Impact of caloric test asymmetry on response to treatment in vestibular migraine.

OBJECTIVE: This study aimed to examine the association between caloric asymmetry and response to treatment in patients with vestibular migraine. METHOD: Dizziness Handicap Inventory scores were compared between patients with less than and more than 25 per cent asymmetry (using Cohen effect size) in a cohort of definite vestibular migraine patients who underwent caloric testing between August 2016 and March 2019. RESULTS: A total of 31 patients (mean age: 48.7 ± 20.0 years; mean follow up: 9.1 ± 8.1 months) were included. Mean caloric asymmetry was 15.1 ± 15.6 per cent, with 6 (19.4 per cent) patients having asymmetry more than 25 per cent. Overall, patients experienced significant improvement in Dizziness Handicap Inventory total (d = 0.623 (95 per cent confidence interval, 0.007, 1.216)), emotional domain (d = 0.635 (95 per cent confidence interval, 0.019, 1.229)) and functional domain (d = 0.769 (95 per cent confidence interval, 0.143, 1.367)) but not physical domain (d = 0.227 (95 per cent confidence interval, -0.370, 0.815)) scores. Patients with more than 25 per cent asymmetry had no significant improvement in Dizziness Handicap Inventory scores, whereas those with less than 25 per cent asymmetry had significant improvement in Dizziness Handicap Inventory functional domain scores only (d = 0.636 (95 per cent confidence interval, 0.004, 1.244)). CONCLUSION: Vestibular migraine patients with peripheral vestibular weakness on caloric testing may be less likely to improve after treatment compared with those without.

Pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine.

OBJECTIVE: Given the lack of evidence on patients with medically refractory vestibular migraine, this study aimed to identify factors associated with pharmacotherapy failure and progression to botulinum toxin injection in vestibular migraine. METHODS: A retrospective cohort study was conducted on definite vestibular migraine patients from September 2015 to July 2019 who completed the Dizziness Handicap Inventory at least six weeks apart.. RESULTS: The study comprised 47 patients (mean age = 50.2 ± 15.8 years), with a mean follow-up time of 6.0 ± 6.0 months. The mean pre-treatment Dizziness Handicap Inventory score was 57.5 ± 23.5, with a mean reduction of 17.3 ± 25.2 (p < 0.001) at last follow up. Oscillopsia (r = 0.458, p = 0.007), failure of first medication (r = 0.518, p = 0.001) and pre-treatment Dizziness Handicap Inventory question 15 (an emotional domain question) score (r = 0.364, p = 0.019) were the only variables significantly correlated with progression to botulinum toxin injection. CONCLUSION: Motion hypersensitivity, failure of first medication, and fear of social stigmatisation suggest a decreased treatment response. These symptoms may require more aggressive treatment at an earlier stage.

Depression in Ménière's disease: a systematic review and meta-analysis.

BACKGROUND: Ménière's disease is a debilitating chronic peripheral vestibular disorder associated with psychiatric co-morbidities, notably depression. METHODS: Database searches were performed to identify studies that assessed depression in Ménière's disease. Metrics used to diagnose depression were extracted, along with the prevalence of depression in each study. RESULTS: Fifteen studies from 8 different countries reported on 6587 patients. The weighted average age was 55.3 years (range, 21-88 years). Depression was measured by eight different scales, with Zung's Self-Rating Depression Scale used most often. A weighted proportion of 45.9 per cent of patients (confidence interval = 28.9-63.3) were depressed. Weighted averages (± standard deviations) of Beck's Depression Inventory and the Illness Behavior Questionnaire - Dysphoria were 8.5 ± 7.9 and 2.4 ± 1.7, respectively. CONCLUSION: The prevalence of depression in patients with Ménière's disease is nearly 50 per cent. Treating otolaryngologists should have a low threshold to screen and refer appropriately. Identifying and treating depression should allow for improvement of overall quality of life in patients with Ménière's disease.

Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care.

