An investigation into the pathogenesis of vulvo-vaginal candidosis.

OBJECTIVE: To monitor yeasts isolated from women during and between episodes of recurrent vulvo-vaginal candidosis (VVC) to determine whether vaginal relapse or re-infection occurred. METHODS: Women presenting at the genitourinary medicine clinic with signs and symptoms of VVC were recruited to the study (n = 121). A vaginal washing, high vaginal swab (HVS) and rectal swab were taken and the women treated with a single 500 mg clotrimazole pessary. Women were asked to re-attend after 1, 4, and 12 weeks, or when the VVC recurred, when vaginal washings and HVS were repeated. Candida isolates recovered were strain typed using the Ca3 probe and their similarity assessed. Antifungal susceptibility to fluconazole and clotrimazole were determined. RESULTS: Of the women recruited, 47 completed the study, either returning for four visits or suffering a recurrence during the study period. Of the 22 women who experienced recurrence, the same strain was responsible for the initial and recurrent episode in 17 women. For the remaining five women, four had strain replacement and one had a change of species. None of the isolates recovered from the women demonstrated resistance to either clotrimazole or fluconazole. CONCLUSIONS: Our findings support the theory of vaginal relapse and thus may support the use of more prolonged courses of antifungal therapy initially to increase the chances of eradication of the yeast.

Predictors of surgery outcome for colorectal carcinoma in the United Arab Emirates.

In this retrospective study, 72 patients with colorectal cancer were followed up for a mean period of 28.2 months. Predictors of recurrence and survival were determined using standard analyses. Univariate analyses identified a group of patients with a shorter time to recurrence. The mean overall survival time was 63.2 +/- 7.7 months and survival time was shorter for younger patients with palliative resection, lymph node metastasis and peritoneal nodules. In multivariate Cox proportional hazards analysis, the hazard ratio for positive lymph nodes was 2.54 (95% CI: 1.36-4.79) compared to negative nodes, and for Dukes' stages A and B compared to stage C it was 0.45 (95% CI: 0.25-0.81).

Predictors of surgery outcome for colorectal carcinoma in the United Arab Emirates

In this retrospective study, 72 patients with colorectal cancer were followed up for a mean period of 28.2 months. Predictors of recurrence and survival were determined using standard analyses. Univariate analyses identified a group of patients with a shorter time to recurrence. The mean overall survival time was 63.2 +/- 7.7 months and survival time was shorter for younger patients with palliative resection, lymph node metastasis and peritoneal nodules. In multivariate Cox proportional hazards analysis, the hazard ratio for positive lymph nodes was 2.54 [95% CI: 1.36-4.79] compared to negative nodes, and for Dukes' stages A and B compared to stage C it was 0.45 [95% CI: 0.25-0.81]

A new flavone diglycoside from Carthamus tinctorius seeds.

From the aqueous ethanol extract (AE) of Carthamus tinctorius seeds, a new acacetin diglycoside has been isolated and identified as acacetin 7-O-beta-D-apiofuranosyl-(1"'-->6" instead of 6')-O-beta-D-glucopyranoside together with previously isolated kaempferol 7-O-beta-D-glucopyranoside, acacetin 7-O-alpha-L-rhamnopyranoside and acacetin. The structures of these metabolites have been established on the basis of chemical, chromatographic and spectral methods.

Chloramphenicol drug failure in typhoid fever.

Two hundred positive blood culture typhoid patients admitted to Embaba Fever Hospital, Giza province, were subjected to: 1) Careful history and thorough clinical examination. 2) Complete blood picture. 3) Widal agglutination test. 4) Urine and stool cultures for Salmonellae. 5) To the isolates of the cultures, disk diffusion chloramphenicol susceptibility test, minimum inhibitory concentrations and chloramphenicol acetyl transferase test were performed. The dose of chloramphenicol was restricted to 50 mg per Kg body weight daily, whatever the route used; whether oral, rectal or intravenous. When fever did not drop up to 5 days or the patient presented with typhoid complications or the blood culture revealed resistant Salmonellae, quinolones or third generation, cephalosporins were administered. Measurement of the level of chloramphenicol in the blood was performed for every patient. Fifty (25%) patients were found to be resistant in vitro and in vivo to chloramphenicol. All their Salmonellae isolates were resistant to chloramphenicol, the mean zone size was 10 mm, the mean inhibitory concentration was 64 microgram per ml. and all were positive for chloramphenicol acetyl transferase. There was no significant difference in the serum level of chloramphenicol between susceptible and resistant groups to the drug. Results were interpreted and discussed.

Histochemical studies on rectal mucosa in active intestinal schistosomiasis.

Thirty patients suffering from active intestinal S. mansoni infection, were classified into 3 groups. The first group: 13 cases with early active intestinal schistosomiasis without hepatosplenomegaly. The second group: 11 cases with hepatosplenomegaly and the third group: 6 cases with splenomegaly and ascites. Also 10 normal individuals were included as a normal control group. Histopathological examination of rectal mucosa showed hyperaemia with extravasation of blood in early cases and granulomatous lesions in the second group with hepatosplenomegaly. The structural changes were severe in the late ascitic group. In this group the rectal mucosal glands showed distorted irregular tubular branching in addition to the granulomatous and the fibrous reactions. Histochemical studies including periodic acid schiff, alkaline phosphatase and acetyl cholinestrase reactions were done. Using the periodic acid shiff stain, the goblet cells showed strong reaction for neutral mucin in cases of group I (early cases) and group II (late hepatosplenomegalic cases). In group III (late ascitic cases) the goblet cells were faintly stained. A notable difference was observed between the lightly and heavily infected patients of this group. No alkaline phosphatase reactivity could be identified in rectal crypts of patients and controls. Alkaline phosphatase reactivity was sharply localised in S. mansoni egg shell. There was obvious decrease in the acetyl cholinesterase stained nerve fibres in the rectal mucosa of all studied patients. The decrease was more in chronic and heavily infected cases rather than in the acute and lightly infected ones.

Endoscopic sclerotherapy versus medical treatment for bleeding esophageal varices in patients with schistosomal liver disease.

A prospective controlled trial was conducted at Ain-Shams and Benha University Hospitals. One-hundred and eighteen chronic liver disease patients, mostly schistosomal in origin and presenting with recent proven variceal hemorrhage, were randomly allocated to injection sclerotherapy or medical therapy. The follow-up period extended to 21 months. Sixty-three patients received injection sclerotherapy using ethanolamine oleate (5% wt/vol) paravariceally while 55 received medical treatment in the form of general resuscitative measures, blood transfusion, vasopressin intravenous drip, and insertion of a Sengstaken-Blakemore tube if bleeding continued. The first 30-day mortality was 7 (11%) in the injection sclerotherapy group compared with 11 (20%) in the medical treatment group. This difference was not statistically significant. During the entire observation period 9 (14.3%) died in the sclerosed group and 16 (29%) died in the medically treated group, and this difference was statistically significant at the 5% level. Comparison of recurrent bleeding among both groups revealed that the difference was statistically not significant. It was concluded that injection sclerotherapy was no better than medical treatment in the control of acute variceal bleeding, but injection sclerotherapy did increase significantly long-term survival of sclerosed patients.