The forgotten oral microbial transplantation for improving the outcomes of COVID-19.

Ever since the uncovering of the severe discrepancy of COVID-19 manifestations, irrespective of viral load, scientists have raced to locate and manage factors contributing to the genesis of a critical state. Recent evidence delineates the role of oral dysbiosis in the development of low-grade inflammation, characterized by the increase of inflammatory cytokines common to those fundamental to the development of severe COVID. Furthermore, high periodontopathic bacteria were recorded in severe acute respiratory syndrome in COVID patients, as well as its common provoking comorbidities such as diabetes and hypertension. This can be explained by the immigration and elimination of oral bacteria into the airways, which, in the context of an injured lung, allows for their preferential overgrowth familiar to that, causing the progression to advanced lung diseases. This is why we indicate the promising usage of oral microbiome transplantation as a treatment of oral microbial dysbiosis, not only associated with the worst outcomes of COVID-19 but also in other disorders of low-grade inflammation.

Contrast echocardiogram in diagnosing rare type of persistent left superior vena cava.

We report a rare case of persistent left superior vena cava (PLSVC) with direct drainage into the left atrium in a 3-yearsold boy who had been electively admitted for hypospadias repair, when he was noticed to have finger clubbing and mild hypoxia but was otherwise asymptomatic. The diagnosis of PLSVC can be made without an invasive tool as direct drainage of PLSVC into the left atrium be visualised using transthoracic echocardiography (TTE) by injecting agitated saline into the left arm.

Rapid determination of sildenafil and its analogues in dietary supplements using gas chromatography-triple quadrupole mass spectrometry.

Application of gas chromatography-triple quadrupole mass spectrometry for identification, confirmation and quantification of 6 phosphodiesterase-5 (PDE-5) inhibitors (sildenafil, dimethylsildenafil, homosildenafil, thiosildenafil, thiodimethylsildenafil and thiohomosildenafil) in dietary supplements was investigated. The MS was operated in multiple reaction monitoring mode, for better sensitivity and selectivity. In this manner, the method is adequate to reduce background noise with less interference from co-eluting compounds in the samples. Two different ionisation techniques, electron ionisation (EI) and chemical ionisation (CI), were studied and compared. The chromatographic separation was performed on a short 10 m non-polar capillary column without any derivatisation step. This permitted fast analysis for all analogues with retention time less than 11 min, for both techniques. Use of backflushing can aid method retention time reduction and improves column maintenance. Evaluation of method validation included limit of detection (LOD), lower limit of quantitation (LLOQ), linearity, precision and recovery were performed for both EI and CI techniques. The LOD obtained varied from 0.03 to 1.50 µg/g and the LLOQ ranged from 0.10 to 5.00 µg/g. Good calibration linearity was obtained for all analogues for both techniques, with correlation coefficients (r(2)) higher than 0.99. Mean recoveries of all analogues using CI show higher values (83.4-108.8%) than that of EI (61.9-91.1%). The intra- and inter-assay precisions were evaluated for all analogues at spiked concentration of 10 µg/g and the relative standard deviation was less than 15% for both methods. These methods were then successfully applied to dietary supplement samples without prior derivatisation, confirming that the samples were adulterated with sildenafil and/or its analogues.

Factors affecting warfarin dose requirements and quality of anticoagulation in adult Egyptian patients: role of gene polymorphism.

BACKGROUND: Warfarin is the mainstay of anticoagulation therapy worldwide. CYP2C9 and VKORC1 are two major genetic factors associated with inter-individual and inter-ethnic variability in the warfarin dose. AIM: This study aims to assess the impact of VKORC1-1639G>A polymorphism and the most common CYP2C9 variant alleles (*2 and *3) on warfarin response in Egyptian patients. METHODS: Genetic analysis of VKORC1-1639G>A and CYP2C9*2, CYP2C9*3 was performed using real-time PCR system. Patients maintained on a constant dose targeting an international normalized ratio range of 2-3.5 for at least three consecutive times were considered as good candidates. A stepwise linear regression analysis was used to determine the independent effects of genetic and non-genetic factors on daily warfarin dose requirements. RESULTS: Patients carrying VKORC1 and CYP2C9 variant genotypes needed a 44.8 % lower mean daily warfarin dose as compared to wild types. Patients with G allele for VKORC1-1639G>A had a significantly higher number of thromboembolic complications per month during therapy. On the first 30 days of therapy, presence of a variant allele either in VKORC1 or in CYP2C9 was associated with increased time required to achieve stable dosing. Multiple regression analysis showed that, VKORC1-1639G>A, age, CYP2C9*3, and smoking status explained 43.4 % of the overall variability in the warfarin dose. CONCLUSION: VKORC1-1639G>A and CYP2C9 polymorphisms contribute to the difference in warfarin dose requirements and quality of anticoagulation amongst Egyptian patients. Study results support using personalized warfarin treatment in Egyptian patients.

