Clomiphene citrate as a new modality in management of vaginal bleeding with depomedroxyprogesterone acetate (DMPA): A randomized controlled trial.

BACKGROUND: Depo-medroxyprogesterone acetate (DMPA) functions as a contraceptive method by inhibiting the secretion of gonadotropins, which prevents follicular maturation and ovulation, as well as thinning of the endometrium leading to unscheduled vaginal bleeding and subsequent discontinuation of DMPA. Our study aimed to evaluate the efficacy and safety of clomiphene citrate (CC) in stopping bleeding among DMPA users. MATERIALS AND METHODS: We randomly assigned 200 DMPA users using a computer-generated random numbers table in a 1:1 ratio to one of two groups; the study group, which received CC at a dose of 50 mg twice daily for five days (n = 100), and the control group, which received a placebo for five days (n = 100). Our primary outcome measure was the onset and duration of bleeding cessation. Secondary outcomes included endometrial thickness, recurrence of vaginal bleeding, and any reported side effects associated with CC use. RESULTS: Clomiphene citrate significantly resulted in early cessation of vaginal bleeding in 83 % of the patients, which continued for three months of follow-up. In addition, the recurrence of vaginal bleeding was significantly reduced in the CC group compared to the control group (11 % vs. 67 %; p < 0.001). Endometrial thickness was significantly greater in the CC group than in the control group (p < 0.001). Breast tenderness was more frequently reported in the study group, with no difference in dyspareunia between the two groups. CONCLUSIONS: Clomiphene citrate is effective in controlling bleeding among DMPA users. Further studies are encouraged to confirm our findings.

The Effect of Endometrial Scratch on Pregnancy Rate in Women with Previous Intrauterine Insemination Failure: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The objective of this study was to evaluate the impact of endometrial scratch on the pregnancy rate among women with previous failed intrauterine insemination (IUI). A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI web of science from inception to November 2021. We selected randomized clinical trials (RCTs) that compared endometrial scratch in the intervention group versus placebo or no intervention in the control group among infertile women with previous failure of IUI regarding different pregnancy outcomes. Revman software was utilized for performing our meta-analysis. Our main outcomes were biochemical pregnancy, clinical pregnancy, and live birth rates. Five RCTs met our inclusion criteria with a total number of 989 patients. We found endometrial scratch significantly improved the biochemical and clinical pregnancy rates in comparison with the control group among women with previous IUI failure (p < 0.001). Moreover, the live birth rate was significantly increased among the endometrial scratch group (RR = 2.00, 95% CI [1.20, 3.34], p = 0.008). In conclusion, endometrial scratch is effective in improving pregnancy outcomes among women with previous IUI failure. More trials are required to confirm our findings.

Polycyclic aromatic hydrocarbons (PAHs) in Greater Cairo water supply systems.

Polycyclic aromatic hydrocarbons (PAHs) pose a constant threat to the environment and public health. There are numerous activities in the Greater Cairo area that emit and release significant amounts of PAHs. Concentrations of these PAHs are released into the air and mixed with surface water, limiting its use. In this study, 17 PAH compounds are mapped at eight sites along the Nile River and its tributaries in Greater Cairo. In addition, their removal efficiency is evaluated with the conventional treatment in eight water treatment plants. PAHs were analyzed using GC-MS from January to December 2018. Naphthalene, anthracene, fluorene, pyrene, and phenanthrene were detected. The total amount of PAHs in raw water was highest in Shamal Helwan (1,325 ± 631 ng/l) and lowest in Mostorod (468 ± 329 ng/l), and the removal ranged from 25 to 31%. Further research is needed to integrate other techniques to reduce PAHs using the conventional treatment, and more efforts should be made to reduce the presence and release of PAHs in raw water.

Aluminum sulfate regeneration from surface water treatment waste in Cairo, Egypt.

