Noncompliance of pediatric cancer patients with chemotherapy: A single-center experience in a lower-middle income country.

Noncompliance with therapy is a big obstacle to successful therapy. We aimed to evaluate the prevalence and risk factors affecting the compliance of pediatric cancer patients with therapy in a tertiary care center far away from the capital in a lower-middle income country (LMIC). A retrospective cohort study of reports of all pediatric cancer patients who were diagnosed and started treatment between 2006 and 2010 at South Egypt Cancer Institute (SECI) was done. The following data were collected: Age, sex, diagnosis, compliance with therapy, and data on potential risk factors that might affect compliance, including time duration of travel from the patient's home to SECI, time lag between the first symptom until the first visit to SECI and until the start of treatment, results of reevaluation after the initial course of therapy, and therapy-related severe adverse events. Noncompliance with therapy was defined as when patients missed their determined therapy appointment for one week or more or abandoned therapy. This study included 510 patients. Eighty-three (16.3%) were non-compliant, as forty patients missed their therapy appointment (7.8%), and 43 abandoned further therapy (8.4%). Noncompliance was found to be more prevalent among patients with solid tumors. Non-compliant patients suffered a significantly higher relapse rate (47.7% vs. 11.2% in compliant patients, p < .001). Unfortunately, 75% of the abandoned patients who returned for further therapy suffered a relapse. Noncompliance with treatment is still a big problem facing cancer management in LMICs.

Psychometric properties of the Arabic version of the Mini-Balance Evaluation Systems Test in patients with neurological balance disorders.

OBJECTIVE: This study aimed to translate and cross-culturally adapt the Mini-Balance Evaluation Systems Test (Mini-BESTest) to Arabic (Mini-BESTest-Ar) and evaluate its psychometric properties in patients with neurological balance disorders. PATIENTS AND METHODS: The translation and adaptation followed the established guidelines. Validity, internal consistency, test-retest reliability, standard error of measurement (SEM), minimal detectable change (MDC95), and limits of agreement (LOA) were examined in 56 patients. The sensitivity was investigated using the receiver operating characteristic curve. RESULTS: The Mini-BESTest-Ar significantly correlated with the Berg balance scale (BBS) (r = 0.80; p < 0.001) and dynamic gait index (DGI) (rho = 0.75; p < 0.001). All domains showed moderate to very good correlations with BBS (r = 0.62-0.81; p < 0.001) and fair to very good correlations with DGI (rho = 0.4 -0.79; p < 0.05). The internal consistency and test-retest reliability of the total score and all domains were excellent (Cronbach's α = 0.96-0.81, ICC = 0.95-0.81, and r = 0.92-0.68). The SEM, MDC95, and MDC% for total score and domains were 1.19-0.31, 3.29-0.86 points, and 16.5%-66.8% respectively. The LOA revealed no systematic error. A cut-off point of 21.5/28 (Area under the curve = 0.85, sensitivity = 75%, specificity = 75%) was specified. CONCLUSIONS: The Mini-BESTest-Ar has appropriate psychometric properties supporting its usefulness for research and clinical purposes.

Bombax ceiba flowers extract ameliorates hepatosteatosis induced by ethanol and relatively moderate fat diet in rats.

Chronic excessive alcohol consumption could induce serious liver injury. In this study, therapeutic effect of aqueous methanol extract of Bombax ceiba L. flowers (BCE) (Family: Bombacaceae) was investigated against hepatic steatosis. This study included seven groups, and the research period was eight weeks. The first group served as control. The six remaining groups were divided into two categories, three groups in each. The first category was fed fat diet. The second category was fed fat diet and orally administrated ethanol, which was given in graduate doses from 2 g/kg/d to 6 g/kg/d. Then, one group from each category was orally treated with the standard drug fluvastatin (2 mg/Kg/d). Another group was orally treated with BCE (200 mg/kg/d). The third group left untreated. The results revealed that BCE significantly decrease both the body and liver weight. The treatment with BCE extract also ameliorates the effect of alcohol induced increase of liver enzyme activities. In addition, the extract was significantly increased hepatic liver antioxidants and decreased malondialdehyde (MDA) level. Also, serum lipid profiles: triglycerides (TG), total cholesterol (TC) and low density lipoprotein (LDL) were significantly decreased after BCE treatment. Histopathological study showed fatty changes induced by alcohol which were improved by BCE treatment. These data suggest that the BCE has anti-inflammatory, anti-oxidant and anti-steatosis potential properties against alcohol induced liver damage. This may be due to the presence of flavonoids and other phenol compounds.

