Tumour necrosis factor α-308 G/a and -238 G/a polymorphisms as predicator of diabetic retinopathy in Egyptians.

BACKGROUND: Diabetic retinopathy (DR) is a duration dependent serious micro vascular insult of diabetes mellitus. Inflammation has a critical role in the development of early and late stage of DR. Tumour necrosis factor alpha (TNF-α) is an inflammatory cytokine that promoteup regulation of adhesion molecule expression, leukocyte recruitment and monocyte attraction. TNF-α levels are increased in retinas or vitreous of diabetic animals. A cross-sectional, observational study was performed in a sample of diabetic patients who attend diabetes polyclinic of RIO Hospital, Giza, Egypt, between October 2016 and December 2019. Three hundred diabetic patients were studied (150 males and 150 females). 100 diabetic patients without retinopathy, 100 diabetic patients with proliferative retinopathy (PDR), 100diabetic patients with non-proliferative retinopathy (NPDR), also 100 healthy subjects as a control group All patients and subjects were analysed for serum TNF-α levels by ELISA assay and -308 G/A and -238 G/A polymorphism by using Restriction fragment length polymorphisms. AIM: Evaluating the role of tumour necrosis factor α and -308 G/A, -238 G/A polymorphisms in the pathogenesis of proliferative diabetic retinopathy among Egyptian patients. RESULTS: A statistically significant increase in TNF-α levels was detected in diabetic without retinopathy, NPDR and PDR groups compared to control group (p > .001). There were no significant different in Genotype and allele frequencies of the -308G/A, and -238 G/A, polymorphisms in both NPDR and PDR. However, the G/G genotype of the -308 G/A polymorphism occurred more frequently in PDR patients with than NPDR patients (0.74% vs 0.68%). CONCLUSION: The present study clearly demonstrated increased levels of TNF-α, in diabetic patients with diabetic without retinopathy, NPDR and PDR. Furthermore, this study suggested that TNF-α assay could be used as diagnostic tools to predict the initiation and progression of diabetic retinopathy. They could serve as biomarkers not only for an early detection of the disease, but also to monitor the effects of therapy. Also, the G/G genotype of the -308 G/A polymorphism and the G allele of TNF-α gene were more frequent in PDR patients than with NPDR.

Validation of a novel UPLC-MS/MS method for estimation of metformin and empagliflozin simultaneously in human plasma using freezing lipid precipitation approach and its application to pharmacokinetic study.

A fast, sensitive one step UPLC ESI-MS/MS method was successfully applied for the simultaneous estimation of two concurrently administrated antidiabetic drugs, Metformin (MET) and Empagliflozin (EMPA) in human plasma. Metformin-d6 (MET-d6) and Empagliflozin-d4 (EMPA-d4) were utilized as internal standards. Extraction of the analytes from the human plasma was performed through acetonitrile precipitation technique followed by freezing the precipitated plasma proteins and lipids to minimize the matrix effect. Chromatographic analysis was developed on Acquity UPLC BEH C18 column (1.7 µm, 2.1 × 50 mm) using isocratic elution mode. A mobile phase of formic acid (0.01 %): acetonitrile (70:30 v/v) with a flow rate of 0.3 mL/min achieved optimum separation. Multiple reaction monitoring (MRM) in positive ion mode, with transitions at (m/z) 130.14 →71.08 for (MET), 451.72 →71.29 for (EMPA), 136.03 →77.02 for (MET-d6), and 455.43 → 75.05 for (EMPA-d4) was used for quantification. The obtained linearity covered the concentration ranges of 10-1500 ng/mL and 2.0-250.0 ng/mL for MET and EMPA, respectively. The run time of the proposed Method didn't exceed 3.0 min allowing faster analysis and determination of larger number of samples per day without affecting accuracy and sensitivity. The presented chromatographic method could be successfully applied in pharmacokinetics studies and therapeutic monitoring of MET and EMPA in patients' plasma administrating fixed dose combination of both drug with high reproducibility and ruggedness.

