Base Deficit, Serum Albumin Level And Blood Haemoglobin Concentration Can Be Used As Predictor Factors For Mortality In Major Burn Patients.

Hypoalbuminemia as seen in major burn injury results in widespread endothelial dysfunction. Base deficit provides the best estimate for degree of tissue anoxia. Acute blood loss describes anemia present in burn patients. Controversy focuses on the administration of protein-based colloids: whether to provide them, which solutions to use, and when to begin? The aim of this study was to determine whether alteration of gas exchange, excess base deficit, hypoalbuminemia and anemia could predict mortality in major burn patients, whether to provide protein-based colloids, and when to begin fluid resuscitation. The prospective study included 42 major burn patients. All the patients were admitted to the burn intensive care unit at Menoufia University Hospital. Serum albumin level, hemoglobin concentration, arterial blood gases and base deficit were measured at admission, third day and after one week. Average serum albumin on admission was 3.33 ± 0.44, after 3 days 2.85 ± 0.54 and after 1 week 2.46 ± 0.67 gm./dL, while hemoglobin concentration was 14.79 ± 2.13, 12.25 ± 1.99, and 10.24 ± 2.47 gm./dl respectively. However, base deficit was 5.75 ± 2.40, 5.24 ± 2.05 and 5.45 ± 2.76 respectively, with significant statistical difference (p<0.001) between the death and survivor groups. Binary logistic regression analysis for independent predictors of mortality declared that base deficit, albumin and hemoglobin serum levels were independent predictors for mortality with an odds ratio of 2.23, 95% CI, 1.66-16.75 for base deficit, 3.56, 95% CI, 1.88-12.59 for albumin and 2.21, 95% CI, 1.56-13.54 for hemoglobin. Hypoalbuminemia, anemia and excess base deficit can be used as prognostic factors for mortality in major burn patients.

L'hypoalbuminémie du brûlé est la conséquence d'un dysfonctionnement endothélial généralisé. Les pertes sanguines occasionnent une anémie. Il persiste une controverse quant à l'utilisation des colloïdes naturels chez ces patients : faut il les utiliser et, si oui, lesquels et quand ? Les buts de ce travail étaient d'étudier si les altérations des échanges gazeux, le déficit de base, l'hypoalbuminémie et l'anémie étaient corrélés à la mortalité, s'il fallait utiliser des colloïdes naturels et quand. Il s'agit d'une étude prospective réalisée sur 42 patients admis en réanimation du CTB du CHU de Menoufia. L'albuminémie, le taux d'hémoglobine, la gazométrie et le déficit de base étaient mesurés à l'entrée, J3 et J7. L'albuminémie moyenne était de 33,3 ± 4,4 g/L à l'entrée, 28,5 ± 5,4 g/L à J3 et 24,6 ± 6,7 à J7. L'hémoglobine était à 14,79 ± 2,13 g/dL à l'entrée ; 12,25 ± 1,99 à J3 et 12,04 ± 2,47 à J7. Le déficit de base était respectivement de 5,75 ± 2,4 ; 5,24 ± 2,05 et 5,45 ± 2,76, avec une différence significative (p<0,001) entre vivants et décédés. En régression logistique binaire, le déficit de base (OR 2,23 ; IC 95 1,66-16,75) ; l'albuminémie (OR 3,56 ; IC 95 1,88-12,59) et l'anémie (OR 2,21 ; IC 95 1,56-13,54) apparaissent comme des variables indépendantes de mortalité. Ces 3 paramètres peuvent donc être utilisés pour prédire la mortalité d'un brûlé grave.

Combined impacts of future land-use and climate stressors on water resources and quality in groundwater and surface waterbodies of the upper Thames river basin, UK.