BACKGROUND: Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities. OBJECTIVES: To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country. METHODS: Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay). We also recorded the time delay between the arrival to hospital and the institution of definitive therapy (hospital delay). Causes of pre-hospital delay are either patient- or transportation-related, while hospital delay causes are either staff- or system-related. RESULTS: We recruited 315 patients, 200 (63.5%) were males, 194 (61.6%) hypertensives, 180 (57.1%) diabetics, 106 (33.7%) current smokers and 196 (62.2%) patients had prior history of cardiac diseases. The mean pre-hospital delay time was 8.7 ± 9.7 h. Sixty-six percent of this time was due to patient-related causes and 34% of pre-hospital delay time was spent in transportation. The mean hospital delay time was 2.3 ± 0.95 h. In 89.8% of cases, the hospital delay was system-related while in 10.2% the reason was staff-related. The mean total delay time to definitive therapy was 11.0 ± 9.8 h. CONCLUSION: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

Synthesis of pyrazolo[3,4-b]pyridines under microwave irradiation in multi-component reactions and their antitumor and antimicrobial activities - Part 1.

An efficient one-pot synthesis in multi-component system (MRCs) for the preparation of pyrazolo[3,4-b]pyridine derivatives from the reaction of 5-amino-1-phenyl-3-(pyridin-3-yl)-1H-pyrazole with 4-anisaldehyde and p-substituted ß-ketonitriles or with pyruvic acid and some aromatic aldehydes in acetic acid medium. The reactions were carried out by two different techniques, conventional heating and microwave irradiation. These compounds were screened for their antibacterial activity against Gram-positive bacteria (Bacillus), Gram-negative bacteria (Escherichia coli, Enterobacter cloaca and serratia) and antifungal activity against Fusarium Oxysporum and Penicillium expansum. Also, among the synthesized compounds 4a-f tested for antitumor activity against liver cell line. Compounds 6-(4-Fluorophenyl)-4-(4-methoxyphenyl)-1-phenyl-3-(pyridin-3-yl)-1H-pyrazolo[3,4-b]pyridine-5-carbonitrile (4e) and 4-(4-Methoxyphenyl)-1-phenyl-3,6-di(pyridin-3-yl)-1H-pyrazolo[3,4-b] pyridine-5-carbonitrile (4a) showed the highest activity.

Foreign body inhalation in the pediatric population: lessons learned from 106 cases.

OBJECTIVES: To review the cases encountered in a tertiary care center so as to assess the incidence of foreign body aspiration in the pediatric population and to draw on our experience to improve prevention and early diagnosis. PATIENTS AND METHODS: Retrospective study of 106 children under the age of 15 years, admitted to the Hôtel-Dieu de France hospital for flexible and/or rigid bronchoscopy between November 1998 and January 2010, for suspected foreign body aspiration (FBA). RESULTS: Among the children, 56.6% were aged between one and three years. Peanuts or pistachios were found in 48% of cases. In 73% of cases, the FB was bronchial, and slightly more frequently on the right side (60%); 17.8% of cases presented in emergency immediately after inhalation; 12% presented with life-threatening symptoms; 29% presented within 24 hours and 49% were seen later than 72 hours. In 81% of subjects, a typical penetration syndrome was found on interviewing the parents. Physical pulmonary examination was normal in 21% of patients and chest X-ray in 21.8%. Rigid bronchoscopy was preceded by flexible bronchoscopy in 12% of cases. Parental underestimation of the gravity of the situation was a significant factor in delayed diagnosis. Among the patients, 64% examined 24 hours after inhalation were initially treated for another pathology. Delay in diagnosis and organic vs inorganic FB did not significantly correlate with duration of bronchoscopy. The rate of complications did not significantly increase after a 24-hour diagnostic delay threshold. CONCLUSION: FB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology.

Cardiovascular risk factors in normotensive and hypertensive Egyptians.

