Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update.

HYPOTHESIS AND/OR BACKGROUND: We recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome. METHODS: This review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts. RESULTS: The group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services. CONCLUSIONS: The finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the "CheckUp" and "RIGHT-Ad@pt" CPG Tools.

Morph-anatomic and histochemical study of ileum of goose (Alopochen egyptiacus) with special references to immune cells, mucous and serous goblet cells, telocytes, and dark and light smooth muscle fibers.

The morphological characteristics of the ileum of 20 adult male Egyptian geese were determined using LM, SEM, and TEM. The mean length of the ileum in the male goose was approximately 158.71 mm, representing nearly 10.19% of the total length of the small intestine. The ileum is composed of four layers: mucosa, submucosa, muscular layer, and serosa. The mucosal layer comprises the epithelium, lamina propria, and muscularis mucosa. The mucosa forms finger-like villi and is invaginated at the bases, forming the crypts of Lieberkühn. The ileum is lined by simple columnar epithelium that contains absorptive dark and light enterocytes with two types of goblet cells (mucous and serous varieties) microfold like cells, dendritic reticulum cells, Paneth cells, and a closed type of enteroendocrine cells. The lamina propria has diffuse lymphoid tissue containing lymphocytes, macrophages, mast cells, plasma cells, and heterophils as well as telocytes. The muscularis mucosa comprises circular smooth muscle fibers extending into the core of the villi. The submucosa is a thin layer of elastic-rich connective tissue. The muscular level consists of four layers, with light and dark smooth muscle fibers. We described in detail the structure of all cellular components and histomorphometric measurements.

Technological and safety properties display biodiversity among enterococci isolated from two Egyptian cheeses, "Ras" and "Domiati".

The technological and safety properties of 35 indigenous strains of Enterococcus faecium isolated from two Egyptian cheeses were characterised in order to determine their ability for rational manufacture of diversified and typical dairy products in the Middle East. A great diversity was observed within the 35 strains on the basis of their technological properties. A statistical analysis made it possible to distribute the 35 strains of E. faecium into different groups. Three groups were identified in terms of their acidification activity, measured by the Cinac system: a group of strains that quickly acidified milk, a second that moderately acidified milk, and a last cluster that revealed weak acidification activity. On the basis of texturing properties that were evaluated using a texturometer and a viscometer, a cluster of strains produced viscous and firm gels, a second cluster included fairly viscous, firm and cohesive gels, and a last group generated slightly viscous, but firm and very cohesive gels. By considering the aroma profiles that were determined by gas chromatography coupled with mass spectrometry, four clusters were identified. One cluster displayed a high dimethyl disulfide level, a second group of strains was highly aromatic, a third cluster led to typical "lactic" products, and the last cluster made it possible to obtain low aromatic products. None of the 35 strains proved to be ß-haemolytic on the basis of the characterisation of their safety properties. The resistance to 20 antibiotics was assessed by the disc diffusion method. The 35 isolates were sensitive to 12 antibiotics, and among them, one isolate was resistant to only two antibiotics (nalixidic acid and streptomycin). The resistance to eight antibiotics was strain-dependant. Finally, this study demonstrates that some indigenous strains of E. faecium displayed interesting technological properties for cheese manufacture, together with good safety characteristics. They could be useful for the manufacture of typical products in Egypt.

Rep-PCR characterization and biochemical selection of lactic acid bacteria isolated from the Delta area of Egypt.

Samples of raw milk and traditional dairy products were collected from different rural areas in the Delta region. 170 isolates from these products were identified using repetitive genomic element-PCR (Rep-PCR) fingerprinting. The identified isolates were tested for efficiency of biomass production and separation, acidifying activity, autolytic and aminopeptidase properties, antagonistic activities and exopolysaccharide production. The obtained results revealed that the Lactobacillus delbrueckii subsp. lactis, Lactobacillus fermentum, Enterococcus faecium Lactobacillus delbrueckii subsp. bulgaricus, Lactobacillus paracasei subsp. paracasei, Lactobacillus plantarum and Lactococcus lactis subsp. lactis were the predominant species in Egyptian dairy products. Two percent of Lactococcus, 10% of Lactobacillus and 1% of Enterococcus isolates showed fast acidifying activity. Aminopeptidase and autolytic properties were generally higher for most Lactobacillus strains when compared to other strains. Among these species, lactobacillus paracasei subsp. paracasei was the highest in Aminopeptidase activity and autolytic properties. Antagonistic activity was detected in 40% of Lactococcus, 70% of Lactobacillus and 50% of Enterococcus isolates. Some isolates produced exopolysaccharides in milk and dairy products.