Cultural adaptation and validation of the "Kidney Disease and Quality of Life--Short Form (KDQOL-SF™) version 1.3" questionnaire in Egypt.

BACKGROUND: Health Related Quality of Life (HRQOL) instruments need disease and country specific validation. In Arab countries, there is no specific validated questionnaire for assessment of HRQOL in chronic kidney disease (CKD) patients. The aim of this study was to present an Arabic translation, adaptation, and the subsequent validation of the kidney disease quality of life-short form (KDQOL-SFTM) version 1.3 questionnaire in a representative series of Egyptian CKD patients. METHODS: KDQOL-SFTM version 1.3 was translated into Arabic by two independent translators, and then subsequently translated back into English. After translation disparities were reconciled, the final Arabic questionnaire was tested by interviewing 100 pre-dialysis CKD (stage 1-4) patients randomly selected from outpatients attending the Nephrology clinic at the Main Alexandria University Hospital. Test re-test reliability was performed, with a subsample of 50 consecutive CKD patients, by two interviews 7 days apart and internal consistency estimated by Cronbach's α. Discriminant, concept, and construct validity were assessed. RESULTS: All items of SF-36 met the criterion for internal consistency and were reproducible. Of the 10 kidney disease targeted scales, only three had Cronbach's α <0.7: quality of social interaction (0.23), work status (0.28), and cognitive function (0.60). All disease specific scales were reproducible. Results from discriminant validity showed that the study questionnaire could discriminate between patients' subgroups. As for concept validity, the correlation between all domains of the questionnaire with overall health ratewas significant for all domains except for the work status, sexual function, emotional wellbeing, and role emotional. Furthermore, the correlation between the disease specific domains and the two composite summaries of SF-36 (physical and mental composite summaries) was significant for all domains except for sexual function with mental composite summary. Construct validity was indicated by the observation that the majority of the domains of the kidney disease targeted scale of KDQOL-SFTM 1.3 were significantly inter-correlated. Finally, principal component analysis of the kidney disease targeted scale indicated that this part of the questionnaire could be summarized into 10 factors that together explained 70.9% of the variance. CONCLUSION: The results suggest that this Arabic version of the KDQOL-SFTM 1.3 questionnaire is a valid and reliable tool for use in Egyptian patients with CKD.

The potential use of 29 kDa protein as a marker of pathogenicity and diagnosis of symptomatic infections with Blastocystis hominis.

The present study was performed to characterize the protein profiles of Blastocystis hominis isolates from symptomatic and asymptomatic individuals by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting using sera from symptomatic and asymptomatic patients. The presence of immunogenic bands associated with pathogenicity or of diagnostic potentials was also evaluated. The study comprised 80 individuals classified into four groups, 20 each: symptomatic blastocystosis (G1), asymptomatic blastocystosis (G2), other parasitic infections (G3), and healthy control subjects (G4). SDS-PAGE analysis of individual antigens form symptomatic and asymptomatic B. hominis isolates revealed similar and distinctive antigenic bands with significant differences in two high (123.5 and 112.3 kDa) and few low molecular weight bands (48.5, 38, 42.3, and 35.5 kDa). Immunoblotting was performed using symptomatic and asymptomatic antigen pools with sera of the four studied groups. It was found that anti-B. hominis IgG reacted with nine protein bands ranging from 100 to 18 kDa of the symptomatic antigen pool. There was a significant difference between G1 and G2 in the recognition of 64, 56, 38, and 29 kDa antigen bands. Also, anti-B. hominis IgG reacted with five protein bands ranging from 56 to 12 kDa of asymptomatic antigen pool. There was a significant difference between G1 and G2 in the recognition of 29 kDa antigen band. These findings suggest the potential use of the 29-kDa antigen as marker of pathogenicity and implicate its use in the diagnosis and differentiation between symptomatic and asymptomatic blastocystosis.

Comparative analysis of the diagnostic performance of crude sheep hydatid cyst fluid, purified antigen B and its subunit (12 Kda), assessed by ELISA, in the diagnosis of human cystic echinococcosis.