The effect of cigarette smoking on human seminal parameters, sperm chromatin structure and condensation.

Considerable debate still exists regarding the effects of cigarette smoking on male fertility. This work aimed to explore effects of cigarette smoking on semen parameters and DNA fragmentation on 95 infertile patients who were divided into infertile male nonsmokers (45) and infertile male smokers (50). Smokers were subdivided according to a number of cigarettes smoked per day into mild (≤10), moderate (11-20) and heavy smokers (≥21). Semen analysis, sperm chromatin condensation integrity with aniline blue staining and sperm viability were compared between the study groups. A significant decrease has been shown in sperm count (p = .006), progressive motility (p = <.001), percentage of normal forms (p = <.001) and viability (p = .002) between infertile nonsmoker and infertile smokers. The percentage of abnormal sperm chromatin condensation was significantly higher in smokers compared to nonsmokers (p = <.001). A linear correlation was detected between the extent of cigarette smoking and the degree of worsening in progressive motility (p = .001), total motility (p < .001), viability (p < .001) and normal morphology (p < .001). These results indicate that cigarette smoking has detrimental effects on semen parameters. It negatively affected all conventional semen parameters in addition to sperm chromatin condensation and sperm viability. These abnormalities were also proportional to the number of cigarettes smoked per day and to the duration of smoking.

Histological alterations in Leydig cells and macrophages in azoospermic men.

The study aimed to compare the histological features of Leydig cells and macrophages in the testicular interstitium of obstructive versus nonobstructive azoospermia. Thirty-nine azoospermic men undergoing testicular sperm extraction during intracytoplasmic sperm injection were allocated into obstructive azoospermia group (GI) and nonobstructive azoospermia group (GII) which was subdivided into Sertoli cell-only syndrome (GIIA), germ cell arrest (GIIB) and hypospermatogenesis (GIIC) subgroups. Serum LH, FSH and testosterone levels were measured. Ultrastructural changes and the mean number of CD68-positive cells were estimated in the different groups. In GIIA, Leydig cells' processes came in contact with macrophages and showed smooth endoplasmic reticulum dilatation. In GIIB, Leydig cells showed apoptotic changes. Macrophages were commonly encountered in their vicinity demonstrating large number of lysosomes. In GIIC, Leydig cells showed euchromatic nuclei. Macrophages showed expulsion of their lysosomal contents in the interstitium surrounded by apoptotic bodies. The mean count of total CD68-positive macrophages was higher in cases of obstructive azoospermia with nonsignificant differences compared to nonobstructive azoospermia groups. Significant increase in FSH level was detected in GIIA compared to GI. It is concluded that structural interactions might take place between Leydig cells and macrophages in the interstitial tissue of azoospermic men.

The use of r-hFSH in treatment of idiopathic male factor infertility before ICSI.

OBJECTIVE: To evaluate the efficacy of pre-treatment of idiopathic oligozoospermic patients with r-hFSH to improve the clinical results of ICSI. PATIENTS AND METHODS: 82 infertile couples due to male factor who attended our center were included in the study. Thirty-six were randomized to the treatment group (group A) and forty-six to the control group (group B). The male partners in group A were treated with recombinant human FSH (r-hFSH; Gonal F®) 150 IU subcutaneously three times a week for a 3-months period. The control group (group B) did not receive any treatment. After the treatment couples of both groups underwent a cycle of ICSI. RESULTS: The fertilization rate was comparable in both groups. However, in the treatment group (group A), the clinical pregnancy rate was significantly higher (42%) compared to the control group (group B) (20%) (p < 0.02). Also, the implantation rate was significantly higher in treatment group (26%) compared to the control (15%) (p < 0.04). Miscarriage rate was lower (15.7%) in the treatment group than in the control (43.7%), and this difference was statistically significant (p < 0.05). CONCLUSIONS: Treatment of idiopathic male factor infertility with r-hFSH before ICSI improves clinical pregnancy rate, increases implantation rate and decreases the early pregnancy loss.

