Epidemiology and predictors of recurrence of Marjolin's ulcer: experience from Mansoura Universityxs.

INTRODUCTION Marjolin's ulcer (MU) is an uncommon malignancy occurring on top of old scars. Once thought to be more common in Caucasians, is now detected increasingly in Africa. METHODS This was a retrospective study of patients with MU attending a tertiary centre within Mansoura University (Egypt) from 2004 to 2015. An institutional-based registry of skin and soft-tissue malignancies in this period revealed 560 cases, from which there were 26 cases of MU. RESULTS The most common underlying cause of MU was burns (92% of patients), followed by trauma. A predilection towards males was detected. The latent period was 4-70 (median, 25) years. Recurrence occurred in 12 cases, with multiple recurrences occurring in 5 cases. MU recurrence was noted as early as 3 months and as late as 25 years after surgery. CONCLUSIONS Young patients with MU are at higher risk of recurrence and should be followed up closely. A thorough search for nodal metastasis (especially in those with high-grade tumours) should be done. Wide local excision and leaving wounds to heal by secondary intention seems to be a viable treatment option.

Atosiban and nifedipine in the suppression of pre-term labour: a comparative study.

This is a retrospective study comparing the efficacy and safety of atosiban and nifedipine in the suppression of pre-term labour. A total of 75 patients were included in this study; 34 received atosiban and 41 received nifedipine. There were no statistically significant differences in the baseline characteristics for both groups. A total of 68.3% of women in the atosiban group remained undelivered at 7 days or more, compared with 64.7% in the nifedipine group, which was not statistically significant. Average birth weight, admission to the neonatal intensive care unit and mode of delivery were similar in both groups. However, the gestational age at delivery was significantly higher in the nifedipine group. We concluded that atosiban and nifedipine are effective in delaying delivery for 7 days or more in women presenting with pre-term labour. They have the same efficacy and associated minor side-effects. However, flushing, palpitation and hypotension were significantly higher in the nifedipine group.

Histopathology diagnosis in women who underwent a hysterectomy for a benign condition.

PURPOSE: To study the correlation between the preoperative clinical diagnosis and the final histopathology of hysterectomy specimens. METHODS: This is a retrospective study by the authors of all cases who underwent a hysterectomy over a 2- year period (2008-2009). All hysterectomies performed for malignant indication were excluded. RESULTS: During the 2- year study period there were a total of 137 cases eligible for analysis. 107 patients had hysterectomy alone and 30 patients had hysterectomy with salpingo-oophorectomy. The abdominal route was used in 122 cases (89%) and the vaginal one in 15 patients (11%). The mean age at the time of hysterectomy was 49.1 years (range 35-76 years). Heavy menstrual loss was the most common indication for hysterectomy accounting for 39% of the cases. The rest of the indications included, fibroids, abdominal pain, postmenopausal bleeding, uterine prolapse and others. The histopathology of the endometrium prior to hysterectomy was reported in 68% of the cases and the most common finding was an endometrium with signs of hormonal imbalance. In the final histopathology reports of the hysterectomy specimens, fibroid was the most common finding reported in 36.5% of the cases. Adenomyosis was reported in 28% of the cases, endometrial hyperplasia in 12%, no specific pathology in 10% and malignancy in 5%. CONCLUSIONS: Hysterectomy will remain a common gynecological operation in both developing and developed countries. The clinical and the pathological correlation are poor, when abdominal pain or dysfunctional uterine bleeding (DUB) was the preoperative clinical diagnosis. However, there was a very high correlation when the clinical diagnosis was a fibroid. All hysterectomy specimens should be sent for histopathology regardless of the preoperative histopathology of the endometrium.

Changes in adenosine deaminase activity in ageing cultured human cells and the role of zinc.

The level of adenosine deaminase (ADA; EC 3.5.4.4) was estimated at different passages in six confluent fibroblast cultures established from forearm skin biopsies of healthy adult normal volunteers. After determination of the zinc concentration in standard growth medium, ADA activity was estimated at different passages of subculture in media with different zinc concentrations. The results indicated that the specific activity of ADA in control confluent skin fibroblast cultures (passage 2) cultivated in standard growth medium containing 15.4 microM zinc (similar to that present in normal human plasma) was equal to 226.6+/-19.64 micromol min(-1) mg(-1) protein. The results showed that there were no significant changes in ADA specific activity in any of the control cultures as the zinc concentration of the medium was increased. To characterize the passage of subculture at which fibroblasts enter the ageing phase, three marker enzymes were assayed namely, phosphofructokinase, lactate dehydrogenase and glycogen phosphorylase. The result showed that the cells enter the ageing phase at passage 20 and beyond. Further investigation showed that ADA activity of serially subcultured confluent cultures cultivated in standard growth medium significantly dropped at passages 20, 25 and 30. ADA activity however was not significantly altered in cells at passage 2, 10 and 15 cultivated in standard growth medium and in the presence of higher zinc levels (23.1, 34.6, 53.8 and 73.1 microM). Furthermore there was significant lowering of ADA activities in cells at passages 20, 25 and 30 when cells were cultured in the presence of 15.4, 23.1 and 34.6 microM zinc. Such lowered activities of ADA were restored to normal when the cells were cultured in the presence of higher zinc concentration equal to 53.8 and 73.1 microM. From the results we concluded that it is possible to restore ADA activity in aged skin fibroblasts to normal levels by raising the zinc concentration in the culture medium to four or five times the control normal plasma zinc level.