The diagnosis of patients with cystic echinococcosis (CE) by means of serology has a limited support in clinical practice due to cross-reactivity with other helminthes leading to overestimation of the parasite's true prevalence. A wealth of reports on the diagnostic performance of antigen B (AgB) has been produced. This study was designed to comparatively assess the diagnostic efficacy of crude sheep hydatid cyst fluid (HCF), AgB and its subunit (12 KDa) to detect IgG or IgG4 antibodies in CE patients' sera using enzyme-linked immunosorbent assay (ELISA).The best diagnostic performance was obtained with anti-HCF IgG ELISA which gave 92.4% sensitivity and 92.6% specificity. Despite the low sensitivity of anti AgB IgG ELISA (84%), it gave the best specificity (94.4%) with less cross-reaction with sera of subjects infected with other parasites. In conclusion, it is recommended to use anti-HCF IgG ELISA for initial screening in large seroprevalence studies. Further analysis of positive serum samples with anti AgB IgG ELISA would allow the confirmation of true positives. Specific IgG4 ELISA may represent a complementary assay, useful as secondary confirmatory tests for patients with suspected CE and negative for total IgG ELISA.

Pathogenic potential of Blastocystis hominis in laboratory mice.

Blastocystis hominis is a ubiquitous enteric protozoan whose pathogenic potential is still controversial. This study was carried out to clarify the pathogenecity of B. hominis infection and to study the proper number of parasites for mice infection. A total of 15 albino mice were orally inoculated with B. hominis and divided according to the inoculums, 10(2), 10(5), and 4 x 10(7) B. hominis forms/100 microl saline, into three groups consisting of five mice each, GI, GII GIII, respectively. In addition with group IV (uninfected control) consisting of five mice. All mice were sacrificed 2 weeks post-infection. The results revealed that all mice of GIII and two mice of GII got the infection while all mice of GI showed a completely negative result. Histopathological examination of large intestine on highly infected group (GIII) showed that B. hominis infiltrated the lamina propria, the submucosa, and the muscle layers in the form of collection of vacuolar forms. This was accompanied by active colitis with infiltration of mixed inflammatory cells. In conclusion, this study revealed that large number of B. hominis is essential for oral infection of mice and that vacuolar forms of B. hominis can invade the lamina propria, the submucosa, and even the muscle layers.

Genetic variability of antigen B among Echinococcus granulosus Egyptian isolates.

Genetic polymorphisms of encoding antigen B2 gene (AgB2) in Echinococcus granulosus were studied using PCR-RFLP and DNA sequencing among 20 Egyptian isolates. Five isolates from different host origins (humans, camels, pigs, and sheep) were collected and used. All examined isolates of each host group gave very similar patterns of PCR-RFLP after restriction enzyme digestion with AluI, with the gene size of approximately 140 bp and 240 bp for sheep and human isolates, and approximately 150 bp and 250 bp for pig and camel isolates. No digestion pattern was obtained after incubation of all studied isolates with EcoRI. These results reveal high intra-group homogeneity. DNA sequence analysis highlighted that human infecting strain showed 100% identity with respect to sheep infecting isolate, 96% and 99% with pig and camel infecting isolates, respectively.

Genetic analysis of Blastocystis hominis isolated from symptomatic and asymptomatic human hosts in Egypt.

Extensive genomic polymorphism was demonstrated among morphologically identical B. hominis isolates. A genetic diversity would be a powerful tool for identification or classification of B. hominis subtypes. In this study, 14 Egyptian B. hominis isolates were collected, 5 of them were isolated from asymptomatic people whose infections were detected during routine medical check-up and 9 were isolated from patients with gastrointestinal symptoms. Restriction fragment length polymorphism (RFLP) analysis of PCR amplified small-subunit rDNA (SSU rDNA) was used to study genetic diversity of B. hominis isolates by 3 different restriction enzymes (Hin-fI, RsaI & Sau3AI). Cluster analysis of the riboprint patterns showed 7 distinct genotypes out of 14 B. hominis isolates, 4 were previously reported riboprints and 3 were new ones. The frequency of intestinal symptoms was 64% in Blastocystis cases. Abdominal pain was the most frequent symptom 78% (7/9). There was no definite correlation between RFLP-banding pattern or genetically distinct genotypes and pathogenecity.

Detection of molecular markers of toxoplasmosis among Egyptian patients with miscarriage using avidity IgG-ELISA and Western blotting.