It is widely acknowledged that waterbodies are becoming increasingly affected by a wide range of drivers of change arising from human activity. To illustrate how this can be quantified a linked modelling approach was applied in the Thames river basin in southern UK. Changes to river flows, water temperature, river and reservoir quality were predicted under three contrasting future "storylines"; one an extension of present day rates of economic development, the others representing more extreme and less sustainable visions. Modelling revealed that lower baseflow conditions will arise under all storylines. For the less extreme storyline river water quality is likely to deteriorate but reservoir quality will improve slightly. The two more extreme futures could not be supported by current management strategies to meet water demand. To satisfy these scenarios, transfer of river water from outside the Thames river basin would be necessary. Consequently, some improvement over present day water quality in the river may be seen, and for most indicators conditions would be better than in the less extreme storyline. However, because phosphorus concentrations will rise, the invoked changes in water demand management would not be of a form suitable to prevent a marked deterioration in reservoir water quality.

Grid refinement in Cartesian coordinates for groundwater flow models using the divergence theorem and Taylor's series.

Grid refinement is introduced in a numerical groundwater model to increase the accuracy of the solution over local areas without compromising the run time of the model. Numerical methods developed for grid refinement suffered certain drawbacks, for example, deficiencies in the implemented interpolation technique; the non-reciprocity in head calculations or flow calculations; lack of accuracy resulting from high truncation errors, and numerical problems resulting from the construction of elongated meshes. A refinement scheme based on the divergence theorem and Taylor's expansions is presented in this article. This scheme is based on the work of De Marsily (1986) but includes more terms of the Taylor's series to improve the numerical solution. In this scheme, flow reciprocity is maintained and high order of refinement was achievable. The new numerical method is applied to simulate groundwater flows in homogeneous and heterogeneous confined aquifers. It produced results with acceptable degrees of accuracy. This method shows the potential for its application to solving groundwater heads over nested meshes with irregular shapes.

Helicobacter pylori and recurrent abdominal pain in children: is there any relation?

BACKGROUND: The role of Helicobacter pylori (HP) as a cause of recurrent abdominal pain (RAP) and gastrointestinal symptoms is controversial and there still remains a big debate whether to test and treat or not. AIM: To investigate the correlation between HP infection and RAP as well as other GI symptoms. METHODS: We conducted a case control study at the Jeddah Clinic Hospital from January 2009 to December 2010. It included 244 cases (group I) aged 2-16 years with RAP after exclusion of any organic disease. Cases receiving antibiotics, bismuth, H2 antagonists or proton pump inhibitors during last 45 days were excluded. 122 age and gender matched asymptomatic children (group II) were enrolled as controls. Both groups were tested for Helicobacter pylori infection using stool antigen and/or urea breath test. RESULTS: The mean age of cases was 7.76 +/- 3.38 years. 48% of cases were males. There was no significant statistical difference between both groups regarding age and sex distribution, nationality and body weight (BW). 42.6% cases were positive for H. pylori infection in group I and 45% in group II. Comparison between HP positive cases and HP negative cases in group I revealed a statistically significant difference in incidence of vomiting, epigastric pain, history of infected family member and iron deficiency anemia (p = 0.001, 0.000, 0.000 and 0.025 respectively). CONCLUSION: HP infection is documented in more than 40% of both symptomatic and asymptomatic children. There is no association between RAP and HP.

Predictive value of assessment of different modalities in the diagnosis of infantile cholestasis.

This study investigated the relative accuracy and roles of abdominal ultrasonography, hepatobiliary scintigraphy and liver biopsy in the diagnosis of infantile cholestasis. A total of 50 infants (27 females) aged 1 - 12 months were classified into those with intrahepatic causes of cholestasis (n = 22) and those with extrahepatic causes (n = 28). Cholestasis is caused by a wide range of conditions and diagnosis requires meticulous history taking, thorough clinical examination and many laboratory tests. The most common cause of intrahepatic cholestasis was found to be idiopathic neonatal hepatitis (54.5%), followed by infectious hepatitis (9.1%), metabolic liver diseases (9.1%), intrahepatic biliary atresia (9.1%) and Alagille syndrome (4.5%). The most common cause of extrahepatic cholestasis was extrahepatic biliary atresia (96.4%). The incidence of choledochal cyst was low (3.6%). The cornerstone of the diagnosis of infantile cholestasis was found to be liver biopsy, which was associated with a high degree of accuracy.

Abnormal morphology of the penis in male rats exposed neonatally to diethylstilbestrol is associated with altered profile of estrogen receptor-alpha protein, but not of androgen receptor protein: a developmental and immunocytochemical study.

