Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study.

OBJECTIVE: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Risk assessment of driver performance in the oil and gas transportation industry: Analyzing the relationship between driver vigilance, attention, reaction time, and safe driving practices.

The increasing use of road traffic for land transportation has resulted in numerous road accidents and casualties, including those involving oil and gas tanker vehicles. Despite this, little empirical research has been conducted on the factors influencing tanker drivers' performance. This study aims to address this knowledge gap, particularly in the energy transportation industry, by examining the driving performance factors that affect tanker drivers and incorporating risk assessment measures. The model variables were identified from the literature and used to develop a survey questionnaire for the study. A total of 307 surveys were collected from Malaysian oil and gas tanker drivers, and the driving performance factors were contextually adjusted using the Exploratory Factor Analysis (EFA) approach. The driving performance model was developed using partial least squares structural equation modeling (PLS-SEM). The EFA results categorized driving performance into two constructs: 1) drivers' reaction time with ß = 0.320 and 2) attention and vigilance with ß value = 0.749. The proposed model provided full insight into how drivers' reaction time, attention, and vigilance impact drivers' performance in this sector, which can help identify potential risks and prevent accidents. The findings are significant in understanding the factors that affect oil and gas drivers' performance and can aid in enhancing oil and gas transportation management by including effective risk assessment measures to prevent fatal crashes.

Outcomes of Clostridioides difficile infection in acute heart failure hospitalizations: insights from the National Inpatient Database.

BACKGROUND: Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of comorbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients. AIM: To identify patients with a diagnosis of acute HF and stratified based on the presence of CDI, using the National Inpatient Sample (NIS) database from 2016 to 2020. METHODS: Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed. FINDINGS: Of 536,595 acute HF hospitalizations in this timeframe, 3030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio: (aOR): 1.91), cardiac arrest (aOR: 1.66), and use of mechanical circulatory support (MCS) (aOR 2.42). In propensity-matched analysis, in-hospital mortality (13.71 vs 8.44%; P=0.005), septic shock (7.54 vs 3.33%; P=0.002), and use of MCS (7.19 vs 3.68%; P=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74) and liver disease (aOR: 2.97) showed the strongest association as independent predictors of mortality. HF patients with CDI had longer hospital stays (14.45 ± 19.40 vs 5.44 ± 7.10 days; P<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs $60,740 ± 153,992; P<0.001) compared to those without CDI. CONCLUSION: The occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and greater financial cost.

Infectious bacterial pathogens, parasites and pathological correlations of sewage pollution as an important threat to farmed fishes in Egypt.

This paper is a part of a multi-disciplinary research "Application of Decentralized On-Site Water Treatment System in Egypt for Use in Agriculture and Producing Safe Fish and Animal Proteins". The project aimed to investigate the environmental impact of implementing sewage water before and after treatment using the effluent of the on-site decentralized Japanese' Johkasou system, in agriculture and producing fish protein. The aim is to establish such system in Egypt to strengthen the sanitary conditions of water resources. In the present study, the impact of the sewage pollution in some fish farms at El-Fayyum, Port Said and El-Dakahlia governorates in Egypt was carried out. Water and fish (Oreochromis niloticus and Mugil cephalus) samples were collected from private fish farms of such localities. Bacteriological and chemical examination of water samples revealed the existence of coliforms and many other bacterial species of significant human health hazards. The chemical parameters of water showed a marked deviation from normal levels while examination of fish flesh specimens indicated contamination with Streptococcus Sp., Staphylococcus Sp., and Salmonella in all examined localities. Other bacterial isolates of human health importance (Morganella morganii, Pseudomonas cepacia and Enterococcos durans) were identified. The parasitological examination revealed the presence of encysted metacercariae (EMC); Diplostomatidae, Prohemistomatidae and Heterphyidae. Moreover, two protozoan parasites (Mxyoboulus tilapiae and Ichthyophthirius multifilis) were also recorded. The histopathological examination revealed mild tissue reaction in case of bacterial infection and severe pathological lesions in different organs in case of EMC infection. Lamellar hyperplasia and mononuclear cell infiltration in branchial tissue was common findings. In skeletal muscles, atrophy of muscle fibres, myolysis and myophagia were detected.