Non-carboxylic analogues of aryl propionic acid: synthesis, anti-inflammatory, analgesic, antipyretic and ulcerogenic potential.

As a part of ongoing studies in developing new potent anti-inflammatory and analgesic agents, a series of novel 6-methoxy naphthalene derivatives was efficiently synthesized and characterized by spectral and elemental analyses. The newly synthesized compounds were evaluated for their anti-inflammatory activities using carrageenin-induced rat paw edema model, analgesic activities using acetic acid induced writhing model in mice and anti-pyretic activity using yeast induced hyperpyrexia method as well as ulcerogenic effects. Among the synthesized compounds, thiourea derivative (6a, e) exhibited higher anti-inflammatory activity than the standard drug naproxen in reduction of the rat paw edema (88.71, 89.77%) respectively. All of the non-carboxylic tested compounds were found to have promising anti-inflammatory, analgesic and antipyretic activity, while were devoid of any ulcerogenic effects.

The effect of antidepressant drugs on thioacetamide-induced oxidative stress.

OBJECTIVE: The aim of the present study was to investigate the effect of the serotonin selective reuptake inhibitors (SSRIs) fluoxetine and sertraline and the tricyclic drug imipramine on oxidative stress in the brain and liver caused by thioacetamide in rats. MATERIALS AND METHODS: Drugs were administered orally once daily at doses of 10 and 20 mg/kg for two weeks prior to intraperitoneal injection of thioacetamide (300 mg/kg). Rats were euthanized 24 h after thioacetamide. Reduced glutathione (GSH), malondialdehyde (MDA) and nitric oxide were measured in brain and liver. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were measured in serum and histopathological evaluation of liver injury was performed. RESULTS: The administration of thioacetamide increased MDA by 151.8% and 161.2%, increased nitric oxide by 57.2% and 63.9% and decreased GSH by -40.6% and -67% in the brain and liver, respectively. Thioacetamide markedly increased serum ALT, AST and ALP by 277.8, 80.8 and 121%, respectively. In the brain, MDA was decreased in rats treated with fluoxetine or sertraline. The level of GSH increased by fluoxetine and by the higher dose of sertraline. Nitric oxide in brain was unchanged by fluoxetine, but increased after sertraline at 20 mg/kg. Brain MDA was increased by imipramine, which also decreased brain nitrite level. In the liver, fluoxetine or sertraline treatment increased GSH and nitrite levels. MDA was also increased by either drug. The drugs markedly decreased ALT, but increased ALP in serum. Meanwhile, imipramine decreased liver nitric oxide levels (at the lower dose only -32.9%), markedly increased hepatic GSH, but did not change MDA level. Serum ALT decreased by imipramine (but AST and ALP showed no change). Histopathological and histochemical examinations indicated that thioacetamide-induced liver injury was not decreased after treatment with the antidepressant drugs. CONCLUSIONS: In thioacetamide-treated rats, pretreatment with the SSRIs drugs fluoxetine and sertraline is associated with decreased lipid peroxidation in brain; liver peroxidation, however, is increased. Imipramine displayed opposite effects. The thioacetamide-induced hepatic damage was not reduced by fluoxetine, sertraline or imipramine.  

Windows into estradiol effects in Alzheimer's disease therapy.

