Sensitivity and Specificity Estimation for the Clinical Diagnosis of Highly Pathogenic Avian Influenza in the Egyptian Participatory Disease Surveillance Program.

Many developing countries lack sufficient resources to conduct animal disease surveillance. In recent years, participatory epidemiology has been used to increase the cover and decrease the costs of surveillance. However, few diagnostic performance assessments have been carried out on participatory methods. The objective of the present study was to estimate the diagnostic performance of practitioners working for the Community-Based Animal Health and Outreach (CAHO) program, which is a participatory disease surveillance system for the detection of highly pathogenic avian influenza outbreaks in Egypt. CAHO practitioners' diagnostic assessment of inspected birds was compared with real-time reverse-transcriptase polymerase chain reaction (RRT-PCR) test results at the household level. Diagnostic performance was estimated directly from two-by-two tables using RRT-PCR as a reference test in two different scenarios. In the first scenario, only results from chickens were considered. In the second scenario, results for all poultry species were analyzed. Poultry flocks in 916 households located in 717 villages were inspected by CAHO practitioners, who collected 3458 bird samples. In the first scenario, CAHO practitioners presented sensitivity (Se) and specificity (Sp) estimates of 40% (95% confidence interval [CI]: 21%-59%) and 92% (95% CI: 91%-94%), respectively. In the second scenario, diagnostic performance estimates were Se = 47% (95% CI: 29%-65%) and Sp = 88% (95% CI: 86%-90%). A significant difference was observed only between Sp estimates (P < 0.01). Practitioners' diagnostics and RRT-PCR results were in very poor agreement with kappa values of 0.16 and 0.14 for scenarios 1 and 2, respectively. However, the use of a broad case definition, the possible presence of immunity against the virus in replacement birds, and the low prevalence observed during the survey would negatively affect the practitioners' performance.

Circulation of avian influenza H5N1 in live bird markets in Egypt.

The poultry meat trade in Egypt depends mainly on live bird markets (LBMs) because of insufficient slaughterhouses, lack of marketing infrastructure, and cultural preference for consumption of freshly slaughtered poultry. There are two types of LBMs in Egypt: retail shops and traditional LBMs where minimal, if any, food safety standards or veterinary inspection are implemented. Before January 2009, LBMs were considered to be a missing link in the epidemiology of avian influenza in Egypt. This incited us to initiate this surveillance to better understand the perpetuation of H5N1 and the risk of infection in poultry markets. Seventy-one out of 573 (12.4%) examined LBMs were positive for the H5N1 subtype by real-time--quantitative polymerase chain reaction (RT-qPCR) from January to April 2009. Where a 70.4% detection rate from LBMs had waterfowl only as a solitary sold species, a 26.8% detection rate from LBMs had waterfowl mixed with chicken and/or turkey, and 2.8% from LBMs had only turkey. Higher incidence, 40.8%, of positive LBMs was recorded during the cold month of February and concentrated mainly in the highly populated Nile Delta. These findings revealed wide circulation of H5N1 avian influenza virus in LBMs in Egypt, which poses a threat to public health and the poultry industry. Long-term control measures are required, and routine surveillance of bird markets should be conducted year-round.

Nail changes in patients with liver disease.

BACKGROUND: Liver cirrhosis, hepatitis C virus (HCV) and hepatitis B (HBV) virus infections are known to be associated with different skin disorders. Nail changes are additional important criteria, which would help in identification of these systemic diseases. OBJECTIVE: To record the nail abnormalities in patients with liver disease which were not reported before, especially those with HCV and HBV infection. PATIENTS AND METHODS: The study comprised 100 patients with HCV, HBV and liver cell failure, and 100 normal healthy controls. Both groups underwent full history taking and thorough general examination, complete blood picture, hepatitis B antigen, hepatitis C antibody, liver function tests, abdominal ultrasonography and PCR were performed in patients with liver disease. Full nail examination was performed. RESULTS: Nail changes were more prevalent in patient group (68%) than in the control group (35%). The nail infection, onychomycosis, was the most common finding in 18% of patients and that in controls was 10% followed by in a descending order, longitudinal striations, brittle nails, onychorrhexis, clubbing of fingers, dystrophic nails, leukonychia and longitudinal melanonychia. CONCLUSION: Nail changes are observed with not only liver cirrhosis but also with HCV and HBV infection, and this will add additional clinical criteria for general practitioners and dermatologists to help them with diagnosis of these common systemic infections.

Genetic diversity in Egyptian and Italian goat breeds measured with microsatellite polymorphism.