OBJECTIVES: To define the prevalence of cardiovascular risk factors and their relation to the level of blood pressure, in Egyptians. METHODS: Data were collected during the Egyptian National Hypertension project, a national hypertension survey in Egypt. During phase I of the survey, hypertensive (HT) patients were identified. In phase II, clinical and laboratory evaluations were made on HT and gender-matched normotensives (NT). A total of 2313 individuals were examined, 311 NT males, 443 NT females, 670 HT males and 889 HT females. RESULTS: The prevalence of obesity was 33 and 47% in hypertensive men and women, respectively. After adjusting for age, HT men had significantly higher heart rate, total cholesterol (TC), triglycerides (TG), fasting blood sugar (FBS), post-prandial blood sugar (PBS), body mass index and waist/hip (W/H) ratio than their NT counterparts. In addition, HT women had higher low-density lipoprotein cholesterol (LDL-C). The prevalence of elevated LDL-C and FBS increased with age. The prevalence of hypertriglyceridemia, elevated FBS and obesity rose with increasing level of blood pressure (BP). From the 25-34 to the 55-64 age group, the percentage of hypertensives with > or = 2 risk factors rose from 42.9 to 60.6% in men, and from 9.4 to 46.2% in women. All risk factors were more prevalent in urban populations. CONCLUSION: This is one of the few reports on the prevalence of cardiovascular risk factors in a developing country. Risk factors cluster with rising level of BP and with ageing. Obesity is very prevalent, particularly in hypertensive Egyptian women. Health efforts directed at the prevention and treatment of obesity should be a high priority.

Gender and the relationship between resting heart rate and left ventricular geometry.

OBJECTIVES: Heightened mortality is common to both an elevated resting heart rate and left ventricular hypertrophy (LVH). We examined the relationship between resting heart rate and left ventricular geometry. METHODS: We analysed resting heart rate and echocardiographic data on 1,685 individuals aged 25-93 years, 756 males and 929 females, without heart failure. The study population, 719 normotensives and 966 untreated hypertensives, was derived from the Egyptian National Hypertension Project (1991-94); a cross-sectional study of the prevalence of hypertension and cardiovascular risk factors in Egyptians. The mean of the last two of three heart rate readings was used to represent the resting heart rate. RESULTS: Left ventricular mass index (LVMI) was weakly inversely related to heart rate in total males (r= -0.14, P< 0.0005) and total females (r= -0.1, P= 0.007) after controlling for age and blood pressure. The relative wall thickness (RWT) of the left ventricle was positively associated with heart rate in females. Resting heart rate increased linearly from 83.8 to 89 b.p.m. (P= 0.03) from the lowest (< or = 0.33) to highest (> or = 0.47) RWT quintiles in hypertensive females after adjusting for age and blood pressure. In both those with and without LVH (defined as LVMI > 125 g/m2), hypertensive females with RWT > 0.45 compared to those with RWT < or = 0.45 had consistently higher resting heart rate (93.8 b.p.m. versus 84.2 b.p.m., P = 0.047 and 88.9 b.p.m. versus 85 b.p.m., P = 0.005, respectively) after adjusting for age and blood pressure. No such relationship was found in males. CONCLUSIONS: Among hypertensive females, an elevated resting heart rate is associated with abnormal left ventricular geometry, namely, concentric left ventricular remodelling and hypertrophy.

Coccidiosis among malnourished children in Mansoura, Dakahlia Governorate, Egypt.

Stool samples of 36 malnourished and 36 healthy control children were examined for oocysts of Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli and Microsporidium. C. parvum infection (single and mixed) was detected in 13.9% and 5.6% in malnourished and control children respectively. C. cayetanensis oocysts were detected in 5.6% malnourished children and in 2.8% of control group. I. belli oocysts were detected only in malnourished children 2.8%. On the other hand, no Microsporidium oocysts were detected in both malnourished and control children.

Rapid detection of a Schistosoma mansoni circulating antigen excreted in urine of infected individuals by using a monoclonal antibody.