BACKGROUND AND OBJECTIVES: Alzheimer's disease (AD) is a neurological disorder associated with aging. The neuropathologic features of this disease are senile plaques and neurofibrillary tangles, which are present in memory structures and cerebral cortex. This study focuses on evaluation of estradiol administration in the management of neurological changes accompanied with AD in ovariectomized rats intoxicated with aluminum. MATERIALS AND METHODS: Fifty adult female rats were classified into 5 main groups as follows: Group (1): gonad intact control, Group (2): ovariectomized control group, Group (3): ovariectomized rats were injected subcutaneously with estradiol for 18 weeks, Group (4): ovariectomized rats were injected intraperitoneally with aluminum chloride (AlCl3) daily for three months, Group (5): ovariectomized rats were injected intraperitoneally with AlCl3 for three months, then, they were injected subcutaneously with estradiol three times weekly for 18 weeks. Hydrogen peroxide (H2O2), malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), B cell lymphoma 2 (Bcl-2), brain derived neurotrophic factor (BDNF), acetylcholinesterase (AchE) and acetylcholine (Ach) were determined in brain tissue of all studied groups. RESULTS: The results showed that brain TAC, SOD activity, Bcl-2 and BDNF levels were decreased significantly due to ovariectomy. Brain H2O2, MDA levels and AchE activity were increased significantly after AlCl3 administration to ovariectomized rats. Brain TAC, Bcl-2, BDNF and Ach levels were decreased significantly as a result of AlCl3 supplementation to ovariectomized rats. Treatment of rats with estradiol produced marked improvement in the most studied biomarkers and this finding was well documented by histological investigation of the brain which showed remarkable improvement in the feature of the neurons in addition to the disappearance of plaques. CONCLUSIONS: We could conclude that estradiol administration significantly ameliorates the neurodegeneration characteristic of Alzheimer's disease in experimental rat model. This may be attributed to its powerful antioxidant, antiapoptotic, neurotrophic as well as its antiamyloidogenic activities.

The protective effects of fish oil and artichoke on hepatocellular carcinoma in rats.

BACKGROUND AND OBJECTIVES: The present study aimed to evaluate the effect of fish oil and Artichoke (Cynara scolymus I.) against diethylnitrosamine (DEN) induced hepatocellular carcinoma in rats. MATERIALS AND METHODS: Animals were divided into 8 groups. Group 1, control rats. Group 2: rats injected with single dose of DEN (100 mg/kg body weight). Groups 3-8 supplemented with different concentrations of either fish oil or artichoke for 25 days before DEN injection. RESULTS: DEN treatment revealed a significant decrease in tissue xanthine oxidase (XO), glutathione, glutathione-s-transferase (GST), and a marked increase in malondialdehyde (MDA) and nitric oxide (NO) levels. Vascular endothelial growth factor (VEGF), alpha-fetoprotein (AFP), and ferritin levels showed a significant increase. A significant increase in serum aspartate amino transferase (AST), alanine amino transferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and total bilirubin levels were found. A significant decrease in tissue total proteins and serum albumin was observed. The administration of DEN affected the liver cell through occurrence of hepatic cellular degeneration and necrosis. Treatment with fish oil (5%, 10%) or artichoke heads or leaves (0.5, 1 g) for 25 days led to significant amelioration of DEN-induced changes in the biochemical parameters. An almost normal histological architecture of the liver, in treated groups, was showed as compared to the controls. CONCLUSIONS: The results pointed that 10% fish oil and 1 g% leaves of artichoke succeeded to protect from hepatocellular carcinoma to a certain degree. In addition, they may be considered as protective foods against angiogenesis.

Recombinant HCG for triggering ovulation increases the rate of mature oocytes in women treated for ICSI.

PURPOSE: To conduct a prospective randomized study in order to investigate the effect of recombinant HCG (rHCG) on oocyte nuclear and cytoplasm maturity compared to urinary HCG (uHCG), for inducing ovulation in women treated with ICSI for male factor infertility. MATERIALS AND METHODS: We compared 89 patients randomly assigned to one of the two study groups. Group A consisted of 42 women who received a subcutaneous (s.c.) injection of 250 microg rHCG and group B consisted of 47 patients receiving an intramuscular (i.m.) injection of 10,000 IU uHCG. RESULTS: Patients treated with rHCG showed a rate of metaphase II oocytes, a number of metaphase II oocytes with mature cytoplasm and a rate of metaphase II oocytes with mature cytoplasm calculated from total MII oocytes statistically higher than in patients treated with uHCG. However this differences were not associated with a significantly better clinical outcome. CONCLUSION: Our data show that in women treated with ICSI for male factor infertility, rHCG increases the rate of metaphase II oocytes, the number and the rate of MII oocytes with mature cytoplasm compared to uHCG. A larger study comparing transfer cycles of embryos all derived from oocytes with mature cytoplasm and transfer cycles of embryos all derived from oocytes with immature cytoplasm may be needed to clarify clinical correlations.

Impaired parvocellular pathway in dyslexic children.