Objectives of the study were to determine developmental changes in morphology and expression of androgen receptor (AR) and estrogen receptor (ER)alpha in the body of the rat penis exposed neonatally to diethylstilbestrol (DES). Male pups received DES at a dose of 10 microg per rat on alternate days from Postnatal Day 2 to Postnatal Day 12. Controls received olive oil vehicle only. Tissue samples were collected on Days 18 (prepuberty), 41 (puberty), and 120 (adult) of age. DES-induced abnormalities were evident at 18 days of age and included smaller, lighter, and thinner penis, loss of cavernous spaces and associated smooth muscle cells, and increased deposition of fat cells in the corpora cavernosa penis. Fat cells virtually filled the entire area of the corpora cavernosa at puberty and adulthood. Plasma testosterone (T) was reduced to an undetectable level, while LH was unaltered in all treated groups. AR-positive cells were ubiquitous and their profile (incidence and staining intensity) did not differ between control and treated rats of the respective age groups. Conversely, ERalpha-positive cells were limited to the stroma of corpus spongiosus in all age groups of both control and treated rats, but the expression in treated rats at 18 days was up-regulated in stromal cells of corpora cavernosa, coincident with the presence of morphological abnormalities. Hence, this study reports for the first time DES-induced developmental, morphological abnormalities in the body of the penis and suggests that these abnormalities may have resulted from decreased T and/or overexpression of ERalpha.

Expression and molecular characterization of estrogen receptor alpha messenger RNA in male reproductive organs of adult goats.

The fact that male estrogen receptor alpha (ERalpha) knockout mice are infertile indicates a role for this receptor in male reproduction. Here, objectives were to evaluate ERalpha expression in male goat reproductive tissues at the transcriptional level using RNase protection assay (RPA) and in situ hybridization (ISH), and to clone a partial cDNA for caprine ERalpha using reverse transcription-polymerase chain reaction (RT-PCR). For RPA and ISH procedures, a radiolabeled antisense cRNA probe, generated in vitro from the ovine oER8 cDNA template, was employed. Evaluations were made on individual samples obtained from adult goats. Labeled cRNA sense probe was used as a negative control in ISH. A 530-base pair amplicon was generated by RT-PCR from efferent ductules (EDs), epididymis (EP), and testis, cloned from the ED and EP, and sequenced. The caprine ERalpha (cERalpha) cDNA displayed 81%-96% sequence identity with that of other species. A signal indicative of ERalpha mRNA was identified by both RT-PCR and RPA in all tissues, but was strongest in the ED. Compared with ED, ERalpha signal was sixfold lower in the EP, and 66-fold lower in the testis. Similarly, strong ERalpha expression was observed in ED epithelium, whereas little or no signal was detected in EP or testis by ISH. Thus, among different segments of the male reproductive tract and testis, the highest level of ERalpha mRNA expression was found in epithelium of the ED.

Total salivary gland proteins of female Culex pipiens and Aedes caspius (Diptera: Culicidae) and their fractionation during adult development and after blood sucking.

Salivary glands of Culex pipiens and Aedes caspius were analyzed to determine total protein content and its fractionation during adult female development and after blood sucking. In both species, the molecular weight of proteins ranged between 26.000 and 84.000 Daltons. These proteins were not identical in the two species. In Cx. pipiens, the total protein level increased during the first 3 days of adult development from 4.94 +/- 0.84 to 6.6 +/- 0.37 micrograms/gland. During this period, the salivary gland proteins were separated into 35, 34 and 37 fractions respectively. Cx. pipiens released in the human host 64% of the total proteins while taking a blood meal compared to unfed females. This decrease in protein level was proportional to protein fractions. Over the next 6 days, the protein level increased again to attain values comparable to those obtained prior to blood sucking. In Ae. caspius, the total protein level of the salivary glands did not change during the first 4 days of adult development (range between 3.13 +/- 0.27 and 3.91 +/- 0.36 micrograms gland), but on the fifth day, 2-fold increase was observed. The total salivary gland protein increased during the next 3 days after blood sucking to reach 15.5 +/- 0.98 micrograms/gland. During this period, a tremendous change in protein patterns was observed. After oviposition, on the fourth day, a significant reduction in the total protein level was observed (4.13 +/- 0.56 micrograms/gland), but over the next 3 days the level increased again (range between 4.13 +/- 0.66 and 7.13 +/- 0.66 micrograms/gland).