Schistosoma circulating antigens were used to indicate the infection intensity and to assess cure. An immunoglobulin G2a (IgG2a) mouse monoclonal antibody was used in a fast dot-enzyme-linked immunosorbent assay (ELISA; FDA) for rapid and simple diagnosis of schistosomiasis in the field. Seven hundred Egyptians were parasitologically examined for Schistosoma mansoni and other parasitic infections. A rectal biopsy was done as a "gold standard" for individuals showing no S. mansoni eggs in their feces. Egg counts were obtained by the Kato smear method for only 100 of 152 individuals with eggs in their feces. Specific anti-schistosome IgG antibodies were evaluated in sera by ELISA. Urine samples from the 700 individuals were tested by FDA for detection of the circulating antigen. The assay showed a sensitivity of 93% among 433 infected individuals and a specificity of 89% among 267 noninfected individuals. FDA showed the highest efficiency of antigen detection (91%) compared with the efficiency of antibody detection by ELISA (75%) and stool analysis (60%). In addition, FDA detected infected patients with 20 eggs/g of feces. Also, the sensitivity of FDA ranged from 90 to 94% among samples from patients with different clinical stages of schistosomiasis. All the assay steps can be completed within 30 min at room temperature for 96 urine samples. The monoclonal antibody identified a 74-kDa antigen in different antigenic extracts of S. mansoni and Schistosoma haematobium and in the urine of infected individuals. In addition, a 30-kDa degradation product was identified only in the urine samples. On the basis of these results, FDA should be used as a rapid tool for the sensitive and specific diagnosis of Schistosoma infection.

Fast-Dot ELISA using urine, a rapid and dependable field assay for diagnosis of schistosomiasis.

The fast dot-enzyme linked immunosorbent assay (FD-ELISA) was used as a field applicable tool for rapid diagnosis of schistosomiasis. Seven hundreds faecal specimens were parasitologically examined for detection of S. mansoni eggs and other parasitic infection. Egg count was done for 100 infected patients. Rectal biopsies (394) were taken from individuals with no S. mansoni egg in their stool where it was used as a golden standard for diagnosis of schistosomiasis. Cross-reactivity with other parasites was studied. Serum samples were tested by ELISA technique for detection of human IgG anti-schistosomal antibodies. Seven hundreds urine samples (433 S. mansoni infected patients and 267 healthy individuals) were tested by FD-ELISA for detection of a schistosomal antigen excreted in urine using BRLF4 mouse monoclonal antibody. FD-ELISA results were compared with ELISA detecting antischistosomal IgG and stool analysis where, it showed highest efficiency (91%), compared with 81% and 60% for ELISA and stool analysis respectively. The sensitivity of FD-ELISA was high ranging from 90-94% in the four different clinical stages of schistosomiasis (Simple intestinal. Hepatosplenomegaly, Shrunken liver & Splenomegaly, and Shrunken liver-splenomegaly & ascites). FD-ELISA was highly sensitive, detecting infection cases with 20 eggs/gm faeces and its specificity was 89%. The antigen was characterized as a protein with a molecular weight of 74 KDa using western blot technique.

Toxoplasma IgG. & IgM. antibodies. A case control study.

This study includes 62 cases of spontaneous abortions and 75 cross matched non pregnant multiparous women as controls. Micro-ELISA test was done to measure Toxoplasma IgM & IgG antibodies. Out of 62 aborting women, 26 gave positive anti-Toxoplasma IgG antibodies, more than 45 Eu/ml and 28 gave positive anti-Toxoplasma IgM antibodies, more than 40 Eu/ml without statistical significant difference. There was a significant difference between aborting women and the controls as regards IgG & IgM antibodies. IgG antibodies, showed statistical significant difference between those with no history of abortions or I-2 abortions versus those with 3 or more abortions. The infection was more among aborting women in rural than urban areas whom suffered poor hygienic measures and awareness about the mode of transmission of Toxoplasma infection. The results were discussed.

Hypertension prevalence, awareness, treatment, and control in Egypt. Results from the Egyptian National Hypertension Project (NHP). NHP Investigative Team.