Improving the physico-chemical and sensory characteristics of camel meat burger patties using ginger extract and papain.

The objective of the current study was to include tenderizing agents in the formulation of camel meat burger patties to improve the physico-chemical and sensory characteristics of the product. Camel meat burger patties were processed with addition of ginger extract (7%), papain (0.01%) and mixture of ginger extract (5%) and papain (0.005%) in addition to control. Addition of ginger, papain and their mixture resulted in significant (P<0.05) increase of the collagen solubility and sensory scores (juiciness, tenderness and overall acceptability) with significant (P<0.05) reduction of the shear force values. Ginger extract resulted in extensive fragmentation of myofibrils; however, papain extract caused noticeable destructive effect on connective tissue. Moreover, ginger and papain resulted in improvement of the lipid stability of treated burger patties during storage. Therefore, addition of ginger extract and papain powder during formulation of camel burger patties can improve their physico-chemical and sensory properties.

Nitric oxide and antioxidant enzyme levels in blood of respiratory distress syndrome--Egyptian preterms and their mothers.

BACKGROUND: The mechanisms of tissue injury in respiratory distress syndrome (RDS) have not been completely elucidated but the involvement of oxidative damage due to reactive oxygen species (ROS) is important in the pathogenesis of preterm labor and RDS. OBJECTIVES: To assess the oxidative status in preterms with and without RDS and in their mothers. PATIENTS AND METHODS: Measuring and comparing concentrations of serum nitric oxide (NO), and erythrocytic activities of some antioxidant enzymes in blood of 20 preterms with RDS and 20 preterms without and their mothers, respectively. RESULTS: Our results confirm significant elevation of mean levels of serum NO and reduced mean levels of erythrocytic activities of antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT), in RDS preterms and their mothers compared with controls and their mothers. A significant positive correlations were found between maternal and preterm serum NO (r=0.3 & 0.6) and erythrocytic activity of SOD (r=0.5 & 0.4) for RDS and control groups, respectively. In addition, a significant negative correlations were found between NO and SOD in all groups. CONCLUSIONS: The existence of oxygen metabolites and lipid peroxidation was significantly more obvious in RDS preterms and in their mothers than those without.

Two New Flavonoids and Biological Activity of Astragalus abyssinicus (Hochst.) Steud. ex A. Rich. Aerial Parts.

2 new flavonoid glycosides, kaempferol 3-O-(4",6"-di-O-α-L-rhamnopyranosyl)-ß-D-glucopyranoside (1) and quercetin 3-O-(4",6"-di-O-α-L-rhamnopyranosyl)-ß-D-glucopyranoside (2), were isolated from the n-butanol soluble fraction of the methanol extract (BF) of Astragalus abyssinicus aerial parts, together with 3 known compounds, rutin (3), kaempferol 3-O-ß-D-rutinoside (4) and 5,7,4'-trihydroxy-3'-methoxyisoflavone (5). The structures of the isolated compounds were characterized on the basis of UV, NMR and negative ESI-MS analyses. The BF fraction showed in vitro weak antibacterial activity against Staphylococcus aureus, while 2 and 3 exhibited in vitro antioxidant activity higher than ascorbic acid using DPPH free radical scavenging activity method.

Mathematical modeling and microbiological verification of ohmic heating of a multicomponent mixture of particles in a continuous flow ohmic heater system with electric field parallel to flow.