First Report of Bacterial Wilt Caused by Ralstonia solanacearum Biovar 2 Race 1 on Tomato in Egypt.

This study aims to isolate and identify the causal pathogen of tomato bacterial wilt in Egypt. In 2008, tomato plants showing typical symptoms of bacterial wilt disease with no foliar yellowing were observed in Minia, Assiut and Sohag governorates, Egypt. When cut stems of symptomatic plants were submerged in water, whitish ooze was evident and longitudinal sections showed a brown discoloration in the vascular tissues. Bacteria were isolated on triphenyl tetrazolium chloride medium and fifteen isolates shown typical morphological and cultural characteristics were confirmed as Ralstonia solanacearum biovar 2 race 1. Pathogenicity tests showed that all isolates proved to be pathogenic to tomato plants, varied from 52 to 97% wilting. This is the first report of R. solanacearum biovar 2 race 1 causing bacterial wilt in tomato crop in Egypt.

GIS-based prediction of malaria risk in Egypt.

Environmental variables in a malaria geographic information system (GIS) database were analysed to discriminate between governorates at high and low risk of malaria. Only Fayoum governorate was categorized as a high risk area for malaria during the last 2 decades. Discriminant models correctly classified 96.3% of the risk categories and indicated that the most important predictor of risk is hydrogeology. Further GIS spatial analysis indicated that the high malaria risk in Fayoum is associated with a unique environmental envelope of biotic (presence of both efficient malaria vectors) and abiotic (hydrogeology and soil) variables. Recommendations for surveillance and control are discussed.

GIS-based prediction of malaria risk in Egypt

Environmental variables in a malaria geographic information system [GIS] database were analysed to discriminate between governorates at high and low risk of malaria. Only Fayoum governorate was categorized as a high risk area for malaria during the last 2 decades. Discriminant models correctly classified 96.3% of the risk categories and indicated that the most important predictor of risk is hydrogeology. Further GIS spatial analysis indicated that the high malaria risk in Fayoum is associated with a unique environmental envelope of biotic [presence of both efficient malaria vectors] and abiotic [hydrogeology and soil] variables. Recommendations for surveillance and control are discussed

Preliminary observations on cross-mating of the malaria vector, Anopheles sergentii from two Egyptian oases.

Intra- and inter-strain crosses were made between randomly collected adults Anopheles sergentii originated from Tersa village (El-Faiyum Governorate) and Siwa oasis (Matruh Governorate). The success of such crosses and their effects on fecundity and fertility of the parental females and on survival and development velocities of the F1 immatures were examined. No overall heterosis effects on such attributes were detected suggesting absence of genetic differences between the vector populations in these two malarious areas.

Characterization of rice field mosquito habitats in Sharkia Governorate, Egypt.

The characteristics of the breeding water, interspecific association and seasonal abundance of 3 mosquito species within rice fields were examined in 6 districts. Larvae of Cx. antennatus were dominant (83.71% collected larvae), of An pharoensis were common (12.29%) and of Cx perexiguus were uncommon (4.0 = .0%). Breeding water has pH of 6-8, salinity of 0.05-0.35 gm Cl/L. and temperature of 21-29 degrees C. Although the relation of larval density (for each species) was positive with pH and negative with salinity and temperature however, no interaction (regression analysis) was existed among the variables (R = 0.26-0.40, P > 0.05). Significant and complete associations (CAB = 1.0, P < 0.01) were detected for Cx. antennatus with other species. During rice growing period (June to October), Cx perexiguus larvae were quite short lasting (June to August). Larval abundance varied monthly in relation to the plant growth stage. No larvae of any species were collected in short plant (< 20 cm, beginning of June) or in very long ones (130 cm in October). Higher numbers of larvae were often associated with the moderate plant growth (50-80 cm) with a peak in plants of 70 cm height in August (161.50 larvae/10 net dips for the 3 species). The highest larval density for Cx antennatus (132.50 larvae) and An pharoensis (22.25 larvae) were during August (70 cm plant) and for Cx. perexiguus (7.67 larvae) was in July (60 cm plant). So, rice fields are potential habitats for these disease vectors. The plant height and irrigation scheme are major factors affecting the abundance of these species.