An alternate method for DNA and RNA extraction from clotted blood.

We developed an alternative method to extract DNA and RNA from clotted blood for genomic and molecular investigations. A combination of the TRIzol method and the QIAamp spin column were used to extract RNA from frozen clotted blood. Clotted blood was sonicated and then the QIAamp DNA Blood Mini Kit was used for DNA extraction. Extracted DNA and RNA were adequate for gene expression analysis and copy number variation (CNV) genotyping, respectively. The purity of the extracted RNA and DNA was in the range of 1.8-2.0, determined by absorbance ratios of A(260):A(280). Good DNA and RNA integrity were confirmed using gel electrophoresis and automated electrophoresis. The extracted DNA was suitable for qPCR and microarrays for CNV genotyping, while the extracted RNA was adequate for gene analysis using RT-qPCR.

Study of the relation between quality of inpatient care and early readmission for diabetic patients at a hospital in the Eastern province of Saudi Arabia.

Readmission of diabetic patients after discharge from hospital has potential value as a quality of care indicator. This retrospective cohort and case-control study aimed to determine the readmission rate for diabetic patients within 28 days after discharge and the association between quality of inpatient care and unplanned readmission. An audit of records was conducted in a hospital in the Eastern province of Saudi Arabia during 2000-2008. The rate of unplanned readmission of patients originally admitted with diabetes mellitus (n = 1125) was 5.2%. Comparison of data from readmitted patients (n = 62) and a sample of nonreadmitted patients (n = 62) showed that adherence by health care providers to American Diabetes Association guidelines for admission work-up (OR 0.91, 95% CI: 0.85-0.99) and readiness for discharge criteria (OR 0.89, 95% CI: 0.84-0.95) were significantly more likely to decrease the risk of readmission within 28 days.

Study of the relation between quality of inpatient care and early readmission for diabetic patients at a hospital in the Eastern province of Saudi Arabia

Readmission of diabetic patients after discharge from hospital has potential value as a quality of care indicator. This retrospective cohort and case-control study aimed to determine the readmission rate for diabetic patients within 28 days after discharge and the association between quality of inpatient care and unplanned readmission. An audit of records was conducted in a hospital in the Eastern province of Saudi Arabia during 2000-2008. The rate of unplanned readmission of patients originally admitted with diabetes mellitus [n = 1125] was 5.2%. Comparison of data from readmitted patients [n = 62] and a sample of non re admitted patients [n = 62] showed that adherence by health care providers to American Diabetes Association guidelines for admission work-up [OR 0.91, 95% Cl: 0.85-0.99] and readiness for discharge criteria [OR 0.89, 95% Cl: 0.84-0.95] were significantly more likely to decrease the risk of readmission within 28 days

Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies.

A study was undertaken to determine the prevalence and relative frequencies of congenital heart diseases diagnosed by echocardiography among school children in Alexandria, Egypt. The study was conducted during a 1-year period (1 May 1995-1 May 1996) at the Students' Health Insurance Hospital, which is a referral center for all health insurance units, providing an echocardiography service. The prevalence of congenital heart diseases (CHD) among school children accounted for 1.01/1,000. There was a male predominance in cases of pulmonary stenosis and single ventricle, while in cases of patent ductus arteriosus, mitral valve prolapse, and partial atrioventricular canal there was a female predominance. The commonest cardiac defects were ventricular septal defects, pulmonary stenosis, and atrial septal defects. Pulmonary stenosis ranked the second commonest defect and is a peculiar finding in our Egyptian population. The mere presence of these cardiac defects in school children is an indicator of the poor quality of care provided to this growing childhood population.

Thoracolumbar fracture--dislocation results of surgical treatment.

Fifteen cases of unstable fracture-dislocation of the thoracolumbar spine have been treated by open reduction, short segment transpedicular fixation and fusion in Universiti Unit, Kuala Lumpur Hospital from January 1994 until December 1997. Twelve male and three female patients were injured; their age ranged from 18 to 45 years. Five fracture-dislocations occurred in the lower thoracic spine (T8 to T11), eight at the thoracolumbar junction (T12 to L2) and two in the lumbar spine (L3 to L5). All the patients had neurological deficit. Seven patients with incomplete or cauda equina lesions regained some neural function, while all eight with complete lesions remained unchanged. Ten of the fifteen cases were grossly unstable and translated beyond 50% of the width of the spinal column. At the time of follow up (more than one year in all patients), no loss of reduction or of fixation was noted in any patient. Solid fusion was achieved in all patients. The advantages of this method of treatment include stable fixation, with maintenance of sagittal and coronal spinal alignments, to allow early rehabilitation.