The world needs to adapt to recycling and reusing water due to limited resources. So, decision-makers and policy leaders should use sustainable practices to improve protection and pollution remediation. Aluminum sulfate is used for surface water treatment, which leads to waste sludge being disposed into water bodies, causing environmental pollution. Coagulants' regeneration from sludge improves water quality and reuse options. Organics accumulation is the primary concern regarding coagulant regeneration, using acidification. Our study investigated the raw water quality, aluminum sulfate, and sludge and evaluated its influence on coagulant recovery, using acidification, from eight water treatment plants (WTPs) in Cairo, Egypt. The significant elements in the tested sludge were aluminum with a concentration range of 86.65-688.85 mg/g sludge in El-Rawda and Embaba and iron with a concentration range of 9.45-7.45 mg/g in Shamal Helwan and El-Fostat. Recovery percentages of aluminum, iron, manganese, and strontium recorded the highest values 97%, 89%, 89%, and 92% for Embaba, Rod El-Farag, Embaba, El-Rawda, respectively. The correlation between metal concentration and recovery was insignificant in the studied matrix and conditions for the four metals. Total organic carbon (TOC) transfer into recovered solutions was maximum in El-Fostat (82.6%) and minimum in Embaba (36.7%). The TOC transfer percentage depends on the matrix of the sludge. The best location for coagulant recovery is at the Embaba WTP, where there were minimum organics transfer and maximum Al recovery.

Repeated Aluminum Sulfate Recovery from Waterworks Sludge: A Case Study in El-Sheikh Zaid WTP.

Although surface water treatment presents a good solution for pollutants in rivers and freshwater lakes, the purification process itself presents a great threat to the aquatic environment through aluminum waste disposal. Recent studies have introduced coagulants recovery from treatment sludge as a green solution for waste handling and cost reduction. This article aims to evaluate repeated aluminum coagulants recovery from sludge using sulfuric acid. The waste from El-Sheikh Zaid Water Treatment Plant (ESZ-WTP) was characterized, then sequential coagulants recovery using optimum conditions was conducted. In addition, treated water was analyzed to determine the efficiency of the obtained coagulants and their influence on treated water quality. Sequential coagulants recovery using acidification revealed that no metals accumulation took place in the produced coagulants until the third recovery from ESZ-WTP sludge. On the other hand, a noticeable increase in trihalomethanes was detected in the treated water, especially using the third recovered coagulant. In conclusion, sequential coagulants recovery and usage in water treatment is an attractive alternative for single-use original coagulant in ESZ-WTP but for no more than three sequential recoveries. It is advisable to apply a fresh coagulant every three sequential recoveries to enrich the aluminum content and regenerate the sludge before restarting the recovery process.

Assessment the viability properties of Lactobacillus casei strain using labneh as a carrier.

BACKGROUND: Our study was conducted in two stages; the first stage was to examine the fructose fermentation profile by Lactobacillus (Lb.) casei FEGY9973. The second stage was to investigate the viability properties of Lb. casei either during cold storage of labneh or under simulated gastrointestinal tract (GIT) conditions. METHODS: Labneh as a carrier medium was classified into four treatments; the first one con- tained 2% free cells of Lb. casei as a control. The second, third and fourth treatments used 2% of encapsulated cells of Lb. casei with different capsule materials, including alginate-milk, sodium alginate and κ-carrageenan served as T1, T2 and T3 respectively. The physiochemical, microbiological and sensory properties of labneh during 15 days of cold storage were shown. Moreover, the viability of free and encapsulated Lb. casei sub- jected to some manufacturing and simulated GIT conditions was tested. RESULTS: It was revealed that lactate was the major metabolite in the medium for colonic fermentation, where- as no amounts of ethanol could be detected. Moreover, labneh samples including free cells of Lb. casei had lower pH values than treatments containing microcapsules of Lb. casei. The levels of moisture, acetaldehyde and diacetyle in treatments with different encapsulated materials were increased during the cold storage period. Accordingly, labneh samples with encapsulated Lb. casei had higher sensory scores than the control. In addition, labneh samples with Lb. casei in milk-alginate microcapsules showed a high viability during cold storage and under simulated GIT conditions. A significant decrease in the viability of free or encapsulated Lb. casei was observed at 15 days of cold storage. CONCLUSIONS: Encapsulated Lb. casei by alginate-milk was more resistant during the cold storage period and under simulated gastric conditions than the other two treatments.