The ecological characteristics of Anopheles mosquitoes associated with low malaria transmission in Siwa oasis, Egypt.

The ecology of Anopheles sergentii and An. multicolor was investigated over eight months to examine the entomological factors maintaining the low Plasmodium vivax transmission in Siwa oasis. The two species were encountered as larvae while the dominant species, Anopheles sergentii was also collected as adults. Breeding sites were characterized for the two species in six localities. Larvae of both species were common during June and November. In Bahi El Din as an indicator village with a higher endemicity, An. sergentii females were endophilic but more common inside animal sheds than in houses, attracted more to donkey-baited traps than to human hosts, more endophagic as human biters and were more common in May/June and November. Female survivorship was higher in November than in the other months. Vector potential of An. sergentii was predicted and revealed that the species characteristics (low human contact, short survival and zoophilic feeding behavior) are responsible for maintaining such low and unstable malaria in Siwa oasis.

Anopheles sergentii (Diptera: Culicidae): seasonal variation in the development rates of immatures from El Faiyum and Siwa Oasis, Egypt.

Three colonies of An. sergentii from El Faiyum (Tersa and El Nazlah) and Siwa oasis were maintained for one year under the circulating room conditions to examine the rates of immature development and survival. For each colony, the egg incubation periods and immature developmental periods (P 50 and E 50) were significantly longer at low temperatures (mean = 13.4 degrees C) during winter. Egg hatch rates and survivorships of the different immature stages did not significantly differ among seasons except for Siwa colony where rates of immature survival decreased during summer (mean = 28.5 degrees C). No differences in such estimates were observed among the three colonies. With the exception of Tersa eggs, the developmental velocity (V = 1/period)--temperature relationships were linear (r2 = 0.94-0.98). The temperature thresholds (to) were 8.64 and 7.35 degrees C with thermal constants (K) of 38.61 and 42.74 degree--days (DD) for eggs of El Nazlah and Siwa, respectively. For adult emergence (male or female) of the three colonies, the to's were 8.02-9.41 degrees C and K's were 212.34-223.71, DD required above the to to complete development. The study indicated that seasons of higher temperatures (mean = > 20 degrees C) are optimal for the development and survival of An. sergentii immatures.

Urovaginal fistulae: 20 years' experience.

During the last 20 years we treated 86 patients suffering from urovaginal fistulae. The highest incidence of fistulae occurred in the third and fourth decades of life (31 and 28 patients, respectively). The incidence was very low after the age of 50 (only 2 patients). Fistulae were either simple between the bladder and vagina (54 cases), urethra and vagina (13 cases) and ureter and vagina (7 cases) or complex connecting more than two organs in 12 cases. The causative trauma was difficult prolonged labour with trial forceps in 28 patients. Fistulae followed caesarean section with or without hysterectomy in 24 women. Hysterectomy, whether abdominal or vaginal, was followed by fistulae in 19 cases. Five cases refused operation and 1 was medically unfit. Ureterovaginal fistulae were successfully treated with ureteroneocystostomy. Vesicovaginal fistulae were met with in 54 cases (3 cases required diversion, 1 was medically unfit and 46 were successfully repaired and 4 failed). Simple repair was performed in 30 cases, repair and flap interposition in 12, ileocystoplasty in 7 and colocystoplasty in 1. Urethral fistulae were reported in 13 cases (simple repair in 11 cases and neourethra in 2), of these, 10 were successfully corrected. Complex fistulae were diagnosed in 12 cases (3 required diversion, 5 refused operation, 2 successfully repaired and 2 unsuccessfully corrected). The 2 successfully repaired case were 1 ureterovisicovaginal (treated with ileocystoplasty) and 1 cervicovesicovaginal (treated with repair and flap interposition). The 2 failures were ureterovesicovaginal and treated with simple repair.