Response of neurons and microglia/macrophages in the area postrema of adult rats following exposure to hypobaric hypoxia.

The response of neurons and microglia/macrophages in the area postrema (AP) was examined in adult rats following exposure to hypobaric hypoxia. In this connection, immunoexpression of complement type 3 (CR3) receptors, major histocompatibility complex (MHC) class I and II antigens and ED1 antigens on the macrophages/microglia was downregulated immediately after the hypoxic insult. However, it showed an upregulation at 7-14 days and was comparable to the controls thereafter. At the ultrastructural level, swollen axons showing disruption of their myelin sheaths were observed between 7 and 14 days. At this time interval microglia/macrophages in the AP were observed to phagocytose such axons. Neurons did not show any structural alteration at any time interval following hypoxic exposure and appeared comparable to the neurons in the control AP. It is suggested that alterations in CR3 receptors, ED1, and MHC I and II antigens on the macrophages/microglia in hypobaric hypoxia were in response to axonal changes. Increased permeability of blood vessels following hypoxia may also play a role in activation of these cells as they would be involved in the clearance of extravasated serum derived substances.

The changing trend in the rate of caesarean section at a teaching hospital.

This is a retrospective study analysing the reasons behind the observed increasing rate of caesarean section (C/S) over a 10-year period (1990-99) in the obstetric unit of Jordan University Hospital. All the indications of C/S carried out in the unit were analysed. The duration of the study was divided into 2, of 5 years each (1990-94, 1995-99). There was a 6.9% increase in the C/S rate over the second half of the study period. This was statistically significant (P < 0.001). All the indications contributed significantly to rise. Fetal distress had the highest contribution 33.5%, while repeat C/S and malpresentation contributed to 21.5% and 21.3%, respectively. This increase was not associated with a significant change in the perinatal mortality. The rise in the caesarean section rate was higher in primigravida compared with multigravida (10.9% vs 6.2%). Fetal distress has the highest contribution in primigravida. In multigravida, if we exclude repeat caesarean section, the major indications were fetal distress and malpresentation. The percentage of elective and emergency caesarean section was similar in both study periods. The reasons behind the increase C/S rate couldn't be understood. Probably a lower threshold concerning the decision to perform the C/S rather than a change in obstetric management in responsible for this rise.

Separation and purification of Echis coloratus venom and some biological and biochemical effects of the proteins.

Crude venom of Echis coloratus was separated into seven protein fractions using 7% preparative native polyacrylamide gel electrophoresis. The effect of crude venom and seven venom protein fractions (F1-F7) from Echis coloratus on key metabolic activities of fibroblast cultures was investigated. Confluent cultures were incubated with the venom proteins for 3 h at 37 degrees C. The specific activity of phosphofructokinase, was significantly lowered upon incubation with the crude venom and with fractions 2, 3, 4 and 6. Citrate synthase activity was significantly lowered by the crude venom and by fractions 2 and 3. Glycogen phosphorylase activity was significantly increased by the crude venom and by fractions 2, 3, 4 and 6 leading to a significant concurrent drop in glycogen content. Creatine kinase activity was significantly increased by the crude venom and by fractions 3, 4, 5 and 6. Cellular ATP levels rose significantly upon incubation with the crude venom and with fractions 3, 4, 5 and 6. Incubation of cell sonicates with all the venom proteins did not significantly alter the activity or content of any of the studied parameters.

Involvement of gacS and rpoS in enhancement of the plant growth-promoting capabilities of Enterobacter cloacae CAL2 and UW4.

The plant growth-promoting bacteria Enterobacter cloacae CAL2 and UW4 were genetically transformed with a multicopy plasmid containing an rpoS or gacS gene from Pseudomonas fluorescens. The transformed strains were compared with the nontransformed strains for growth, indoleacetic acid (IAA) production, antibiotic production, 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase activity, siderophore production, cell morphology, and the ability to promote canola root elongation. All transformed strains had a longer lag phase, were slower in reaching stationary phase, and attained a higher cell density than the nontransformed strains. Transformation resulted in cells that were significantly shorter than the nontransformed cells. The transformed strains also produced significantly more IAA than the nontransformed strains. Introduction of rpoS or gacS from Pseudomonas fluorescens was associated with a reduction in the production of both antibiotics, 2,4-diacetylphloroglucinol and mono-acetylphloroglucinol, produced by Enterobacter cloacae CAL2. With Enterobacter cloacae CAL2, plasmid-borne rpoS, but not gacS, increased the level of ACC deaminase activity, while introduction of rpoS in Enterobacter cloacae UW4 caused a decrease in ACC deaminase activity. Neither gacS nor rpoS significantly affected the level of siderophores synthesized by either bacterial strain. Overproduction of either GacA or RpoS in Enterobacter cloacae CAL2 resulted in a significant increase in the root lengths of canola seedlings when seeds were treated with the bacteria, and overproduction of RpoS caused an increase in canola shoot as well as root lengths.