Recent studies report that some children with dyslexia have impaired visual processing, specifically in the fast-processing magnocellular pathway. The objective was to study the effect of varying luminance and temporal and spatial frequency on the latency and amplitude of the visual evoked potentials (VEPs) in normal and dyslexic Egyptian children who speak Arabic (a right-left reading and writing system). VEPs were recorded in 52 dyslexic and 41 normal children in the fourth grade using a black and white checkerboard pattern with different checkerboard sizes and different rates of stimuli at high- and low-contrast media. The peak of the major positive wave component (P100) of each waveform and the trough of the previous major negative wave component were identified, and the peak-to-trough amplitude was measured. The latency and amplitude of VEPs in response to different experimental conditions showed significant shortening of P100 latency under high-contrast media and under low spatial frequency in children with dyslexia compared with normal readers. Furthermore, dyslexia children showed prolonged P100 latency in response to high spatial frequency stimulation compared with the low spatial frequency (P=0.003) and significantly higher N1-P1 amplitude under high-contrast media compared with low-contrast media (P=0.02), whilst no such changes were observed in normal readers. These results are suggestive of deficiency within the parvocellular pathway rather than the magnocellular pathway. As reading apparently places demands primarily on the ability to discriminate fine details, which is to say, on the parvocellular system, we suggested that deficiency in this system, at least in Arabic speaking children, could be a predisposing factor in dyslexia.

The use of a modified hypo-osmotic swelling test for the selection of viable ejaculated and testicular immotile spermatozoa in ICSI.

A modified hypo-osmotic solution was used to select viable ejaculated and testicular spermatozoa to perform intracytoplasmic sperm injection (ICSI) in 27 treatment cycles from patients with total absence of sperm motility. The treatment cycles consisted of 15 cycles in which ejaculated spermatozoa were used and 12 cycles in which testicular spermatozoa were used. The hypo-osmotic solution consisted of 50% culture medium and 50% deionized water and was shown in previous in-vitro studies to be superior to the original solution used in the classical hypo-osmotic swelling test. Fertilization was achieved in 37.3% of the oocytes injected. Embryos were replaced in 70.4% of the cycles with a mean of 2.0 embryos per cycle. There were no statistically significant differences between the ejaculated sperm group and the testicular sperm group in the fertilization rate (42.7 versus 30.1%) or in the cleavage rate (92.7 versus 77.3%). Four pregnancies resulted, two in the ejaculated sperm group and two in the testicular sperm group, a pregnancy rate of 14.8%. All pregnancies were singletons but one pregnancy in each group had an early miscarriage. There were no statistically significant differences between both groups in the pregnancy rates (13.3 versus 16.7%), in the implantation rates (5.3 versus 11.8%) or in the delivery/ongoing pregnancy rates (6.7 versus 8.3%). It is concluded that the use of this solution to select viable but immotile spermatozoa for ICSI is a simple and practical method and is associated with acceptable fertilization and pregnancy rates.

Soluble adhesion molecules as a marker of disease severity in human fascioliasis.

Fasciola gigantica is one of the parasites which affect the liver by producing biliary tract lumen syndrome. Soluble adhesion molecules namely soluble intercellular adhesion molecule-1 (sICAM-1) and soluble E-selection (sELAM-1) were assayed in human fascioliasis cases with or without complications. It was found that sICAM-1 and sELAM-1 were significantly increases in complicated cases more than the control group, while only sICAM-1 was significantly increased in complicated cases more than non complicated ones. However, non of both soluble adhesion molecules were significantly elevated in non complicated cases as compared to controls suggesting that sICAM-1 is a useful marker for differentiation between complicated and non complicated cases of human fascioliasis.

On the morphology of Heligmosomoides polygyrus (Nematoda-Trichostrongylidae) from the field mouse apodemus sylvaticus.

The morphology of the trichostrongylid nematode Heligmosomoides polygyrus is described by light and scanning electron microscopy. In light microscope, the present material agrees with the original description given by Baylis (1926), except for the addition of more details about the structure of the genital cone and the synlophe. The scanning electron microscopy of the present nematode revealed that the oral opening of the immature worm (L5) is rounded and its cuticular surface is loosely attached to the body, while the oral opening of the mature worm is triangular, the two copulatory spicules of the male are alate and closely adhering to each other and the right lobe of the male bursa is longer than the left one. Male prebursal and bursal papillae are described. The female posterior extremity is characterized by crescent vulval and anal openings and a terminal spike.