Molecular cloning and characterization of the polypeptide backbone of Schistosoma mansoni circulating cathodic antigen.

One of the candidate schistosome antigens for the development of a circulating antigen detection diagnostic assay is the circulating cathodic antigen (CCA). Detection of CCA in urine provides a non-invasive assay with high sensitivity. Previously we reported that CCA is secreted in patients' urine as a small molecular weight material which is probably of a proteinaceous nature. In an attempt to further characterize the secreted component of CCA, we used a monoclonal antibody (MAb) reactive with urine-CCA to isolate an adult worm cDNA clone (SmN3-1) that encodes the polypeptide backbone of CCA. The sequence, gene organization and expression of SmN3-1 were analyzed. The 1.6 kb nucleotide and 347 amino acid sequences of SmN3-1 showed no significant homology to any published sequence. The size and antigenic properties of the expression product of SmN3-1 in Escherichia coli greatly resembled the CCA molecule excreted in urine, suggesting that the latter is primarily composed of the protein element of CCA.

Hydrodynamic fluctuations in the Kolmogorov flow: linear regime.

The Landau-Lifshitz fluctuating hydrodynamics is used to study the statistical properties of the linearized Kolmogorov flow. The relative simplicity of this flow allows a detailed analysis of the fluctuation spectrum from near equilibrium regime up to the vicinity of the first convective instability threshold. It is shown that in the long time limit the flow behaves as an incompressible fluid, regardless of the value of the Reynolds number. This is not the case for the short time behavior where the incompressibility assumption leads in general to a wrong form of the static correlation functions, except near the instability threshold. The theoretical predictions are confirmed by numerical simulations of the full nonlinear fluctuating hydrodynamic equations.

Expression and cellular distribution of baculovirus-expressed bovine herpesvirus 1 (BHV-1) glycoprotein D (gD) sequences.

Glycoprotein D (gD) of bovine herpesvirus 1 (BHV-1), a homolog of herpes simplex virus gD, represents a major component of the viral envelope and is a dominant immunogen. To study the antigenic properties of the different regions of gD, we have expressed the full-length gD encoding gene and overlapping fragments spanning various regions of the gD open reading frame in a baculovirus (Autographa californica nuclear polyhedrosis virus)--insect cell (Spodoptera frugiperda, SF-9) system. Maximum levels of expression for all proteins were obtained 48 to 72 h post infection of SF-9 cells by recombinant viruses. Full-length and truncated recombinant gD proteins reacted specifically with anti-gD monospecific serum as determined by immunoprecipitation and immunoblotting, indicating that the proteins retained their antigenicity. However, based on the reactivity with a panel of gD-specific monoclonal antibodies (Mabs), the full-length recombinant gD lacked proper expression for two highly neutralizing linear epitopes identified by Mabs R54 and 9D6. The rest of the epitopes appeared to be preserved and antigenically unaltered. Immunofluorescence studies of recombinant baculovirus infected SF-9 cells using gD monospecific serum, revealed no direct correlation between cellular localization of the expressed proteins and their amino acid sequences.

Evaluation of baculovirus-expressed bovine herpesvirus-1 (BHV-1) glycoproteins for detection and analysis of BHV-1-specific antibody responses.

