A descriptive study of inflammatory bowel disease at an Egyptian tertiary care center.

INTRODUCTION AND AIMS: Inflammatory bowel disease (IBD) is a group of chronic intestinal disorders that trigger prolonged inflammation of the digestive tract. Its incidence and prevalence appear to be increasing in the African population and in Egypt. The present study aims to highlight the pattern and management of IBD in Egyptian patients. MATERIALS AND METHODS: Two hundred patients with IBD were assessed for ulcerative colitis (UC), through the Mayo score, and for Crohn's disease (CD), with the Crohn's disease activity index (CDAI). RESULTS: Median patient age was 35 years, with a predominance of females. UC was more common than CD (88% and 12%, respectively) and severity was moderate, in the majority of cases. Most UC patients had left-sided lesions, whereas ileitis was the most common finding (37.5%) in the CD patients. Proctitis was the least common finding in both diseases and Crohn's fistulizing disease was detected in 4.1% of the patients. Interestingly, peripheral arthropathy was the most common extraintestinal manifestation in the IBD patients (70%) and axial arthropathy was the least common (6%). Severe ocular or mucocutaneous involvement was very rare. Finally, biologic treatment was prescribed to 15.4% of the UC patients and 20.8% of the CD patients. CONCLUSIONS: Although the clinical presentation of IBD in Egypt is comparable to that reported worldwide, diagnoses were found to be delayed. There were fewer cases of CD than UC, but more mild-to-moderate disease severity. The surveillance of patients with IBD must continue and awareness of the disease in the Egyptian medical community needs to increase. A national registry must be established, multicenter studies need to be conducted, and molecular diagnostics is recommended.

Utility of Moringa oleifera waste as a coagulant in goat soft cheese production.

Milk clotting enzyme (MCE) of Moringa oleifera from prepared seed cake (PSC) dissolved in acetate buffer pH 5.0 recorded the highest activity compared to other samples, as well as 20-40% saturation of ammonium sulfate precipitated MCE with 28.20% yield and 1.01 purification fold. The proteolytic activity (PA) of crude MCE from Moringa oleifera PSC was higher than those of partial purified MCE with 180.81 and 155.47 as MCA/PA ratio, respectively. PSC moringa MCE exhibited their optimal activity at pH 5.0 and 60 °C; it could be capable to coagulate different milk types. Also, goat soft cheeses coagulated with moringa MCE exhibited significantly (p ≤ 0.05) higher levels of water soluble nitrogen content and total sensorial scores than control cheese. It could be concluded that partial purified MCE from Moringa oleifera PSC may prove to be a good candidate in goat cheese production without any appeared defects during their storage period.

Immunolocalization of androgen and vitamin D receptors in the epididymis of mature ram (Ovis aries).

This study illustrated the immunohistochemical distribution of androgen and vitamin D receptors of epididymis in 20 sexually mature ram (Rahmani breed) with average age ranged from (2_4) years and average weight ranged from (50_65kg). Androgen receptor was localized in the cytoplasm of both ciliated and non ciliated cells of efferent ductules, besides the principal cells via the entire epididymal duct. The principal cells of both corpus and proximal cauda epididymis showed the highest immunoreactivity to androgen receptors. Furthermore, vitamin D receptor was localized in the cytoplasm of all epithelium of the efferent ductules besides principal cells of all epididymal regions, however the immunoreaction was significantly higher in the efferent ductules, distal caput and distal cauda epididymis. In conclusion, these results suggest that the function of ram epididymis is regulated by both androgen and Vitamin D.

Effect of Quinoa (Chenopodium quinoa) Flour on the Production and Quality of Low-Fat Camel Milk Processed Cheese Spread.