Diagnostic Value of Glypican-3 for Hepatocellular Carcinomas

Background: Hepatocellular carcinoma (HCC) is a common and dangerous malignancy in many parts of the world, and especially in Egypt. Early diagnosis is the most important step in successful HCC management. However most cases are detected at late stage making effective intervention impossible. Aim: The aim of this study was to evaluate the potential of Glypican-3 (GPC-3) to aid in diagnosis of HCC, especially in patients with low serum alpha-fetoprotein (AFP). Subjects and methods: Serum GPC-3 was assessed by flow-cytometry and serum AFP by enzyme-linked immunosorbent assay (ELISA) in 40 HCC patients with AFP< 400ug\l. (GI), 40 HCC patients with AFP> 400ug\l. (GII) and 20 healthy controls (GIII). Results: GPC-3 was found to be significantly elevated in HCC as compared to healthy subjects (GI 38.2±22. 5, GII 50.2±22.6, and GIII 2.24±1.19), with sensitivities of 85% for GI and 84% for GII and specificities of 95% for GI and 92% for GII. AFP showed respective sensitivities of 50% and 79%, and specificities of 80% and 90%, for HCC diagnosis. The combination of GPC-3 with AFP achieved the highest sensitivity (98.5%) and specificity (97.8%). Conclusion: Serum GPC-3 has a better sensitivity than AFP for the diagnosis of HCC. Combination of two markers appears warranted for greatest accuracy.

Evaluation of leached metals in recovered aluminum coagulants from water treatment slurry.

The water treatment industry consumes large quantities of coagulant and produces huge amounts of slurry. The cost of alum used in water treatment, stringent regulations and negative impacts of sludge disposal are the motive to do integrated research studies on the technical feasibility of aluminum coagulant recovery from sludge using acidification. This work studied the leaching of iron, manganese, and chromium as the most extracted metals with aluminum during sludge acidification; furthermore, these metals have a great impact on the recovered coagulants' efficiency and treated water quality. The sludge used was collected from El-Sheikh Zayd water treatment plant in Egypt, then dried and ground; afterward, the effect of acid concentration, sludge mass, temperature, mixing speed and mixing time was studied. In addition, it was noticeable that the efficiency of sulfuric acid in leaching iron, manganese and chromium is higher than that of hydrochloric acid. Also, higher leaching for the three metals was obtained in all the experiments using higher acid concentration, elevated temperature, and rotational speed. Finally, the leached metals in recovered aluminum coagulants will not limit its application to water and wastewater treatment, as their concentrations are still very low if compared with aluminum, even with the highest leaching efficiency.

Incidence of HCV induced-Esophageal varices in Egypt: Valuable knowledge using data mining analysis.

Esophageal varices is one of the most important comorbidity related liver cirrhosis, patients usually presented with hematemesis, melena, or both, ultimately 20% is the mortality during the first attack, hence we aimed to investigate the incidence of such esophageal varices related chronic Hepatitis C virus (HCV) in randomized Egyptian population.One thousand eighteen Egyptian patients, aged between 17 and 58 years, positive for Hepatitis C virus genotype 4 (HCV-4) by enzyme linked immunosorbent assay Ab and HCV RNA-polymerase chain reaction were screened for the presence of esophageal varices.Incidence of esophageal varices was 62.3%; 635 patients, those with large Esophageal varices (LEVs) was 47.4%; 301 patients. Model for end-stage liver disease (MELD) score has not been significantly improved post variceal band ligation (VBL). Using 2D U/S was useful for EVs prediction.Incidence of esophageal varices in HCV Egyptian patients still high, valuable knowledge would be helpful in clinical field have been discovered by data mining computational intelligent analysis using in practical medicine to improve overall health care.