Risk factors for congenital heart diseases in Alexandria, Egypt.

A matched case control study has been conducted in the children's hospitals in Alexandria, Egypt, during 2 years-period, aiming at investigating the risk factors for the occurrence of congenital heart diseases. Our results showed that the significant risk factors for developing any type of congenital heart disease and ventricular septal defects were: older paternal age at birth, positive consanguinity, positive family history, female sex hormones, irradiation, hazardous maternal occupation, diabetes mellitus and suburban or rural residence. However, some environmental/teratogenic factors were not implicated in the etiology of atrial septal defects or pulmonary stenosis. These findings strongly suggest that environmental factors vary according to the specific type of congenital heart disease. This study emphasizes on the need to instruct the public about the importance of pre-marital counseling and the deleterious effects of various teratogens in the environment.

Granule cell development in the cerebellum is punctuated by changes in Sox gene expression.

Development of the vertebrate cerebellum is unusual compared to most other regions of the brain since it involves two germinal regions. Most cell types arise from the luminal, ventricular zone as in other brain regions, but granule cells arise from the second germinal layer, the external granular layer (EGL). Our analysis of the temporal and positional expression of three members of the Sox gene family of transcription factors in the cerebellum shows that granule cell development is unusual compared to most other neurons of the central nervous system (CNS). We show that granule cell precursors lose expression of cSox2 and cSox3 as they migrate to form the EGL. The EGL is the first example of a germinal layer in the CNS which does not exhibit expression of these genes. Throughout most of the CNS cSox11 expression is very low in the ventricular zone but increases dramatically as cells cease proliferation and migrate to form the subventricular zone. We also find that cSox11 expression increases when cells of the cerebellum migrate to form the EGL, but levels of expression as high as that in the subventricular zone are only seen when cells cease proliferation and migrate inwards to form the deep EGL. These observations demonstrate that cells of the proliferative superficial EGL differ qualitatively from cells of the ventricular zone in their expression of Sox genes whereas the post-proliferative cells of the deep EGL appear analogous, in their expression of Sox genes, to cells of the subventricular zone.

Effect of low-energy laser application in the treatment of denture-induced mucosal lesions.

STATEMENT OF PROBLEM: Mucosal inflammation under dentures causes problems for prosthodontists and patients. PURPOSE OF STUDY: This study evaluated the effectiveness of a low-energy laser used in the treatment of denture-induced mucosal lesions in comparison with other conventional methods. MATERIAL AND METHODS: Eighteen men were selected and divided into three groups of six according to the treatment applied: denture removal, relined dentures with temporary tissue treatment, and application of laser irradiation for the lesions while continuing to wear the dentures. Oral hygiene and nutrition were maintained during the study. Clinical, histologic, and densitometric assessments were used to evaluate the three treatment methods. RESULTS: The results revealed that lesions in the group treated with laser irradiation were clinically superior in healing when compared with the other groups. Histologic evidence of the therapeutic effect of lasers in healing denture-induced mucosal lesions was demonstrated. Densitometric evaluation showed an increase in the optical density of alveolar bone underneath the irradiated lesions compared with untreated lesions. CONCLUSION: These findings suggest the effect of therapeutic laser treatment on both soft tissue and bone with subsequent improvement of denture foundation after treatment of denture-induced mucosal lesions.

Swyer syndrome: an unusual presentation.

We report a 27-year-old XY female who presented with abdominal pain due to hemoperitoneum from a ruptured abdominal mass. Gonadoblastoma overgrown by endodermal sinus tumor and dysgerminoma was detected. The risk of neoplasia in such cases is discussed.

Risk factors for non-melanomatous skin cancer in Alexandria, Egypt.

The role of constitutional and environmental factors on the risk of non-melanomatous skin cancer was evaluated in a case-control study conducted in 1992 in Alexandria, Egypt, on 136 incident histologically confirmed (99 basal-cell and 37 squamous-cell) cases of non-melanomatous skin cancer (NMSC) and 145 controls in hospital for a broad spectrum of acute non-sun-related dermatological conditions. In relation to skin colour, compared with brown-skinned subjects, the multivariate relative risks (RR) were 2.3 for olive-skinned subjects and 3.8 for fair/medium-skinned subjects. Three cases and 29 controls were black (RR = 0.2). The trend in risk with skin colour was significant. Likewise, compared with subjects with brown or hazel eyes, those with green or blue eyes had a RR of 3.1. In relation to acute sun reaction, compared with subjects reporting easy tanning, the RRs were 2.5 for subjects reporting moderate tanning and 4.7 for those reporting easy burning. The risk of NMSC was higher for subjects reporting an outdoor occupation than for those reporting an indoor occupation (RR = 7.7). A significant trend in risk was observed with degree of sun exposure: compared with subjects reporting light sun exposure, the RR was 3.0 for those reporting moderate exposure, and 6.1 for those reporting heavy sun exposure. There was an indication of a relationship between clothing pattern and skin-cancer risk: compared with subjects reporting frequent use of traditional Egyptian clothes, the RR for dressing in short clothes was 1.8. The presence of signs of photodamage was also associated with NMSC (RR = 3.7). Exposure to arsenic was reported by 10 cases and 1 control (RR = 9.5). A positive interaction between sun exposure and skin colour was observed, and the RR rose to 14.2 for medium- or fair-skinned subjects with heavy exposure compared with brown- or black-skinned subjects with light or moderate sun exposure. In this Egyptian population, over 60% of NMSC could be attributed to sun exposure and approximately 45% to skin colour.

