and a marked significance was noticed also in the levels of IgM and IgE. An inverse relationship between the concentration of IgG and egg count and a direct association between the percentage of T-lymphocyte and IgG level was proved.

Histopathological picture of two cases of ectopic fascioliasis in Mansoura, Dakhalia.

Two cases of ectopic fascioliasis were reported. The first case was detected in a haematoma in the anterior abdominal wall in a diabetic patient, the second was in an abscess in the upper part of the thigh. The clinical and laboratory findings were discussed.

Incorporation of simulated waste raffinates containing 134Cs into cement-clay matrices.

Simulated waste solutions containing 134Cs were incorporated into cement matrices at varying compositions and in the presence and absence of various additive materials. Montmorillonite and kaolinite clay minerals, in addition to sand, were added for improving the properties of the cement composites. The leachability of 134Cs was measured for different cement-clay mixtures. The effect of the presence of ions, such as borates, sulphate, and nitrates commonly found in waste raffinates, was also investigated. The results for compressive strength and leachability were explained in light of the effect of the presence of clay additives on cement matrices.

Toxocara canis antibodies by counter immuno-electrophoresis.

Counter immunoelectrophoresis was used for anti-toxocaral antibodies in mice experimentally infected with Toxocara canis using adult worm antigen. The test seems to be valuable and gives good information about the infected rate.

Axenic growth in vitro of Ancylostoma duodenale to the filariform (resting) larvae.

Large numbers of free-living stages of Ancylostoma duodenale can be grown in vitro on formalin-killed Escherichia coli supplemented with cholesterol and Dulbecco's minimum essential medium (DMEN). Eggs at 28 degrees C hatched and released first-stage larvae in 24 hr. First-stage larvae molted in 36 hr. at 28 degrees C. Second-stage larvae, molted in 2-3 days at 28 degrees C, but retained the old cuticle. Third-stage larvae characterized by the presence of a buccal cap capsule; sheath; filariform esophagus and absence of lips. Lateral alae were observed in all free-living stages.

Evaluation of immunodiagnostic tests in detection of trichinosis in experimentally infected rats.

The enzyme-linked immunosorbent assay (ELISA), the indirect immunofluorescent (IF) and the counter current immunoelectrophoresis (CEP) were evaluated in detection of anti-Trichinella antibodies in experimentally infected rats. The CEP was the most specific and highly sensitive test. Also, the IF was highly sensitive but less specific. ELISA was the least specific but extremely sensitive specially in detecting early infection.

Ultra structure study of schistosomula recovered after cercarial penetration of isolated skin.

The ultrastructure, development and antigenic nature of the surface and the viability of schistosomula formed after cercariae had penetrated isolated skin has been studied. Within 2 hours of transformation, the surface membrane of schistosomula had changed from trilaminate to heptalaminate structures and lost their cercarial glycocalyx. The preacetabular glands of schistosomula were emptied, the mixed agglutination reaction demonstrated the presence of human A and B blood group-like antigenic determinant on approximately 30% of 3 hours old schistosomula. The first schistosomula reached the gut closed stage by day 12 (50-70%), and between 40% of all schistosomula developed to maturity when injected intravenously into mice.