Seven microsatellite markers were used to study genetic diversity of three Egyptian (Egyptian Baladi, Barki and Zaraibi) and two Italian (Maltese and Montefalcone) goat breeds. The microsatellites showed a high polymorphic information content (PIC) of more than 0.5 in most of the locus-breed combinations and indicated that the loci were useful in assessing within- and between-breed variability of domestic goat (Capra hircus). The expected heterozygosity of the breeds varied from 0.670 to 0.792. In the geographically wider distributed Egyptian Baladi breed there were indications for deviations from random breeding. Analysis of genetic distances and population structure grouped the three Egyptian goat breeds together, and separated them from the two Italian breeds. The studied Mediterranean breeds sampled from African and European populations seem to have differentiated from each other with only little genetic exchange between the geographically isolated populations.

Towards a universal dissolution medium for carbamazepine.

The aim of this study was to develop a dissolution medium for assessment of various carbamazepine (CBZ) formulations with different strengths. The design of a system inhibiting transformation of the anhydrous CBZ (CBZ A) to the dihydrate form (CBZ D), with minimum surface-active properties and suitable sink was investigated. The effect of pH, different concentrations of sodium lauryl sulphate (SLS), polyvinylpyrrolidone (PVP), and methyl cellulose (MC) on dissolution rate, solubility, dissolution solubility, and polymorphic transformation of CBZ was assessed. Solution-mediated transformation of CBZ A into CBZ D was monitored using optical microscopy, Fourier transform infrared spectroscopy and differential scanning calorimetry. Results showed that different strengths (100, 200, 400 mg) of the same CBZ tablet formulation exhibited different dissolution patterns, in 1% SLS (USP system). Such differences were reduced in 0.5% SLS solution which provided sufficient sink for up to 200 mg CBZ. It was also shown that solubility of CBZ A could not be detected in the media under study (water, SGF, SIF, and SLS solutions) due to its rapid transformation into CBZ D. The use of 3% PVP solution protected CBZ A from conversion for 75 min, while 0.01% MC completely inhibited the transformation up to 24 h. Therefore, a medium consisting of 0.5% SLS and 0.01% MC was selected. The medium provided: a) protection against transformation of CBZ A to CBZ D, b) increased solubility of CBZ A (204 mg % compared to 128 mg % of CBZ D in 0.5% SLS), c) suitable sink for up to 400 mg CBZ and d) overlapping dissolution profiles of various strengths of the same CBZ formulation. The suggested system may be a step in the way of solving CBZ dissolution problems that forced the USP to specify two similar dissolution tests with two different limits for conventional 200 mg CBZ tablets.

Study of in-vitro release characteristics of carbamazepine extended release semisolid matrix filled capsules based on Gelucires.

Various extended release carbamazepine (CBZ) formulations have been developed previously, in order to reduce the frequency of dosing in chronic therapy and to decrease the variability in drug plasma concentration. In the present study, the suitability of different grades of Gelucires (G, glyceride based excipients) to formulate CBZ extended release capsules by the application of semisolid matrix (SSM) filling capsule technology was investigated. The possible modification of CBZ release kinetics by using Gelucire blends or inclusion of hydrophilic additives in the SSM was studied. The effect of ageing on some selected formulations was also evaluated, using scanning electron microscopy and differential thermal analysis. Twenty-one capsule formulations were prepared and assessed for their release characteristics. The mechanism of drug release from the test formulations was studied. The following results were obtained: a) Release data could not be correlated to the melting point (mp) of Gelucires used, pointing to relative lipophilicity of the base as a more important determinant of drug release. Among Gelucire grades having melting points higher than 37 degrees C, the release rate proved to be highly dependent on the HLB value and matrix composition. b) CBZ release occurred by different mechanisms, including matrix disintegration, diffusion and or erosion depending on the vehicle employed. c) Zero order release profiles of CBZ were obtained from SSM-based on G50/13, G53/10 and their blends in ratios higher than 1:1 and G53/10 containing croscarmellose sodium. d) The ageing study revealed that these latter formulations, except those based on G50/13, also showed high dissolution stability during one year of shelf ageing. e) PVP, as a polymorphic transformation inhibitor, can be used to reduce the storage-induced changes of some grades of Gelucires. From the above data, it can be concluded that different grades of Gelucires and their blends as well as hydrophilic additives could be successfully used to formulate CBZ extended release SSM filled capsules with various release kinetics.

Semisolid matrix filled capsules: an approach to improve dissolution stability of phenytoin sodium formulation.