Chlamydia trachomatis associated with chronic dysuria among patients with Schistosoma haematobium.

Eighty-seven Egyptians with Schistosoma haematobium infection (current or past) and chronic dysuria seen at the Theodor Bilharz Research Institute outpatient urology clinic in Imbaba, Cairo, Egypt were investigated for Chlamydia trachomatis infection. Direct fluorescent antibody tests (DFAT) showed 30 urethral swabs (35%) and 40 urine sediments (46%) were positive for Chlamydia. Indirect fluorescent antibody testing showed 29 (34%) serum samples and 25 (29%) urethral smears were positive for Chlamydia. There was a highly significant association between patients with active Schistosoma infection and those with urine and urethral specimens positive for Chlamydia by DFAT (P < 0.01).

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.

A study of depression among Alexandria preparatory school adolescents.

Using a constructed Arabic version of Children Depression Inventory (CDI), screening of a stratified random sample of 1% (1561) of Alexandria Preparatory school adolescents was carried out. The prevalence of depressive scorers was 10.25% of total sample. A sub-sample of depressed scorers (111 pupils) were compared with controls (non-depressed scorers) matched on age and sex to study a variety of personal, familial, medical and scholastic ecological variables. Pupils neuroticism scorers were most predictive of depressive scorers where they explained 59.79% of the variance. Other ecological factors including peer and sibling relationships, introversive and lie scale scorers and scholastic performance explained an additional 14.87% of the variance. Using Beck Depression Inventory (BDI) and Mother-Father relationship check list, a sub-sample of depressed pupils' mothers were compared with controls of non-depressed pupils' mothers (42 mothers for each). Results indicated a strong positive correlation between pupils, CDI scores and their mothers BDI scores. On the other hand poor mother-father relationship was significantly associated with depressive scores of pupils. Findings, pointed to the need for reconsideration of school mental health program, since the presented medical and social services to depressed pupils were very poor.

Patient satisfaction with hospital services: development and testing of a measuring instrument.

The present study was undertaken with the aim of developing and testing an instrument that could be used to measure patient satisfaction with hospital services in Kuwait. The instrument, which comprised 57 items, and measured satisfaction with 7 specific dimensions of hospital services, was administered to 493 patients using the interview technique. Statistical analysis showed that the instrument yields good response variability. Reliability of the instrument, measured in terms of the internal consistency coefficient alpha, exceeded the acceptable criterion level, the coefficients ranging between 0.73 and 0.86. Evidence of the construct validity of the instrument was found in significant positive correlation between the dimension specific satisfaction scale scores and scores for allegiance scale and for overall rating of quality of hospital services. Construct validity was further supported by convergent discriminant analysis, which showed that correlations between items of all 7 scales and their total scale scores were greater than correlations between scale items and the total scores of scales they do not represent. Analysis of an open-ended question about dissatisfying aspects of hospital services not included on the interview was undertaken to examine the instrument's content validity. Results indicated that patients identified 11 items, 8 of which were identified more than once, and 2 of which were not classifiable to the 7 dimensions assessed by the instrument. It was suggested to add the 8 items that were identified more than once, and to reassess the reliability and validity of the revised instrument. Assessment of the test-retest reliability, by comparing scale scores over time, was also suggested.

Enzyme-linked immunosorbent assay (ELISA) in the diagnosis of active pulmonary tuberculosis.

This study evaluates the sensitivity and specificity of an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against Mycobacterium tuberculosis antigen. Twenty seven of the 35 patients with pulmonary tuberculosis had positive serology with an antibody titre of 10 nineteen of them had positive serology with an antibody titre of 100. All the 27 patients with positive serology were either smear or culture positive or both. Twenty six of the 35 control group had negative serology and 9 had positive serology with an antibody titre of 10. The test has a sensitivity of 77.14% and a specificity of 74.29%.