Utilization of Drinking Water Treatment Slurry to Produce Aluminum Sulfate Coagulant.

In Egypt, water treatment consumes about 365 000 tons of aluminum sulfate and produces more than 100 million tons of sludge per year. The common disposal system of sludge in Egypt is to discharge it into natural waterways. Toxicity of aluminum, environmental regulations and costs of chemicals used in water treatment and sludge treatment processes led to an evaluation of coagulant recovery and subsequent reuse. The present work aimed at aluminum recovery from sludge of El-Shiekh Zayd water treatment plant (WTP) to produce aluminum sulfate coagulant. Sludge was characterized and the effect of five variables was tested and the process efficiency was evaluated at different operating conditions. Maximum recovery is 94.2% at acid concentration 1.5 N, sludge weight 5 g, mixing speed 60 rpm, temperature 60 °C and leaching time 40 min. Then optimum conditions were applied to get maximum recovery for aluminum sulfate and compared to commercial coagulant on raw water of El-Shiekh Zayd (WTP).

Parasites-allergy paradox: Disease mediators or therapeutic modulators.

The noticeable phenomenon of an increased frequency of immune-inflammatory disorders, in the industrialized world, has led to the implication of parasitic infections in the pathophysiology of these diseases. Most of the studies investigated the infection connection to allergy have centered on helminthes. Parasitic helminthes are a group of metazoans that are evolutionary diverse, yet converge to evolve common modes of immunomodulation. Helminth immunoregulation is mainly mediated by a regulatory response including Treg and Breg cells with alternatively-activated macrophages. There is increasing evidence for a causal relationship between helminth infection and allergic hyporesponsiveness, however, conflicting data are still generating. The helminth immunoregulation seems to be species-specific and phase-specific. It depends on the stage of the clinical disease which correlates with a corresponding parasitic stage (egg, larva or mature adult). Here, we review the cellular and molecular mechanisms utilized by helminthes to manipulate the immune system and the consequent bystander immunomodulatory responses toward environmental allergens. We especially focus on parasitic species and molecules involved in the modulation of allergic disorders and summarize the experimental and clinical trials using them as therapeutic agents. We also discuss the potentials and obstacles, for helminthes and/or their derived molecules, to emerge as novel therapeutic modalities.

Zoonoses from cats: with special reference to Egypt.

A zoonosis is an animal disease that is transmissible to humans. Humans are usually an accidental host that acquires disease through close contact with an infected animal, who may or may not be symptomatic. Children are at highest risk for infection because they are more likely to have close contact with pets. Cats are responsible for transmission of an extensive array of bacterial, fungal, and parasitic zoonotic pathogens. The route of transmission can be through the saliva (e.g., bites or contaminated scratches), feces, respiratory secretions, direct contact, or by the cat acting as a vehicle and source of tick or flea exposure. Although cats have been implicated in transmission of zoonosis to their owners, risk of transmission from contact with cats is low and may be further reduced by simple precautions. There is a need for education on zoonotic disease prevention practices for pet-owning households with individuals at higher risk of infection, and to educate future veterinarians during their early years in veterinary school about the risks associated with their future jobs. Also, zoonotic disease awareness training is a valuable service to animal shelter workers.

Emergence of carbapenem-resistant Acinetobacter baumannii harboring the OXA-23 carbapenemase in intensive care units of Egyptian hospitals.