BACKGROUND AND OBJECTIVE: Camel milk has nutritional and therapeutic properties. Quinoa flour has been incorporated into many kinds of food because of its various nutrients and bio-actives. This study aimed to investigate the effect of using quinoa flour on the properties of low-fat camel milk processed cheese spread (LF-CMPCS) made from fermented retentate camel milk as a camel cheese base. MATERIALS AND METHODS: Quinoa flour was used to substitute 1, 3 and 5% of the camel cheese base made with Ras cheese. The resultant cheeses were analyzed for several parameters. Such as physiochemical, texture properties, antioxidant activity, fatty acids, microstructure and organoleptic properties as fresh and during storage period at 5±1°C for 3 months. The data were analyzed by ANOVA using the SPSS computer program. RESULTS: Total solids, protein, fat/dry matter and soluble nitrogen decreased significantly while the fiber, carbohydrates and pH values increased significantly. Meltability value of LF-CMPCS significantly decreased. The results indicated that the hardness increased significantly with the increase in the addition of quinoa flour. The fatty acid profile indicated a significant increase in oleic acid (18:1), linoleic acid (18:2), linolenic (18:3) and eicosenoic (20:1) with the increase of quinoa flour. Scanning electron microscopy (SEM) images showed the presence of quinoa flour in the space within the casein particle network. CONCLUSION: It could be concluded that the addition of quinoa flour to camel cheese (up to 3%) can improve the chemical, sensory and microstructure and texture properties of LF CMPCS camel milk cheese without altering the quality of the product.

Neurofibromatosis type 2: Hearing preservation and rehabilitation.

The main manifestation of neurofibromatosis type 2 (NF2) is the development of bilateral vestibular schwannomas (VS). Consequently, one of the most severe functional sequelae is bilateral sensorineural hearing loss, caused by spontaneous tumor progression and/or treatment-related damage (surgery or radiosurgery). Preserving or restoring hearing is still challenging in NF2 no matter the strategy applied to each individual based on the natural history of VS. In this review, the different strategies for hearing preservation or rehabilitation are discussed and illustrated by several cases. A decisional algorithm for NF2 patients with VS is proposed that takes into consideration the tumor size and hearing level.

PORTAL HYPERTENSION TREATMENT WITH CANDESARTAN PLUS PROPRANOLOL FOR NINE MONTHS RESTORES NORMAL PORTAL CIRCULATION HEMODYNAMIC PATTERN.

Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow (PVF) and intrahepatic resistances (IHR). PVF is partially controlled by using both specific and non-specific beta blockers (NSBBs) that have insignificant effects on IHR. Angiotensin recep- tor blockers (ARBs) inhibit the activated hepatic stellate cell (HSC) contraction and thought to reduce the dynamic portion of IHR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension (PH). Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices (OV), were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index(DI),,pu1se Pulsatiity Index (P), Portal Venous Flow (PVF) Volume, Portal Venous Peak Velocity (PVPV), and Portal Vein Diameter (PVD) were evaluated once every.third month. Our study concluded that combined therapy (Propranolol + Candesartan) induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume & PVPV overtime compared to monotherapy regimens (P>O.001). Data strongly recommended using Propranolol plus Candesartan' in overtime management of portal hypertension.

Nutrient Digestibility, Ruminal Fermentation Activities, Serum Parameters and Milk Production and Composition of Lactating Goats Fed Diets Containing Rice Straw Treated with Pleurotus ostreatus.

The study evaluated replacement of Egyptian berseem clover (BC, Trifolium alexandrinum) with spent rice straw (SRS) of Pleurotus ostreatus basidiomycete in diets of lactating Baladi goats. Nine lactating homo-parity Baladi goats (average BW 23.8±0.4 kg) at 7 d postpartum were used in a triplicate 3×3 Latin square design with 30 d experimental periods. Goats were fed a basal diet containing 0 (Control), 0.25 (SRS25) and 0.45 (SRS45) (w/w, DM basis) of SRS. The Control diet was berseem clover and concentrate mixture (1:1 DM basis). The SRS45 had lowered total feed intake and forages intake compared to Control. The SRS25 and SRS45 rations had the highest digestibilities of DM (p = 0.0241) and hemicellulose (p = 0.0021) compared to Control which had higher (p<0.01) digestibilities of OM (p = 0.0002) and CP (p = 0.0005) than SRS25 and SRS45. Ruminal pH and microbial protein synthesis were higher (p<0.0001) for SRS25 and SRS45 than Control, which also had the highest (p<0.0001) concentration of TVFA, total proteins, non-protein N, and ammonia-N. All values of serum constituents were within normal ranges. The Control ration had higher serum globulin (p = 0.0148), creatinine (p = 0.0150), glucose (p = 0.0002) and cholesterol (p = 0.0016). Both Control and SRS25 groups had the highest (p<0.05) milk (p = 0.0330) and energy corrected milk (p = 0.0290) yields. Fat content was higher (p = 0.0373) with SRS45 and SRS25 groups compared with Control. Replacement of BC with SRS in goat rations increased milk levels of conjugated linoleic acid and unsaturated fatty acids compared with Control. It was concluded that replacing 50% of Egyptian berseem clover with SRS in goat rations improved their productive performance without marked effects on metabolic indicators health.