Seven semisolid fill bases were selected for the formulation of 24 capsule formulations, each containing 100 mg of phenytoin sodium. The fill materials were selected based on the water absorption capacity of their mixtures with phenytoin sodium. The fill matrices included lipophilic bases (castor oil, soya oil, and Gelucire (G) 33/01), amphiphilic bases (G 44/14 and Suppocire BP), and water-soluble bases (PEG 4000 and PEG 6000). The drug:base ratio was 1:2. Excipients such as lecithin, docusate sodium, and poloxamer 188 were added to some formulations. The dissolution rate study indicated that formulations containing lipophilic and amphiphilic bases showed the best release profiles. These are F4 (castor oil-1% docusate sodium); F10 (castor oil-3% poloxamer 188); F14 (G33/01-10% lecithin); F17 (G33/01-1% docusate sodium), and F20 (Suppocire BP). Further, the dissolution stability of the five formulations above was assessed by an accelerated stability study at 30 degrees C and 75% RH using standard Epanutin capsules for comparison. The study included the test and standard capsules either packed in the container of marketed Epanutin capsules (packed) or removed from their outer pack (unpacked). Release data indicated superior release rates of castor oil based formulations (F4 and F10) relative to standard capsules in both the unpacked and packed forms. For instance, the extent of drug release at 30 min after 1 month was 91% for F4 and F10 and 20% for standard capsules. Drug release from packed capsules after 6 months storage was 88% for both formulations F4 and F10 and 35% for standard capsules. In conclusion, the pharmaceutical quality of phenytoin sodium capsules can be improved by using a semisolid lipophilic matrix filled in hard gelatin capsules.

Self-reported adolescents' health and gender: an Egyptian study.

To identify self-reported health problems among adolescents, a multistage, stratified random sample of 1002 adolescents from preparatory and secondary schools in Cairo (67.6% of the total sample) and the rural district of Qaliubia (32.4%) was surveyed. Of 863 completed questionnaires analysed, 54% were from males and 46% from females (age range: 12-18 years). The study showed that more boys than girls perceived their health as very healthy whereas more girls considered their health to be average. Significantly, more adolescent females reported weekly occurrence of abdominal pain, headache, dizziness, backache, morning tiredness, sleep disturbance and nervousness. Awareness-raising of parents and adolescents is necessary to allow determination of the relationship between gender and health.

Infections in children under 5 years old and latrine cleanliness.

The aim of this study is to assess the cleanliness of the latrine and its relation to occurrence of disease in children under 5 years old. A stratified random sample of 1327 households was conducted in 11 villages in Upper Egypt. It included a sub-sample of 541 children under 5 years living in households with latrines. The latrine cleanliness was assessed and its relationship to disease occurrence within a period of 2 weeks. Thirty-three percent (33.1%) of children under 5 years old with latrines in their household had infections, compared to 28.3% of those without latrines in the house. Infection with diarrhoea was found most in houses with latrine and water tap. A relation was found between latrine cleanliness score and presence of flies, house building material and maternal education, but none with occurrence of infection in children under 5 years old within a period of 2 weeks.

Self-reported adolescents' health and gender: an Egyptian study

To identify self-reported health problems among adolescents, a multistage, stratified random sample of 1002 adolescents from preparatory and secondary schools in Cairo [67.6% of the total sample] and the rural district of Qaliubia [32.4%] was surveyed. Of 863 completed questionnaires analysed, 54% were from males and 46% from females [age range: 12-18 years]. The study showed that more boys than girls perceived their health as very healthy whereas more girls considered their health to be average. Significantly, more adolescent females reported weekly occurrence of abdominal pain, headache, dizziness, backache, morning tiredness, sleep disturbance and nervousness. Awareness-raising of parents and adolescents is necessary to allow determination of the relationship between gender and health

Spectrophotometric analysis of some guanidino drugs by acid-dye and charge-transfer complexation methods.

Two spectrophotometric methods are described for the determination of guanethidine sulphate (I), guanfacine hydrochloride (II), guanoclor sulphate (III), guanoxan sulphate (IV) and debrisoquine sulphate (V). The first method involves ion-pair formation of the selected compounds (I-V) with bromocresol purple at pH 3.8. The yellow ion pair is extracted with chloroform and the absorbance is measured at about 415 nm. The second method is based on the reaction of the basic guanidino compounds (I, III-V) with iodine in chloroform to give molecular charge-transfer complexes with maximum absorbance at 292 and 345 nm. Beer's law was obeyed for both methods and the relative standard deviations were found to be less than 2%. The apparent molar absorptivities were found to be 2.1 x 10(4) to 6.9 x 10(4) l mol-1 cm-1 using bromocresol purple and 0.7 x 10(4) to 2.4 x 10(4) l mol-1 cm-1 using iodine. The investigated drugs were assayed in tablets. The mean percentage recoveries were found to be 99.8-100.8% by the acid-dye method and around 100.4% by the charge-transfer complexation method.