Comparison of the life table characteristics of Anopheles sergentii (Diptera: Culicidae) from two malarious areas in Egypt.

Life table characteristics were examined for the malaria vector, An. serenti from two Faiyum villages: Tersa (T) and El Nazlah (N) from Siwa oasis (Sw) under constant laboratory conditions at 25 degrees C and 70% RH. Females of T, N and Sw completed 4, 5, and 2 gonotrophic cycles (gc) respectively. The first gc required a significantly longer period (p<0.05) than the subsequent ones. Development times for Sw immatures were longer (p<0.05) than for the other colonies. Life expectancies at emergence for males of the 3 colonies were significantly shorter than for their respective females. Generation time was shorter (p<0.05) for T (mean = 31.15 days) than for Sw (37.81 days) or N (43.64 days) colonies. The birth rate of Sw colony (mean = 0.33 female female/female) was significantly higher (p

Digital subtraction angiography in potential live-kidney donors: a study of 1000 cases.

Intravenous digital subtraction angiography (IV-DSA) combined with excretory urography (IVU) were utilized to study the renal anatomy of 1000 potential live-kidney donors. In the entire series, 712 donors (71.2%) had bilateral single renal arteries, whereas 255 (25.5%) had unilateral multiple, 26 (2.6%) had bilateral multiple, and 7 (0.7%) had unilateral hypoplastic or absent renal arteries determined by IV-DSA. Major renal abnormalities that might be potentially significant for safe renal donation were detected in 76 donors (7.6%) by combined IV-DSA and IVU studies. In 10% of the potential donors, intraarterial digital subtraction angiography (IA-DSA) was required because of the equivocal results of IV-DSA. Of the 1000 potential donors, 700 underwent nephrectomy and the number of renal arteries at nephrectomy was compared with both IV-DSA and IA-DSA reports. Analysis of data revealed a sensitivity of 96% vs 95%, a specificity of 57% vs 75% and an overall accuracy 93% vs 90% for IV-DSA and IA-DSA, respectively, both IV-DSA and IA-DSA were accurate enough in identification of single renal arteries. However, the accuracy of IA-DSA was better than that of IV-DSA in visualization of double (84% vs 64%) and triple (66% vs 33%) renal arteries. It is concluded that IV-DSA combined with IVU is an effective technique for the evaluation of potential kidney donors. In cases where IV-DSA is equivocal, we recommend confirming IA-DSA.

Cutaneous leishmaniasis in outpatients of dermatology and venereology clinic, Benha Faculty of Medicine, Zagazig University, Egypt.

Zoonotic cutaneous leishmaniasis (ZCL) is a disease of an ancient history and more or less encountered in several Egyptian Governorates. However, no data is available concerning CL. in Qualyobia Governorate. In the present study, a number of 10920 patients who attended the outpatient's clinic of Dermatology and Venereology, during the year 1991, were clinically examined for any manifestations suggesting CL. Lesion when present was examined by Giemsa stained smear and N.N.N. medium culture. Serum samples were separated from blood of suspected CL. cases for detection of antileishmanial antibodies by the indirect haemagglutination tests. The results showed that six patients had parasitologically proven lesions and that IHAT was less specific in diagnosing CL. It was concluded that CL exists as endogenous cases in Qualyobia Governorate and that the presence of CL and VL within nearly the same focus is a point of medical importance.

The clinical picture of six Egyptian cases of cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is a skin disease encountered in the East Mediterranean Region including Egypt. In this paper, it was intended to throw some light on the clinical picture of six parasitologically proven human CL. Also, the results of treating three cases of them with Pontostam or Cryosurgery. The whole results were discussed.

Percutaneous nephrolithotripsy for renal stones in over 1000 patients.