To accomplish continuous flow ohmic heating of a low-acid food product, sufficient heat treatment needs to be delivered to the slowest-heating particle at the outlet of the holding section. This research was aimed at developing mathematical models for sterilization of a multicomponent food in a pilot-scale ohmic heater with electric-field-oriented parallel to the flow and validating microbial inactivation by inoculated particle methods. The model involved 2 sets of simulations, one for determination of fluid temperatures, and a second for evaluating the worst-case scenario. A residence time distribution study was conducted using radio frequency identification methodology to determine the residence time of the fastest-moving particle from a sample of at least 300 particles. Thermal verification of the mathematical model showed good agreement between calculated and experimental fluid temperatures (P > 0.05) at heater and holding tube exits, with a maximum error of 0.6 °C. To achieve a specified target lethal effect at the cold spot of the slowest-heating particle, the length of holding tube required was predicted to be 22 m for a 139.6 °C process temperature with volumetric flow rate of 1.0 × 10(-4) m3/s and 0.05 m in diameter. To verify the model, a microbiological validation test was conducted using at least 299 chicken-alginate particles inoculated with Clostridium sporogenes spores per run. The inoculated pack study indicated the absence of viable microorganisms at the target treatment and its presence for a subtarget treatment, thereby verifying model predictions.

Nisin treatment to enhance the efficacy of gamma radiation against Listeria monocytogenes on meat.

Treatment of meat with gamma radiation for inactivation of foodborne pathogens might cause undesirable quality changes in the product. The objective of the present study was to use nisin for enhancing the lethality of gamma radiation against Listeria monocytogenes, so that moderate doses of radiation can effectively eliminate the pathogen on meat. Cubes of raw meat (10 g each) were inoculated with L. monocytogenes (10(7)CFU/g) and treated with nisin (10(3) IU/g), gamma radiation (0.25 to 1.5 kGy), or combinations of these treatments. Meat was analyzed for L. monocytogenes survivors immediately after treatment and during storage at 4 °C for up to 72 h. Nisin treatment alone inactivated L. monocytogenes by 1.2 log CFU/g. Gamma radiation caused dose-dependent inactivation of the pathogen. Treatment with combinations of nisin and gamma radiation resulted in an additive antimicrobial effect when inoculated meat was tested during the first 24 h and in a synergistic effect when tested after 72 h of storage at 4 °C. When L. monocytogenes was inoculated onto meat at low levels (4×10(3) CFU/g), treated with nisin (10(3) IU/g), and then irradiated (1.5 kGy) and stored at 4 °C for 72 h, the pathogen's most probable number was <0.03/g, indicating that such a combination is potentially effective in eliminating L. monocytogenes in meat.

The use of natural herbal extracts for improving the lipid stability and sensory characteristics of irradiated ground beef.

Ground Longissimus dorsi of beef were treated with herbal extracts of marjoram, rosemary and sage at concentration of 0.04% (v/w), radiation (2 or 4.5 kGy) or their combination. Treated samples were stored at 5°C and analyzed periodically for thiobarbituric acid reactive substances (TBARS), sensory characteristics and psychrotrophic bacterial counts during storage for 41 and 48 days for samples treated at 2 and 4.5 kGy respectively. Results demonstrated a significant benefit of the addition of herbal extracts to the ground beef prior to irradiation. All three extracts significantly (P<0.05) lowered the TBARS values and off-odor scores and significantly (P<0.05) increased color and acceptability scores in all samples with marjoram being the most effective. The combination treatment with herbal extracts plus irradiation resulted in extension of the shelf life of samples treated with 2 kGy by one week and samples treated with 4.5 kGy by two weeks, over that treated with irradiation alone. In conclusion, the addition of herbal extracts can minimize lipid oxidation, improve color and decrease off-odor production in irradiated ground beef.

Impact of clean delivery kit use on clean delivery practices in Beni Suef Governorate, Egypt.