A total of 54 miscarriage patients were divided into 3 groups. GI: 10 toxoplasmosis patients with +ve IgM-ELISA; GII: 24 toxoplasmosis patients with +ve IgG-ELISA, and GIII: 20 non-toxoplasmosis cross-matched females as a control. All groups were subjected to IgG-avidity ELISA & IgG-avidity immunoblotting. Avidity Indices (AI) by ELISA ranged from 22.6% to 73.3% in GI and from 9.6%-75.6% in GII. AI were high (>40%) in 3 (30%) patients in G I and in 8 (33.3%) patients in G II. Sera of GI recognized the 20, 28, 32, 60, 93 & 100 Kda bands with 55% reduction in the 38 and 60 Kda bands after treatment with 6 M urea solutions. Sera of GII recognized the 20, 28, 32, 38, 45, 95-97 & 106 Kda bands. There was 12.5%, 16.6% & 16.7% reduction in the 20, 32, & 106 Kda bands, respectively, after urea. The 38 & 60 Kda bands were identified as good diagnostic markers for the recent toxoplasmosis infection (GI). The 20, 32 & 106 Kda bands were good markers of high avidity antibodies during the chronic toxoplasmosis (GII).

A single-step immunochromatographic lateral-flow assay for detection of Giardia lamblia and Cryptosporidium parvum antigens in human fecal samples.

RIDA Quick immunochromatographic lateral-flow assay was evaluated for diagnosis of giardiasis and cryptosporidiosis as compared to the "gold standard" stool examination. Of the 300 specimens were examined by microscopy of direct wet films, concentrated sediments, modified trichrome and modified Ziehl-Neelsen stained slides, 35 samples of Giardia, ten Cryptosporidium, 35 of other parasites, and 20 negative controls were selected for RIDA Quick test examination. All the samples that gave discrepancy results were retested by the centrifugation prior to preparation for the permanent stained smear. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RIDA quick test for Giardia were 91.6%, 98.4%, 97% & 95.4% respectively, while that of the microscopic stool examination were 94.5%, 100%, 100% & 96.9%. The sensitivity, specificity, PPV and NPV of RIDA quick test for Cryptosporidium was 91.6%, 100%, 100% & 98.8% respectively, while that of the microscopic stool examination were 83.3%, 100%, 100% & 97.7%.

Impact of experimental duel infections with Schistosoma mansoni and Echinoccocus granulosus on hepatic histopathology.

Experimental duel infection with S. mansoni and E. granulosus was induced in mice to determine their effect on serum nitric oxide (NO) level and accordingly on the sequences of histopathological lesions affecting the liver. The results showed that serum NO level was significantly increased (p<0.05) in mice infected with both parasites (GI) in comparison to either S. mansoni (GIV) or E. granulosus (GV). The NO elevation on hepatic pathological lesions of both diseases showed a marked reduction of granuloma size with absence of concentric fibrosis in GI as early as 4 weeks of concomitant infection as compared to GIV. In spite of the significant increase of NO level when E. granulosus infection induced in late stages of schistosomisais (GsII & III), yet granuloma size was not suppressed. Also, there was absence or death of hydatid cyst in mice (GI) compared to E. granulosus (GV). So, the duel infection with the two parasites affected serum NO level and hepatic histopathology, by ameliorative or deteriorative effects, according to duration of infection with either.

Characterization of specific Trichomonas vaginalis target antigens from different isolates by immunoblotting against hyperimmune rabbit serum.

The SDS-PAGE and immunoblot methods were used to identify Trichomonas vaginalis specific target antigen(s). Ten T. vaginalis isolates, cultured on TYM media, were analyzed by Sodium Dodecyl Sulphate Poly Acrylamide Gel Electrophoresis (SDS-PAGE), revealed 34 distinct bands. Immunoblotting against a hyperimmune rabbit serum, showed 20 reactive bands ranging from 14-205 kDa. There was isolate to isolate variability among 8 isolates, while 2 isolates (6,7) showed a similar antigenic patterns. Imunoblotting of the isolates showed a total of 20 molecular weight bands, 80% of isolates gave positive immunologic reactions above 100 kDa, while below 100 Kda all the isolates recognized the different molecular weight bands. Out of 20 reacting bands, 5 main bands were detected, 29, 66, 84, 95 & 115 kDa gave positive percent of 60, 60, 60, 90 & 80% among the 10 isolates respectively.