Over a period of 5 consecutive years, 1039 renal units were treated by percutaneous nephrolithotripsy for stone disease of the kidney. The success rate was 93.7%. Residual stones remained in 4.2% of patients and in 2.1% we failed to remove the stones. The complication rate was 17.8%. Complications were treated conservatively in most cases but nephrectomy was required on one occasion to control severe bleeding. The average hospital stay was 6.9 days. Follow-up of 339 renal units (333 patients), for a minimum of 60 months, revealed minor late sequelae such as pelviureteric junction obstruction in 1 patient (0.3%) and post-catheterisation strictures of the anterior urethra in 4 (1.2%). Stone recurrence was observed in 9.1% of patients. Percutaneous nephrolithotripsy is an effective, safe treatment for renal stones with minimal late sequelae and is still required even in the era of extracorporeal shock wave lithotripsy.

Impact of donor age on living related donor kidney transplantation.

Two comparable groups of kidney transplant recipients were identified according to the age of their kidney donors. The first group (A) comprised 42 recipients of donors aged < 40 years, and the second group (B) comprised 48 recipients of donors aged > 50 years. The patients were followed for a mean period of 26 months (range 13-50 months). Post-transplant renal function and graft survival were assessed together with the frequency of post-transplant proteinuria and hypertension. Moreover, the functional reserve of the grafts was determined by comparing the clearance values, obtained by both isotope and chemical means, before and after a combined infusion of dopamine and an amino acids preparation. The graft function was significantly better in group A according to the serum creatinine levels (micromol/l) at 1 month (107+/-4.5 vs. 134+/-10.7, P < 0.01), 12 months (119+/-5.3 vs. 181+/-88, P < 0.05) and at last follow-up visit (118+/-6.2 vs. 223+/-63, P < 0.03) for groups A and B, respectively. The graft survival in group A was significantly higher than that in group B (100% vs. 87% at 1 year, P < 0.05). The graft functional reserve was significantly better in group A than in group B. Post-transplant proteinuria was significantly more frequent in group B recipients (70% vs. 40%, P < 0.03). The age of the donors had no impact on the incidence of post-transplant hypertension. These observations suggest that the transplantation of a kidney from an older live kidney donor is associated with an inferior post-transplant outcome.

Development and survival of Anopheles pharoensis and An. multicolor from Faiyum, Egypt.

Adults of Anopheles pharoensis and An. multicolor were held under cycling environmental conditions in the laboratory to examine the duration of the gonotrophic cycles, survival and life expectancy, and to examine the life table characteristics of F1 larvae. The first gonotrophic cycle took 6.14 and 7.37 days for An. pharoensis and An. multicolor, respectively. Subsequent gonotrophic cycles for the 2 species were shorter. Daily survival rates of An. pharoensis and An. multicolor in the laboratory were 0.95 and 0.93, respectively. The parity rate of field-collected females and estimates of the duration of the gonotrophic cycle yielded daily survivorship estimates of 0.89 and 0.80 for An. pharoensis and An. multicolor, respectively. Mean life expectancy at emergence was 19.0 days for An. pharoensis compared with 17.9 days for An. multicolor. Survivorship from egg eclosion to adult emergence and development time were similar for both species. Both the duration of gonotrophic cycles and mean life expectancies indicated that An. pharoensis had a greater potential to serve as a malaria vector than An. multicolor.

Spinal and interpleural bupivacaine for percutaneous nephrolithotomy.

The promising interpleural block (IPB) technique stimulated the comparison of its adjuvant effect to spinal analgesia for percutaneous nephrolithotomy (PCNL) with that of meperidine-diazepam. Twenty five patients receiving spinal analgesia 15 mg 0.5% heavy bupivacaine for PCNL were randomly allocated to receive the adjuvant effect of either meperidine 1 mg/kg IV and diazepam 10 mg total dose (n = 10) or IPB with 10 ml 0.5% plain bupivacaine (n = 15). It was found that IPB produced a totally pain free operation and needed less frequent administration in the postoperative period, while meperidine-diazepam produced a pain free in 20% of patients and needed more frequent postoperative meperidine (1 mg/kg IM) administration.