Cost-effectiveness of ultrasound use by on-call registrars in an acute gynaecology setting.

Ultrasound, and in particular transvaginal sonography (TVS), plays an important role in the management of women with acute gynaecology conditions. This study compared the cost-effectiveness of two models of out-of-hours care for women in an acute gynaecology setting. In the ultrasound-based model, the on-call registrar with ultrasound experience managed such patients after performing pelvic ultrasound as a part of the initial assessment. On the other hand, in the traditional model of care the on-call registrar managed the patients without the use of ultrasound. The conclusion is that the use of ultrasound by the on-call registrars has significant cost implications through reduced hospital admissions. It leads to improved outcomes of such patients through timely diagnosis and treatment.

Expectant management of first-trimester miscarriage.

Miscarriage is the most common complication of pregnancy, which creates a significant workload for health-care professionals. For decades, surgical evacuation of the uterus has remained the conventional treatment of first-trimester miscarriage. Recently, non surgical treatments have been introduced with increasing popularity. This review explores the evidence in support of expectant management of first-trimester miscarriage. It is safe, effective and well-tolerated by women. It enhances women's choice and control. It generates significant cost savings compared with the traditional surgical management. Accurate diagnosis, counselling, 24/7 telephone advice and follow-up are among the important aspects of expectant management. More studies are needed to develop methods for identifying miscarriages suitable for expectant management.

Isolation and identification of some steroidal glycosides of Furcraea selloa.

The antischistosomal impact of different extracts of the leaves of Furcraea selloa C. Koch (Family Agavaceae) were screened against adult Schistosoma mansoni worms in vitro using well established culture media. The methanol extract of the plant showed the highest activity as S. mansoni worms recorded 100% mortality at 50 microg/ml after 24 h (EC50 = 29.78 and 29.41 microg/ml for female and male worm respectively). Owing to the high potency of the crude butanolic extract (100% mortality at 20 microg/ ml; EC50 = 10.42 and 8.94 microg/ml for female and male worm respectively) obtained from the methanolic extract, it was submitted to chromatographic separation and isolation using silica gel and Sephadex columns as well as preparative thin layer chromatography. Three steroidal glycosides (saponins) (I-III) were isolated and their structures were elucidated using some spectroscopic and chemical methods. The structure of the three compounds was formulated as 6-O-beta-glucopyranosyl-(1-->4)-beta-D-glucopyranoside chlorogenin (I), 3-O-beta-D-glucopyranosyl-(1-->4)-beta-D-glucopyranoside crestagenin (II) and 3-O-beta-D-glucopyranosyl-(1-->3)-beta-D-glucopyranosyl-(1-->3)-beta-D-xylopyranoside gloriogenin (III). Only compound III at 5 micro/ml led to 100% mortality of the S. mansoni (EC50 = 2.25 and 1.91 microg/ml for female and male worm respectively) whereas compounds I and II did not show any activity up to 50 microg/ml.

Intracranial tuberculomas: the Hofuf, Saudi Arabia experience.