Epidemiology of occupational injuries and illnesses in a university population: a focus on age and gender differences.

BACKGROUND: Occupational injuries and illnesses are a major preventable public health problem. METHODS: This study evaluated the incidence, nature, and cause of awarded workers' compensation claims for a large state university and teaching hospital. Rates and types of injury were compared across age and gender. RESULTS: Rates of injury varied over twofold with age, with those 16-25 having the lowest rates of injury and those 36-45 having the highest rates. Claims rates were 1.36-fold higher for women than men. Women had higher rates for injury resulting from lifting, falling, noxious exposures, repetitive motion, and carpal tunnel syndrome. Similarly women had significantly higher rates of claims for pain, sprains, bruises, burns, concussion, and inhalation injury; with lower rates of cuts, ligament injury, and jammed joints. CONCLUSIONS: These group differences suggest the need to examine age and gender job distributions and relevant ergonomic and environmental causative factors.

Rural hospitals and the adoption of managed care strategies.

This research examined the performance of rural hospitals engaged in different levels of managed care activities and identified factors related to performance and competition that affected rural hospitals' likelihood of pursuing managed care as a strategy. The sample studied consisted of 139 rural hospitals in Iowa and Nebraska. Results showed that a relatively high percentage of hospitals were engaged in managed care activities, mainly through contractual arrangements. The study found that high competition in the marketplace increased the likelihood of hospitals pursuing managed care strategies, while high demand markets had a negative association with the likelihood of pursuing a managed care strategy. No significant relationship was detected between poor performance and pursuing a managed care strategy.

Acceptability of telepsychiatry to a rural population.

Sixty-seven residents of a rural Midwestern state were surveyed by telephone to determine which factors influence their willingness to receive mental health services through live, two-way audio and video transmission. Two-thirds of the survey respondents were willing to participate in telepsychiatry. Many expressed reluctance, however. They were concerned about maintaining confidentiality, and they perceived telepsychiatry as impersonal. Medicare enrollees and older survey respondents were less willing than younger respondents to endorse the use of telemedicine.

Ultrastructural variations of rat myocardium due to Walterinnesia aegytia snake envenomation.

This study was undertaken to investigate the toxic effect of Walterinnesia aegyptia venom on the ultrastructure of rat myocardium. Male albino rats were prepared for intraperitoneal injection of saline (control group) and saline solution of W.aegyptia venom (study group) at a dose of 0.04 mg animal-1. Biopsies from the left ventricle were prepared for electron microscopy after 1 h (D1 group), 2 h (D2 group), 18 h (D3 group) and 24 h (D4 group). Myocardial cells were in a state of partial to complete contraction. The D1 group showed some mitochondrial vacuoles; D2 group demonstrated more vacuolation and alterations in the form of disorganized cristae. Similar findings were depicted in D3 group. The D4 group demonstrated, in addition, dissolution of mitochondrial cristae. Myofilaments in D3 group experienced coalescence into ill-defined amorphous masses (foci of myolysis). These masses were characterized by the presence of multiple, parallel, Z-like dark bands with disorganization of the filamentous arrangement. In the D4 group, more myolytic foci were observed. This reaction was not limited to one myocyte but extended to the neighbouring ones. Mitochondrial vacuoles were mostly associated with electron dense deposits. Glycogen particles tended to decrease as the experiment proceeded from D1 to D4. These ultrastructural changes were time dependent. They would suggest a cardiotoxic action of W.aegyptia snake venom.

The effect of the desert cobra (Walterinnesia aegyptia) crude venom and its protein fractions on the metabolic activity of cultured human fibroblasts.

Fibroblast cultures were used to study the effect of crude venom and six venom protein fractions (F2-F7) from Walterinnesia aegyptia on their metabolic activity. This was done by incubation of six fibroblast cultures with 10 micrograms of crude venom for 3 h at 37 degrees C. The activities of phosphofructokinase, lactate dehydrogenase, and citrate synthase were significantly lowered upon incubation with all fractions except F2. Glycogen phosphorylase activity was significantly increased, leading to a significant concurrent drop of glycogen content. This effect was only seen for fractions F3 and F5. Creatine kinase activity and cellular ATP levels rose significantly upon incubation with all venom proteins except fractions F2 and F7. Increases were seen for aspartate and alanine aminotransferases by all venom proteins except fractions F2 and F4. Incubation of cell sonicates with all the venom proteins did not significantly alter activities of any of the parameters. Thus, fibroblasts in culture under such conditions appear to mobilize glycogen, phosphocreatine, and protein for ATP production to compensate for decreased glucose.

Retrograde esophageal dilation in children without the string.

A new technique for retrograde esophageal dilation is presented, which does away with the indwelling string. The method utilizes a Teflon-coated arterial guide wire, which is passed through the gastrostomy and, under fluoroscopy, is directed up the esophagus and out the mouth. The wire is followed by the string and dilators. This method avoids both embarrassment caused by the string and occurence of the usual complications.