Spectrofluorimetric determination of guanethidine sulphate, guanoxan sulphate and amiloride hydrochloride in tablets and in biological fluids using 9,10-phenanthraquinone.

A highly sensitive spectrofluorimetric method for the determination of some drugs of the monosubstituted guanidine derivatives in laboratory made tablets, in spiked human serum and in urine samples is presented. The method is based on the reaction of guanethidine sulphate (I), guanoxan sulphate (II) and amiloride hydrochloride (III) with 9,10-phenanthraquinone (IV) to give highly fluorescent derivatives. The linearity ranges were found to be 0.06-0.96 mug/ml for (I) and (II) and 0.04-0.28 mug/ml for (III), with relative standard deviation less than 2%. Mean percentage recoveries for tablets were found to be 99.9 +/- 1.3, 100.5 +/- 1.1 and 100.0 +/- 1.6 for I, II and III, respectively. For I and III the results are highly correlated with the B.P. methods. Using the synchronous fluorimetry, differentiation between I and II was possible. Chloroform, dichloromethane and ethyl acetate have been used to extract I, II and III, respectively from serum and urine at basic pH, followed by applying the proposed fluorimetric method. Percentage recoveries were found to be 95.7-102.2%. The limit of detection is 0.04 mug/ml for I and II and 0.02 mug/ml for III.

Assay for amoxycillin in urine using derivative spectrophotometry.

Three derivatives spectrophotometric methods have been described for the assay of amoxycillin in urine. The methods were based on the amplitude measurements of second derivative (D2), first derivative difference (delta D1) or second derivative difference (delta D2) curves. These values were linearly correlated to the amoxycillin concentration in the range of 0.2-1.0 mg% with negligible intercepts. The absolute recovery from urine specimens was found to be 98%. The within-day and between-day precision were satisfactory.

Derivative spectrophotometric determination of antiprotozoal drugs in two-component tablet preparation.

First (D1-) and second (D2-) derivative spectrophotometric methods for the determination of diloxanide furoate and metronidazole in two-component preparation are presented. The methods are based on the direct measurements of diloxanide furoate in 0.1N hydrochloric acid solution at 262 nm and 248 nm for D1- and D2- curves, respectively without the interference of the coexisting component. Metronidazole, on the other hand is determined before and after its acid extraction from chloroformic solution and the subsequent D1- measurement at 288 nm and D2- measurement at 296 nm. The methods have been applied for the determination of both components in laboratory made mixtures and in tablet with a coefficient of variation less than 2%.

Specialization preference and attitude of medical students in Cairo within the primary health care context.

This cross-sectional study investigates specialization preference of medical students in Cairo, Ain Shams and El-Azhar Medical Schools using a stratified systematic random sample of 428 students and house officers (199 females and 229 males). They represent 5% of all second, fifth year students and house officers from all three universities. In addition 31 female students of El-Azhar were followed up to the final year and house officer year. The aim of the study is to compare students specialization preference with PHC needs. The questionnaire used comprised besides demographic data like age, sex, origin, maternal and paternal education and occupation also factors influencing the specialization preference like motive for choosing medical education, lecturer's personality, subject content, future location and setting intention. The distribution of specialization preference was found significantly different with educational year, sex, maternal education and occupation, father's occupation, socioeconomic standard, reason for choosing medical study and content attraction of the subject. Major subjects like surgery, medicine and gynaecology and obstetric were preferred significantly more by males, students with non-medical fathers, of lower SES, those who choose medicine for prestige and help of people, and who were attracted by the content of subject, while vis versa for pediatric and other specializations like cardiology, ophthalmology, clinical pathology and psychiatry among others. The follow-up study indicated that female students of El-Azhar tended to gynaecology and obstetric (from 32.3% to 42.1%) orienting themselves toward community needs being themselves to 34.1% from rural areas. The multiple regression analysis indicated that the best subset of variables influencing specialization preference are SES, maternal education, study reason, father occupation, sex, future setting and location. Students preferences are far from the PHC needs.

Study of serum copper and zinc in cases of hyperemesis gravidarum.

The dehydration, electrolyte and metabolic changes which occur in hyperemesis gravidarum are well recognized. The aim of this paper was to study the changes in serum copper and zinc and their correlation with the changes in serum electrolytes that occur in patients with hyperemesis gravidarum. Serum copper, zinc, sodium and potassium and urinary chloride were measured in 30 patients suffering from hyperemesis gravidarum and compared to the levels in 10 normal pregnant women in their first trimester. There was no significant change in serum copper or zinc in patients with hyperemesis compared to normal pregnant women. Also, there was no significant correlation between the changes in the level of these trace elements and the decrease which occurred in serum sodium and potassium and urinary chloride.