Tuberculosis usually involves the brain through haematogenous spread. The mass lesion caused by tuberculosis in the brain is called tuberculoma, which is a conglomerate of tubercles. Tuberculomas may also be found in the spinal cord. Because of their slow growth they often become calcified. The study was conducted at the King Fahad Hospital, Hofuf, Al Hassia, Saudi Arabia between 1992 and 1998. It was a prospective study of all patients which had intracrainal mass lesions which showed typical ring-enhancement on brain CT scan with contrast. Twenty patients satisfied inclusion into the study. Of the 20 patients studied, 19 (95%) were males and 1 (5%) was a female. The ages ranged between 22 and 50 years. Eighteen (90%) of the patients were immigrant labourers from Asia and 2 (10%) were Saudi nationals, a male aged 50 years and a female aged 22 years. Fifteen (83.5%) were from India, 2 (11.1%) from Bangladesh, and 1 (5.6%) from Sri Lanka. The presenting feature in 60% of cases was focal seizure with secondary generalisation. 20% had primary generalized seizures, and 30% presented with headache, 25% with weakness of the limbs, 15% with fever and 10% each with vomitting and blurred vision, respectively. In 65% of cases, there was noneurological deficit but 35% had pyramidal weakness in the limbs. In 55% of cases the Tuberculomas were located in the left cerebral hemisphere. 30% in the right cerebral hemisphere and in 15%, the lesions were in both hemisphere. When a male Asian immigrant labourer aged between 20 and 40 years presents with seizures with or without headache, he should have a brain CT scan with contrast to exclude intracranial Tuberculoma. A short course of anti-tuberculous therapy may be tried where there is doubt, irrespective of normal erythrocyte sedimentation rate (ESR). We suggest that when the presenting symptom is primary generalized tonic clonic seizure, the intracranial Tuberculoma is located in the frontal lobe: a high erythrocyte sedimentation rate (ESR) may indicate multiple Tuberculomas.

Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy.

OBJECTIVES/HYPOTHESES: Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL STUDY DESIGN: Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. METHODS: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma A computer program was written to classify whether the patient was amenable to SCPL. RESULTS: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). CONCLUSIONS: 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.

Estimation of the effect of NaCl on the solubility of organic compounds in aqueous solutions.

The Setschenow constant, K(salt), of a nonelectrolyte in a NaCl solution is shown to be related to the logarithm of its octanol-water partition coefficient, log K(ow), determined by K(salt) = A log K(ow) + B, where K(ow) is the octanol-water partition coefficient of the solute and the coefficients A and B are constants. The values of A and B were empirically determined from literature data for 62 organic compounds and validated for a test set of 15 compounds including several drugs.

Characteristics of stroke in Hofuf, Saudi Arabia.

BACKGROUND: Stroke is a common neurological disorder that is encountered in most hospitals in both developed and developing countries. This two-year study was designed to show the characteristics of the problem at the King Fahad Hospital, Hofuf, Saudi Arabia. PATIENTS AND METHOD: This was a prospective study of all Saudi stroke patients admitted to the medical wards in the study period. All patients were assessed individually by one of the two available neurologists. Data was collected on pre-designed protocol, and analysis was performed using tables and figures, and EpiInfo A(R) computer software. RESULTS: The 329 Saudi patients studied fulfilled the criteria for stroke. The male:female ratio of the patients was 1:1, and their ages ranged between 42 and 92 years (mean 62.8+/-11.1) for males, and between 20 and 100 years (mean 59.6+/-15.4) for females. The relative frequencies of stroke subtypes were ischemic infarcts (79%), of which 46% were lacunar infarcts, intracerebral hemorrhage (18.8%), and subarachnoid hemorrhage (2.2%). The most common risk factor was concomitant hypertension with diabetes mellitus (40.4%), hypertension alone (24.9%), diabetes alone (11.6%), atrial fibrillation (5.8%), other cardiac factors (5.5%), transient ischemic attack (TIA) and prior stroke (2.1% each), and smoking (1.8%). No risk factor was detected in 5.8% of the patients. The overall in-hospital mortality was 10.0%, with a significant male preponderance. CONCLUSION: This study demonstrated that stroke is a common neurological condition in the Al-Hassa region of the Kingdom. The male:female ratio was dissimilar from that observed in other parts of Saudi Arabia. The study also showed that hypertension with diabetes constituted a potent risk factor. Sickle cell anemia was not found to be a risk factor. The case fatality was low and both the incidence and mortality showed seasonal preference. We believe that there is a need to establish a Stroke Register at the King Fahad Hospital at Hofuf for the Al-Hassa region.