OBJECTIVE: A major factor contributing to neonatal and maternal infections is unhygienic delivery practices. This study explores the impact of clean delivery kit (CDK) use on clean delivery practices during home and facility deliveries. DESIGN: Kits were distributed from primary care facilities and mothers and birth attendants received training on kit importance and use. The study was designed as a cross-sectional cohort study. Raedat (community health workers) visited 349 women during the postpartum period to administer a structured questionnaire. SETTING: The study was conducted from mid-March through mid-July 2001 in two rural areas of Ihnasia district in Beni Suef Governorate (Upper Egypt). RESULT: In bivariate analysis, CDK users in the home were more likely to report that the birth attendant had clean hands (P<0.001), washed/wiped the mother's perineum (P<0.001), used a sterile cord tie (P=0.001), applied antiseptic to the cord after cutting (P<0.001), and used a sterile cord cover (P<0.001) as compared with non-CDK users. CDK users at the facility were more likely to report that the birth attendant washed/wiped the mothers perineum (P=0.049) and used a sterile cord cover (P=0.030) as compared with non-CDK users. CONCLUSION: In settings in which unhygienic practices during home as well as facility deliveries are prevalent, use of inexpensive CDKs can promote clean delivery practices.

Synthesis of certain substituted quinoxalines as antimicrobial agents (Part II).

Several fused triazolo and ditriazoloquinoxaline derivatives such as 1-aryl-4-chloro-[1,2,4]triazolo[4,3-a]quinoxalines (3a-d), 4-alkoxy[1,2,4]triazolo[4,3-a]quinoxalines (4a,b), 4-substituted-amino-[1,2,4] triazolo[4,3-a]quinoxalines (5a-h), 1-(aryl)-[1,2,4]triazolo[4,3-a]quinoxalin-4(5H)-thione (6), 4-(arylidenehydrazino)1-phenyl-[1,2,4]triazolo[4,3-a]quinoxalines (10a-e) and [1,2,4]ditriazolo[4,3-a:3',4'-c]quinoxaline derivatives (11-13) have been synthesized and some of these derivatives were evaluated for antimicrobial and antifungal activity in vitro. It was found that compounds 3a and 9b possess potent antibacterial activity compared to the standard tetracycline.

Melon chlorotic leaf curl virus, a New Begomovirus Associated with Bemisia tabaci Infestations in Guatemala.