BACKGROUND: Healthcare-associated infections are a worldwide threat to hospitalized patients, especially those in intensive care units. The prevalence of these infections in Egypt, and their antimicrobial resistance patterns and mechanisms, were investigated in this study. METHODS: A total of 547 cases of healthcare-associated infections were investigated. Causative agents were identified and antimicrobial susceptibility determined. Carbapenem-resistant Acinetobacter baumannii isolates were further investigated for their resistance mechanism via the modified Hodge test, inhibitor-potentiated disk diffusion test, synergy with carbonyl cyanide chlorophenylhydrazone, and PCR. Moreover, clonal linkage was examined via enterobacterial repetitive intergenic consensus (ERIC)-PCR. RESULTS: Klebsiella spp was the most prevalent species in the isolates examined (217; 40%). Although A. baumannii represented only 10% of the total isolates, it showed the highest percentage of carbapenem resistance (74%). PCR showed that 100% of the resistant isolates carried both blaOXA-51 and blaOXA-23 genes, 85% carried the class 1 integrase genes, and only 2.5% carried metallo-beta-lactamase (blaVIM). ERIC-PCR indicated that isolates from different hospitals were genetically linked. CONCLUSIONS: These findings represent the first report of the alarming spread of OXA-23 carbapenemase in A. baumannii in Egyptian intensive care units. The spread of such strains has serious health consequences and requires the application of strict infection control measures.

Entomophobia, acarophobia, parasitic dermatophobia or delusional parasitosis.

Entomophobia or acarophobia, parasitic dermatophobia (PD) or delusional parasitosis (DP) is a disorder in which affected individuals has the mistaken but unshakable belief (delusion) that they are infected by insects, spiders, scorpion, ticks, mites, parasitic worms, bacteria, or other living organisms. As with all delusions, this belief cannot be corrected by reasoning, persuasion, or logical argument. To avoid them, they may always be cleaning rooms, floors, doors, windows and scratching. Many affected individuals are quite functional; for the minority, delusions of parasitic infection may interfere with usual activities. However, most insects are not harmful to humans and pose no threat, those who suffer with this phobia experience extreme anxiety at the mere thought or sight of an insect. Most patients consult dermatologists, veterinarians, pest control specialists, or entomologists. The DP cases are increasing worldwide; it remains an extremely unrepeatable disorder.

Nutrition in pregnancy and pathogenic diseases.

A woman's nutritional status should be assessed preconception with the goal of optimizing maternal, fetal, and infant health. Pregnancy-related dietary changes should begin prior to conception, with appropriate modifications across pregnancy and during lactation. The Recommended Dietary Allowances (RDAs) are levels of nutrients recommended by an expert IOM panel based on extensive evaluation of available scientific evidence and mathematically adjusted to meet the needs of 97% of the population.

Zoonotic Dicrocoeliasis dendriticum in a farmer's family at Giza Governorate, Egypt.

Dicrocoeliasis (Lancet liver fluke disease) is caused by Dicrocoelium dendriticum, a trematode living in bile ducts of sheep, cattle and other mammals including man. Human infection is asymptomatic or mild to moderately severe, but being sporadic or rarely reported. This paper reported zoonotic dicrocoeliasis dendriticum among a farmer's family and his domestic animals. The father and mother were successfully treated with Triclabendazole and the children and animals were successfully treated with Mirazid and Oleo-resin solution of Commiphora molmol respectively.

Detection of Entamoeba histolytica/dispar in stool specimens by using enzyme-linked immunosorbent assay in the population of Jeddah City, Saudi Arabia.