Preparation of targeted isoniazid microspheres.

Isoniazid (INH) albumin microspheres were prepared by two different stabilization processes: chemical denaturation using glutaraldehyde and heat denaturation. The extent of stabilization was characterized by the solubility of the microspheres. In vitro drug release rates were correlated to the stability of the microspheres and the results showed that the more denatured the albumin by heat stabilization, the slower the drug release rate. A factorial concept has been utilized to synthesize microspheres suitable for passive targeting to the lungs by varying protein concentration, stabilization temperature, time and aqueous volume. These factors significantly affected the sphere size, payload and a release profile of the drug. As the severity of the denaturation conditions increased, the payload decreased and the rate of drug release was slowed. The microspheres carrying isoniazid were followed in experimental animals to validate the targeting process.

Biochemical studies on proteins from cheese whey and blood plasma by-products.

Efforts have been done to recover proteins from waste liquors rich in protein in a soluble form. Cheese whey and animal bloods are by-products from the manufacture of cheese and meat. It contains a variety of proteins which can be reclaimed. The efficiency of protein precipitation from the sweet-cheese whey by the use of hydroxyethyl cellulose (HEC) was similar to that precipitated by the use of carboxymethyl cellulose (CMC). Both are greater than that precipitated by trichloro acetic acid. The same results of the efficiency of precipitation were attained when the plasma was precipitated. It was found that cheese-whey protein-HEC-complex and plasma protein-HEC-complex contain a large amount of essential amino acids. Electrophoretic separation of whey protein complex showed that beta-Lactoglobulin forms the major fraction while in case of plasma protein complex albumin forms the major fraction. The fractionation patterns of different complexes with HEC, CMC or TCA gave the same components and about the same ratio. It appears from these results that HEC-protein complexes are preferable than CMC-protein complexes or proteins precipitated by TCA. Chemical analysis of whey protein complexes revealed that lactose content of whey protein-HEC-complex was higher than that of CMC-complex or protein precipitated by TCA. Elemental analysis of protein complexes showed that the level of sodium, phosphorus, and potassium was increased while that of copper or zinc decreased. Cellulose derivative protein complexes showed no significant effects on the liver or kidney function of albino rat and these results indicted that no toxic effect was observed from the uses of these protein complexes in feeding.

Parasitological and clinical studies on human scabies in Cairo.

This study is a parasitological and clinical study on human scabies. This study was carried out on 100 patients attending the Dermatology Outpatient Clinic at Ain Shams University Hospitals, including 54 males and 46 females. All patients were subjected to detailed history taking, complete dermatological examination including Skin Scraping Test and Burrow Ink Test. Younger patients attended the dermatology clinic earlier than older patients, who usually delayed their visits until complications occurred. Scratching, erythematous papules and secondary infected lesions were the commonest lesions. The hands, wrist and external genitalia were the most frequently affected sites while the feet, ankles, knees and back were the least affected. Burrows could only be detected in 40% of patients. The most frequent sites were the web spaces, external genitalia, and finger sides. Burrow Ink Test was positive among 85% of patients with burrows while mites could be identified by Skin Scraping Test in 55% of patients. The most frequent clinical manifestations in the parasitologically positive patients were itching, burrows, and papules, and the most frequent sites were the web spaces, and the finger sides. Multiple sites affection was the characteristic feature among the preschool age children who represented 14% of cases.

Molluscicidal activity and clinico-pathological effect of Agave lophantha.

Dry powder and different extracts of Agave lophantha were tested against Biomphalaria alexandrina. The results showed that the butanol extract has high molluscicidal activity. The activity of the dry powder has been found to be stable under the effect of some simulated field conditions. Also the toxicological effect of the plant on mice was tested through determination of certain parameters such as total protein, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and acid phosphatase enzymes as well as histopathological study on liver and kidney.