In 2000, geminivirus-like symptoms were widespread in muskmelon (Cucumis melo L.) fields (70 to 80% incidence) in Zacapa Valley, Guatemala. Muskmelon fields were infested with the whitefly Bemisia tabaci (Genn.), and plants exhibited patchy foliar chlorosis, leaf curling, and reduced fruit set, which is reminiscent of symptoms caused by certain whitefly-transmitted geminiviruses. Quarantine restrictions prevented experimental transmission experiments from being carried out with the whitefly vector or biolistic inoculation. Leaves collected from six symptomatic plants were assessed for the presence of begomovirus DNA by polymerase chain reaction (PCR) with the use of degenerate primers that amplify the core region of the coat protein (CP) gene of most begomoviruses (1). PCR products of the expected size (approximately 576 bp) were obtained from all three melon samples. The core CP amplicons were cloned, and their nucleotide sequences were compared. Nucleotide sequences of core CP fragments shared 99.7% identity, suggesting the presence of a single begomovirus in all assayed symptomatic melon plants. Two additional pairs of degenerate primers were used to obtain contiguous viral fragments containing the CP gene, the common region of the A component (CR-A; approximately 2,100 bp), and a fragment containing the CR of the B component (CR-B; approximately 1,100 bp), respectively (2). At least three amplicons obtained with each primer pair were cloned and their nucleotide sequence was determined. Virus-specific PCR primers were then designed within the CP open reading frame and used to obtain fragments that overlapped with the 2,100-bp fragment to yield an apparent full-length A component of 2,662 nucleotides (accession no. AF325497). CR-A and CR-B (accession no. AF325498) sequences (161 nucleotides) shared 98.1% identity and contained an identical directly repeated, replication-associated protein (REP) binding site: GGTGT CCT GGTGT. Nucleotide sequence alignment, with CLUSTAL W, of the melon virus A-component with that of other well-studied begomoviruses revealed that its closest relatives were members of the Squash leaf curl virus (SLCV) group. The melon virus from Guatemala shared its greatest sequence identity, 83.1%, with SLCV extended (SLCV-E) (accession no. M38183), indicating that it is a new, previously unidentified begomovirus species, herein referred to as Melon chlorotic leaf curl virus (MCLCV). The next closest relatives of MCLCV were SLCV restricted (SLCV-R; 78.6%) (S. G. Lazarowitz, unpublished) Cucurbit leaf curl virus-Arizona (CuLCV-AZ; accession no. AF256199; 74.1%) (3), Cabbage leaf curl virus (CaLCV; 72.0%), Bean calico mosaic virus (BCMoV; 71.7%), and Texas pepper virus-Tamaulipas (71.4%). Additionally, the theoretical REP binding element, GGTGT, is 100% identical among MCLCV and BCMoV, CaLCV, CuLCV-AZ, SLCV-E, and SLCV-R. On the basis of shared nucleotide sequence identities with other begomoviruses described to date and the presence of B. tabaci in melon fields, it is likely that MCLCV also is whitefly-transmitted. Collectively, CP and CR sequences suggest that MCLCV is a new species of the SLCV lineage that contains other bipartite begomoviruses indigenous to Central America, Mexico, and the U.S. Sunbelt states. References: (1) S. D. Wyatt and J. K. Brown. Phytopathology 86:1288, 1996. (2) A. M. Idris and J. K Brown. Phytopathology 88:648, 1998. (3) J. K. Brown et al. Plant Dis. 84:809, 2000.

Epidemiology 1, 2, 3: origins, objectives, organization, and implementation.

This supplement is a report on the Epidemiology 1, 2, 3 (EPI 1, 2, 3) investigation, its origins, evolution, and findings that were carried out over a period beginning in 1990 and ending in 1994 in Egypt. The large scope and size of the study, the largest to date on schistosomiasis in Egypt, was a rationale for publishing a supplement to document EPI 1, 2, 3 methods and results collectively in sufficient detail to serve as a reference for planning, designing, and analyzing future epidemiologic studies and evaluation of schistosomiasis control in Egypt. The 3 objectives of EPI 1, 2, 3 were to 1) determine the changing patterns of Schistosoma haematobium and S. mansoni, 2) investigate factors contributing to differences between villages in the Nile Delta, Middle Egypt, and Upper Egypt, and 3) investigate risk factors for morbidity. The objectives were addressed using standardized techniques, stool and urine examinations, clinical examinations (including abdominal ultrasound), and questionnaires on a selected sample of the populations of selected villages in 9 governorates in Egypt.

Epidemiology 1, 2, 3: study and sample design.

Bad sample designs and selection bias have plagued studies on schistosomiasis, and as a result some believe that schistosomiasis is too focal, making it difficult to draw reliable samples. The Epidemiology 1, 2, 3 (EPI 1, 2, 3) sample design, although complex, demonstrates that sampling theory is readily applicable to epidemiologic studies of schistosomiasis. The EPI 1, 2, 3 sampling scheme was designed to achieve the smallest feasible standard errors given EPI 1, 2, 3 objectives and certain logistical constraints. The sample design is a multi-stage selection of villages (ezbas, which were stratified by size) and households within each of 9 purposely selected Egyptian governorates. Villages and households were systemically selected from census frames. The sampling of ezbas was especially difficult because of the lack of complete sampling frames and their wide variation in population size. Ultimately, ezbas were stratified by size and then randomly selected from each stratum. Sample sizes for villages and ezbas and individuals within ezbas were calculated based on EPI 1 and 2 objectives, respectively. No re-selection was made for non-respondents. A 20% subsample of the full sample was drawn for clinical and ultrasonographic examinations. The sample selected from individual governorates closely parallel the age structure of the 1986 census of the respective rural populations. Details of the study design and related methods are given below.