This study determined the prevalence of intestinal parasites, particularly pathogenic Entamoeba sp. (E. histolytica), in patients attending three hospitals in Jeddah City, King Abdulaziz University Hospital, King Abdulaziz Hospital and King Fahad Hospital for gastro-intestinal troubles. 186 stool specimens were examined microscopically for parasites and by ELISA kit (E. histolytica II) for true E. histolytica. 83 samples (44.6%) were positive by microscopy for at least one parasite. Of which, 23 (12.4%) showed two parasites and 15 (8.1%) three parasites. Eight different parasite species were identified. The most prevalent were E. histolytica/dispar (n = 26, 31.3%) and Giardia lamblia (n = 13, 15.7%). Others were Blastocytosis hominis (n = 12, 14.5%), Entamoeba coli (n = 11, 13.3%), Trichuris trichuria (n = 8, 9.6%), Endolymax nana (n = 6, 7.2%), Hymenolepes nana (n = 4, 4.8%) and Chilomastix mesnili (n = 3, 3.6%). Only five stool samples (19%) from those identified by microscopy to contain E. histolytica/dispar, were E. histolytica positive by E. histolytica II ELISA. For the first time to the authors' knowledge the true prevalence of E. histolytica in Saudi Arabia was 2.7%. E. histolytica II ELISA proved to be a highly useful technique to differentiate pathogenic E. histolytica from non pathogenic E. dispar.

Cytokines and immunoglobulin-E in certain parasitic diseases.

Ninety Egyptian patients were classified into 7 groups, 6 with different parasitic infection and 10 normal controls. Forty patients with different schistosomiasis stages (1, 2 & 3) with compensated but the last one (stage 4) of decompansated schistosomiasis. Gs3 & 4 of mixed infections with schistosomiasis and HCV & HBV respectively. The last 3 patients groups were infected with toxoplasmosis, filariasis and hymenolepiasis nana. IL2, IL4 & Ig E levels were measured. The results showed significant increase in IL2 (P < 0.05), (P < 0.01), P < 0.01) & (P < 0.001) among stages (1, 2, 3 & 4) versus control respectively. In chronic schistosomiasis with HCV & HBV, significance was P = < 0.001 & P < 0.05 respectively, among toxoplasmosis, filariasis and hymenolepiasis patients, it was P = < 0.001, 0.05 & 0.01 respectively. The IL 4 level showed highly significant increase (P< 0.001) among stage 1, 2, Gs 2, 3 & 6. There was significant increase (P < 0.01) with stage 3 in Gs 4 & 5 but, without significance (P > 0.05) increased in decompensate schistosomiasis patients. IgE level and test of significance versus controls were given and results were discussed.

Present situation of house dust mites in Dakahlia Governorate, Egypt.

House dust mites are common inhalant allergens, which can precipitate atopic disease episodes. The present study revealed presence of four mites. These are Dermatophagoides farinae, D. pteronyssinus, Acheles gracilis and Ornithonyssus bacoti. Population densities of different live adult mites were investigated in different house habitats. In urban houses, pyroglyphid mites were the predominant in bedrooms and D. farinae was the most abundant. A. gracilis was more abundant in living rooms followed by D. farinae then D. pteronyssinus. A. gracilis was the most prevalent in kitchens. While in rural houses, O. bacoti was the most abundant species followed by pyroglyphid mites. Since Dermatophagoides species and A. gracilis were present in numbers high enough to allow their ecological consideration, their seasonal abundance in urban bed-rooms was investigated and revealed that both D. farinae and D. pteronyssinus have two peaks of abundance, one slightly higher in spring and the second in autumn. A. gracilis has two peaks but the higher occurred in autumn and the second in spring.

Effect of Commiphora molmol on adults, egg masses and egg-deposition of Biomphalaria arabica under laboratory conditions.

Commiphora molmol (Myrrh) has molluscicidal effect on Biomphalaria arabica snails at low concentration (40 ppm) after 48 hours exposure. The number of dead-snails increased with increasing the time of exposure. One day-old egg masses were more susceptible (death 100% with 80ppm) to the ovicidal effect of C. molmol than the five-day old ones (Death 95% with 80ppm). However, the eggs were more resistant to the C. molmol effect than the adult snails, embryogenesis began to stop at 20 ppm and eggs were all killed at 60 & 80 ppm. B. arabica fecundity decreased at 1 ppm. Based on safety to man and animals, C. molmol is recommended as a safe molluscidide.