Evaluation of the IgG4 in Egyptian bancroftian filariasis.

The IgG4 response against antigen extracts from Wuchereria bancrofti microfilariae and Dirofilaria immitis adult worms was determined by ELISA in 65 Egyptian adult male patients suffering from different clinical manifestations of W. bancrofti infection. They were divided into microfilaremic (n-35) and amicrofilaremic (n = 30) and these divisions were subdivided into early asymptomatic, hydrocele and late chronic elephantiasis subgroups. The IgG4 responses were significantly higher in early asymptomatic patients whether microfilaremic or amicrofilaremic than in hydrocele or in chronic elephantiasis (P < 0.05) & (P < 0.001) respectively. The IgG4 response was slightly higher in microfilaremic than in amicrofilaremic subjects. The mean OD value of IgG4 among the microfilaremics against the microfilaria antigen in early asymptomatic patients (0.840 nm) was lower than the IgG4 response against the adult antigen in the same group (0.960 nm), while among the early asymptomatic amicrofilaremics it was the same (0.690 nm) in both microfilaria and adult antigens.

Chironomid potent allergens causing respiratory allergy in children.

Generally speaking, chironomids contain potent inhalant allergens. The skin prick tests with chironomid crude extract (Chironomus (C.) calipterus) were positive in 20 out of 25 children with respiratory allergy. The skin prick tests with house dust mite crude extract (Dermatophagoides pteronyssinus) were positive in 3 of these 20 chironomoid positive skin tests. Chironomid-specific IgE-ELISA were demonstrated in the sera of 17 (85%) of the chironomid skin positive patients. These 17 patients gave negative skin prick test to house dust mite crude extract. It is concluded that chironomid allergens should be considered when dealing with human respiratory allergy caused by arthropods.

Efficacy of BaySir-8514 and precocene II against the grey flesh fly Parasarcophaga dux (Thomson) (Diptera: Sarcophagidae).

Five doses (1, 0.5, 0.25, 0.125 and 0.0625) of the chitin inhibitor BaySir-8514, and anti-juvenoid precocene II were topically applied to the third larval instar of the grey flesh fly Parasarcophaga dux. Toxicity of both compounds were recorded against different developmental stages at the different dose levels. The lowest dose (0.0625) of both compounds caused a low toxicity percent (0.1). On the other hand, the highest dose (1mg) increased the larval, pupal and adult malformations after larval treatment by both compounds. Highest percentage of larval deformations was obtained by the maximal dose-level (1mg), which in turn did not lead to the highest percentage of adult deformations. Shortening of larval-pupal durations and adult longevities were observed. Sterilizing action of precocene II on P. dux could be remarkably detected by the effect of higher doses (0.5 and 1%) on the 3rd larval instar because no larvae were deposited by the emerging adult females. Doses of 0.125 and 0.0625 mg inhibited the female natality.

Evaluation of ELISA kit hypodermosis in serodiagnosis of Przhevalskiana silenus in goats and Cephalopenia titillator in camels.

Myiasis is a problem of Medical and Veterinary importance worldwide. It affects human welfare both directly and indirectly. ELISA kit hypodermosis was evaluated in detecting antibodies against two oestrid larvae, Przhevalskiana silenus in goats and Cephalopina titillator in camels. Both animals were parasitologically proved to have oestrid myiasis infestation. Antibodies against P. silenus were detected in 38 out of 40 (95%) infested goats and negative results among the control group. With C. titillator, antibodies were detected in 39 out of 40 (97.5%) infested camels. But one of the control (10%) gave false seropositivity. ELISA kit hypodermosis diagnosed antibodies against P. silenus in goats and C. titillator in camels. Consequently, there are cross reactions between anti-hypoderma antibodies and antibodies against both Przhevalskiana and Cephalopina. ELISA is confirmed to be an easy and economic tool in diagnosing myiasis infestation when direct examination is not a simple mean and/or for epidemiological studies. The whole results were discussed. Focusing on the clinical pictures and pathogenesis of human myiasis was included to clarify the zoonotic importance of myiasis in Egypt.