The epidemiology of schistosomiasis in Egypt: patterns of Schistosoma mansoni infection and morbidity in Kafer El-Sheikh.

This is a descriptive report of the Epidemiology 1, 2, 3 project in Egypt that made use of large probability sampling methods. These results focus on Schistosoma mansoni infection in the northern Nile Delta governorate of Kafr El Sheikh. A probability sample of 18,777 persons, representing the rural population of the entire governorate, was drawn. The sample was designed not to exclude villages based on location or presence of health care facilities and to include representation of the smaller ezbas or hamlets. The objective was to obtain detailed estimates on age- and sex-specific patterns of S. mansoni infection, and to provide a baseline for prospective studies. Stool specimens were examined by the Kato method. The estimated mean +/- SE prevalence of S. mansoni infection in the rural population was 39.3 +/- 3.3% in 44 villages and ezbas after weighing for the effects of the sample design. The estimated mean +/- SE geometric mean egg count per gram of stool (GMEC) was 72.9 +/- 7.3. Prevalence and GMEC varied considerably by village and ezba, with ezbas having a significantly higher prevalence. Villages and ezba-specific prevalence was strongly associated with GMEC (r2 = 0.61, P < 0.001). The prevalence of S. mansoni infection increased by age to 55.4 +/- 3.2% at age 16 without a significant change in the adult ages. There were no gender differences until age 6, after which males were consistently higher until middle age, when the differences converged. The age- and sex-specific pattern of GMEC varied widely; however, when the GMEC data were collapsed into 5-year age groups, the GMEC peaked at 81.5 +/- 12.1 eggs/g in the 10-14-year-old age group. These estimates provide the basis for evaluating control measures for reducing prevalence, intensity of infection, and transmission.

The epidemiology of schistosomiasis in Egypt: Gharbia Governorate.

Health questionnaires and parasitologic examinations of urine and stool were performed upon a stratified random sample of 14,344 individuals from 1,952 households in 34 rural communities in Gharbia Governorate of Egypt to investigate the prevalence of, risk factors for, and changing pattern of infection with Schistosoma sp. A subset, every fifth household, of 1,973 subjects had physical and ultrasound examinations to investigate prevalence of and risk factors for morbidity. Community prevalence of Schistosoma mansoni ranged from 17.9% to 79.5% and averaged 37.7%. The geometric mean egg count (GMEC) was 78.9 eggs/gram of feces. The prevalence and intensity of infection was 40-50% and 70-100 eggs/gram of feces in those > or =10 years of age. Schistosoma haematobium was detected in 5 of the 34 communities. The maximum infection rate was 2.8% and mean GMEC in the five communities was 2.1/10 ml of urine. The overall prevalence of S. haematobium in the governorate was 0.3%. Risk factors for infection with S. mansoni were male gender, an age >10 years, living in smaller communities, exposures to canal water, prior therapy for schistosomiasis, or blood in the stool (in children only). Morbidity detected by physical examination or ultrasonography did not correlate with S. mansoni infection in individuals with the exception of periportal fibrosis (PPF, odds ratio [OR] = 1.25). Periportal fibrosis was detected in more than half of the subjects by ultrasonography; 5.3% had grade II lesions and 1.0% had the most severe grade III changes. Risk factors for morbidity as manifested by ultrasonographically detected PPF were similar to those for infection. Periportal fibrosis had a negative relationship with abdominal pain (OR = 0.45) and hepatomegaly detected by physical examination and ultrasonography (ORs = 0.72 and 0.68), but it was associated with splenomegaly (ORs = 4.14 and 3.55). The prevalence of PPF, hepatomegaly, and splenomegaly increased with age. There was no relationship between community burden of schistosomiasis mansoni and any measurements of morbidity with the exception of splenomegaly detected by physical examination (r = 0.40). Schistosoma mansoni has almost completely replaced S. haematobium in Gharbia, which has a high prevalence and moderate intensity of S. mansoni infection. Periportal fibrosis was detected by ultrasonography in more than half of the subjects, and 1 in 16 had grade II and III lesions. The only relationship between PPF and other morbidity findings was its positive relationship with splenomegaly and negative association with hepatomegaly. Hepatic morbidity is common in communities in Gharbia but the role of schistosomiasis mansoni in this is uncertain.