Baculovirus (Autographa californica nuclear polyhedrosis)-expressed bovine herpesvirus-1 (BHV-1) glycoproteins B (gB), gC, and gD were developed and characterized. The recombinant proteins retained their antigenic properties as determined by immunoblotting against monoclonal antibodies. The proteins were examined as antigens for detection of BHV-1 infection and for the analysis of antibody responses to the individual viral proteins. A total of 115 bovine serum samples were tested for their reactivity with individual recombinant proteins from baculovirus-infected Spodoptera frugiperda (SF-9) cell lysates by enzyme-linked immunosorbent assay (ELISA), western blotting, and dot blotting assays. These serum samples were previously tested for BHV-1-specific antibodies by virus neutralization (VN) at the veterinary diagnostic laboratory. All 90 serum samples tested positive with VN were positive by ELISA against gC and gD, separately. However, reactivities of sera against gB were generally low and inconsistent. On the other hand, out of 25 sera that were negative with VN, 22 sera were consistent and gave negative results against gC or gD by ELISA, whereas reactivities with gB were inconsistent. Similar results were obtained when the sera were tested by western blotting and dot blotting. The positive sera consistently reacted strongly against gC and to a lesser extent gD. These results suggest that baculovirus expressed gC from infected cell lysate can be used as a potential diagnostic antigen for detection of anti-gC-specific antibody responses in BHV-1 infected cattle.

Tuberculosis meningitis, Abbassia Fever Hospital-Naval Medical Research Unit No. 3-Cairo, Egypt, from 1976 to 1996.

A total of 1,430 patients with the presumptive diagnosis of tuberculous meningitis were admitted to the U.S. Naval Medical Research Unit No. 3/Abbassia Fever Hospital in Cairo, Egypt from January 1976 to January 1996. Diagnosis was confirmed by culture of the mycobacteria from the cerebrospinal fluid CSF of 857 patients and these patients are included in the final analysis. There were 497 males and 360 females. The patients ranged in age from five months to 55 years. The number of patients admitted during the months of March, April, and May were more than double those admitted during October, November, and December. The duration of symptoms prior to admission ranged from seven to 90 days (mean = 29.5 days). Upon admission, 4% of the patients were alert, 34% were drowsy, and 62% were in a coma. Of the 857 patients studied, 490 (57%) died, 256 (30%) recovered completely, and 11 (13%) recovered with sequelae. The mortality and neurologic sequelae were directly related to the stage of disease and duration of symptoms prior to admission. Mortality was significantly lower in patients admitted in stage II and or with short duration of disease compared with those in stage III and or with prolonged duration of symptoms prior to admission. The use of dexamethasone in patients with tuberculous meningitis significantly reduced the ocular complications that occur in these patients and also significantly reduced the fatality rate.

Evaluation of antibodies reactive with Campylobacter jejuni in Egyptian diarrhea patients.

Serum and stool samples were collected from 128 individuals: 96 diarrhea patients and 32 apparently healthy controls. Stool specimens were cultured for enteric bacterial pathogens, while sera were screened by enzyme-linked immunosorbent assay for Campylobacter jejuni-reactive antibodies. Of 28 diarrhea patients who demonstrated C. jejuni-reactive antibodies (titers, > 100), 14 were culture positive for this organism. The 32 healthy controls showed significantly lower antibody titers (P < 0.05) with the exception of 10 subjects who were culture positive for C. jejuni and had reactive immunoglobulin M (IgM) (6 subjects) and IgG (7 subjects). IgA was not detected in those 10 individuals (asymptomatic). Avidity was expressed as the thiocyanate ion concentration required to inhibit 50% of the bound antibodies. The avidity was higher in symptomatic patients than asymptomatic healthy controls. IgG was less avid (0.92 M) compared to IgM (0.1 M) and IgA (1.1 M), with no correlation between antibody titer and avidity. However, the thiocyanate ion concentration required for the complete inhibition of IgG (5 M)-bound antibodies was higher than that of IgA (2 M) and IgM (3 M). This study also shows that C. jejuni antibodies were variably cross-reactive with Escherichia coli, Shigella flexneri, Shigella sonnei, and Neisseria meningitidis in addition to Campylobacter coli and Campylobacter rectus.

Schistosoma mansoni antigens applicable to diagnosis of prepatent infections.