This report from the Egyptian National Hypertension Project presents national estimates of the prevalence of hypertension and the extent to which high blood pressure is being detected, treated with medications, and controlled in the Egyptian population. The results are based on findings from a national probability survey of adults > or = 25 years of age conducted in six Egyptian governorates. With the use of a stratified multistage probability design, 6733 people (85% response rate) were examined. Hypertension was defined as systolic pressure > or = 140 mm Hg, and/or diastolic pressure > or = 90 mm Hg, and/or reported treatment with one or more antihypertensive medications. Overall, the estimated prevalence of hypertension in Egypt was 26.3%. Hypertension prevalence increased progressively with age, from 7.8% in 25- to 34-year-olds to 56.6% in those 75 years or older. Hypertension was slightly more common in women than in men (26.9% versus 25.7%, respectively). Overall, 37.5% of hypertensive individuals were aware that they had high blood pressure, 23.9% were being treated with antihypertensive medications, and 8.0% were under control (systolic pressure < 140 mm Hg and diastolic pressure < 90 mm Hg). Hypertension prevalence as well as awareness, treatment, and control rates varied by region, with Cairo having the highest prevalence (31.0%) and the Coastal Region having the highest control rate (15.9%). Rates of awareness, treatment, and control tended to be lowest in areas of lower socioeconomic status. Our results indicate that hypertension is highly prevalent in Egypt and that the rates of hypertension is awareness, treatment, and control are relatively low.(ABSTRACT TRUNCATED AT 250 WORDS)

Importance of E. histolytica antigen in serodiagnosis and follow up of patients with amoebic liver abscess.

This study is composed of a community based study and a hospital based study. The community based study was conducted on 200 apparently healthy individuals randomly chosen from rural areas. They were examined clinically, sonographically and parasitologically for E. histolytica cysts and by ELISA for circulating amoebic antigen. They were negative for antigenaemia at 1/16 which was considered the diagnostic titre of amoebic hepatitis. The hospital based study was carried out on 27 patients suffering from amoebic liver abscess (ALA). Circulating amoebic antigen was detected in 66.66% of them before treatment which decreased to 14.82% two months after treatment. There was no significant association between the diameter of the abscess and the level of circulating amoebic antigen. It was concluded that the circulating amoebic antigen may be useful for the diagnosis and follow up of amoebic liver abscess patients.

Malaria as a cause of prolonged fever among children in Mansoura fever hospital.

Prolonged fever represents a diagnostic dilemma in small age group. Little attention was given as regard parasitic infections and prolonged fever. The objective of this study was to throw some light upon the role of malaria infection as a cause of prolonged fever. The study revealed malaria by blood film in 5 out of 129 children by IFA test 8 patients were seropositive intermittent fever was the main symptom of presentation.

Dot-ELISA as a diagnostic test in hydatid disease.

Detection of circulating echinococcal antigens and antibodies were tried in 18 patients with hydatid disease and 32 healthy blood donors as controls using dot-ELISA. Hydatid cyst fluid antigen and anti-echinococcal hyperimmune rabbit sera were used for the detection of antibodies and antigens respectively. The results proved that this test is sensitive (88.9%), specific (96.9%) and rapid for detecting echinococcal antibodies. On the other hand, circulating antigens could be detected with 55.6% sensitivity. This low sensitivity was attributed to the small amounts of circulating antigens and/or immune complexes formation.

Human fascioliasis: a parasitic health problem in Dakahlia Governorate, Egypt.

Fascioliasis has a cosmopolitan distribution and is prevalent in sheep-raising countries. Now, it is an increasingly important parasite of man in the Mediterranean countries. In Dakahlia G., human fascioliasis has imposed itself as a parasitic health problem. In this paper, 23 human cases were selected to throw some light on the signs, symptoms and diagnosis of the disease. It was concluded that painful hepatomegaly, fever, anaemia and marked eosinophilia are tetrad suggesting fascioliasis in patient who has consumed watercress as green salade. Data concerning treatment and follow up will be published later.

Trends in fertility and family planning in Jordan.

A national fertility sample survey conducted in 1972 on the East Bank of the Hashemite Kingdom of Jordan collected information on fertility levels, desire for additional children, and knowledge and practice of family planning. The data suggest that in Jordan, as in many other developing countries, the fertility rate is extremely high, and that, while rural/urban residence and socio-economic status have no significant influence on fertility, educational attainment of wives does have a marked effect on fertility. The survey results also indicate that, while knowledge of contraception is not lacking, its practice is limited, and that the average ideal family size is lower than the actual size among almost all socioeconomic groups.