The epidemiology of schistosomiasis in Egypt: Assiut governorate.

In the Assiut, Egypt Epidemiology 1, 2, 3 investigation, a sample of 14,204 persons in 10 villages, 31 ezbas (satellite communities), and 2,286 households was drawn from a rural population of 1,598,607. Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 5.2 +/- 0.5 (+/- SE). This varied considerably by village and ezba, ranging from 1.5% to 20.9%, with ezbas having a slightly higher overall prevalence than villages. The overall estimated geometric mean egg count was 6.6 +/- 0.5 eggs per 10 ml of urine and was consistently low throughout the communities. Infection with S. haematobium was associated with age (peak prevalence of 10.6 +/- 1.5% in 15-19-year-old age group) males, children playing in the canals, a history of blood in the urine, and reagent strip positivity for hematuria and proteinuria. The prevalence of either hepatomegaly or splenomegaly detected by physical examination was low (4.0% and 1.5%, respectively). The prevalence of hepatomegaly determined by ultrasonography was substantially higher, 24.1%. The prevalence of periportal fibrosis (PPF) was 12.0%, but grade II or III PPF was present in less than 1%. Ultrasonography-determined hepatomegaly, in both the midclavicular line and the midsternal line, increased by age to more than 30%. Periportal fibrosis was more common in the age groups in which infection rates were the highest. At the village and ezba level of analysis, the prevalence of hepatomegaly, splenomegaly, and PPF tended to be higher in communities having the highest prevalence of infection with S. haematobium.

The epidemiology of schistosomiasis in Egypt: Qena governorate.

Qena is the southernmost governorate of Egypt included in the Epidemiology 1, 2, 3 national study. A probability sample selected 17,822 individuals from 2,950 households in 34 ezbas and 10 villages from a total rural target population of 1,731,252 (based on the most recent 1986 census of the population by the Egyptian Central Agency for Public Mobilization And Statistics). Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, respectively, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 4.8 +/- 0.7% (+/-SE) and geometric mean egg count (GMEC) was 7.0 ova per 10 ml of urine. Considerable variation in prevalence was observed between the villages and ezbas, ranging from 0.0% to 20%, with the smaller ezbas having a slightly higher overall prevalence. The age- and sex-specific patterns of S. haematobium showed typical peak prevalence in early adolescence, with males having a higher prevalence than females. A history of hematuria was associated with current infection (odds ratio = 3.6, 95% confidence interval = 2.32-5.63). Hepatomegaly and splenomegaly determined by physical examination present in 7.9% and 3.0%, respectively. Ultrasonography-determined hepatomegaly of the left liver lobe was found in 10.1%. Ultrasonography-detected hepatomegaly in both the left and right lobes increased in prevalence from approximately 5% in children to 15-20% in adults. The prevalence of ultrasonography-detected splenomegaly increased slightly with age. Grade III periportal fibrosis was detected in only 2 individuals in the sample. Bladder wall lesions and obstructive uropathy were also very infrequent. Other associations with these measures are given. Most villages and ezbas had an S. mansoni prevalence of less than 1%. The exception was Nag'a El-Sheikh Hamad, where the prevalence was 10.3 +/- 0.5% (GMEC = 57.4 +/- 2.6). Two other communities also had a prevalence >1% (Ezbet Sarhan and Kom Heitin).