Diagnosis of schistosomiasis still depends upon demonstration of eggs in excreta, by which time significant pathology may occur to the human host. This study was undertaken to identify Schistosoma mansoni antigen(s) to be exploited in serodiagnosis of prepatent and/or acute infections. Immunoglobulin G and M responses of inbred and outbed mice to Schistosoma mansoni whole adult worm antigen were monitored in immunoblots using sera obtained at sequential times from mice infected with either 600 or 100 Schistosoma mansoni cercariae each. Regardless of the initial infection dose, immunoblot reactions to two doublets, 31/32 and 34/35 kDa appeared as early as two and three weeks post infection respectively and reactions to 38 and 70 kDa antigens appeared after five weeks infection. Antigens 31/32 and 38 induced both IgG and IgM responses whereas 34/35 and 70 predominantly induced IgG response. Homologues of these four antigens equally reactive with serum of infected mice were also demonstrated in Schistosoma haematobium, worms. Examination of sera from 25 patients suffering from acute Schistosoma mansoni, two suffering from Schistosoma haematobium and 16 patients suffering from infections with other parasite species confirmed the potential of 31/32, 34/35 and 38 kDa antigens in the specific diagnosis of prepatent and acute schistosomal infections but showed cross-reactivity of the 70 kDa antigen.

Immune response to Shigella sonnei in U.S. Marines.

Pre- and postdeployment serum samples obtained from U.S. marines in Operations Desert Shield and Desert Storm were tested for antibodies to Shigella sonnei. High predeployment levels of immunoglobulin A (IgA) and/or IgG antibodies to S. sonnei lipopolysaccharide antigen in serum and seroconversions were accompanied by higher IgA and/or IgG antibody response to Shigella invasion plasmids (Ipa). The results suggest exposure to S. sonnei in predeployment troops and frequent exposure to this bacterial agent during deployment.

Detection of circulating schistosome antigens in serum and urine of schistosomiasis patients and assessment of cure by a monoclonal antibody.

From a panel of monoclonal antibodies (MAb), an IgM monoclonal antibody (7F1/6B) reactive with repetitive epitopes on S. mansoni soluble egg antigen was selected. This MAb was employed both as antigen capture and detection antibody in a sandwich ELISA and had a detection limit < 1 ng S. mansoni SEA/mi. Serum and urine samples were collected from rural students who had S. mansoni (169 subjects) or mixed S. mansoni and S. haematobium (64 subjects) infections. Samples were collected before and at 4, 8 and 12 weeks after praziquantel therapy. Circulating schistosome antigens (CSA) were demonstrated in 90% of sera and 97% of urine samples of S. mansoni group and in 91% of sera and 100% of urine samples of mixed infection group. All sera from 29 uninfected individuals, 30 patients with other parasites and 70% of 55 S. haematobium-infected subjects were negative in this assay. CSA level in serum and urine samples correlated positively with the number of S. mansoni eggs/g stool in both groups. A significant reduction in CSA level was observed in serum and urine samples after praziquantel therapy. By 12 weeks post-treatment, negativity was 98% in sera and 97% in urine of S. mansoni-infected group and 98% in sera and 91% in urine of mixed infection group. The data demonstrate that the use of MAb 7F1/6B for the detection of CSA provides a sensitive method for immunodiagnosis of schistosomiasis and monitoring of cure.

Use of Kato and nucleopore techniques for qualitative diagnosis of schistosomiasis.

A comparison on qualitative basis, is attempted between merthiolate-iodine-formaldehyde concentration (MIFC) and Kato thick smear techniques for diagnosis of schistosome eggs in stools. As well, the centrifugation-sedimentation method was compared with the Nucleopore filtration technique for schistosome eggs in urine. Using MIFC and Kato techniques, 149 out of 185 subjects were found to have Schistosoma mansoni infection, 41 of them were diagnosed by Kato alone, while no case was solely MIFC positive. The sensitivity of MIFC compared to kato was 72.3% and both techniques were 100% specific. For diagnosis of S. haematobium infection, 78 out of 103 subjects were positive by centrifugation- sedimentation and/or Nucleopore techniques. 42 of them were diagnosed by Nucleopore alone and none was positive by centrifugation- sedimentation only. The sensitivity of the latter technique was 46.2% and both techniques were 100% specific. The study demonstrates that Kato thick smear and Nucleopore filtration are highly sensitive techniques that can be used for routine qualitative diagnosis of schistosomiasis. Under field conditions, they are qualitatively and quantitatively useful. The Kato technique besides its high sensitivity is very cheap. The only limitation for the Nucleopore technique is its relative high expenses.