Assessment of internal fit and micro leakage of conventionally fabricated ceramometallic restoration versus CAD wax and press veneering (in-vitro study).

STATEMENT OF PROBLEM: Accuracy of internal fit and microleakage for CAD-CAM systems used in metal coping fabrication and veneered with layering or pressing porcelain in ceramometallic restoration is unclear. MATERIAL AND METHODS: A master metal die was milled to resemble the right mandibular first molar preparation for coverage with ceramometallic restoration. Master die was duplicated to twenty-four resin specimen dies.They were divided into two groups according to metal coping construction technique using either conventional (C) or CAD (D) wax. Each group was subdivided into two subgroups (n = 6) according to the technique of porcelain veneering (layered or pressed) to fabricate ceramometallic restorations, where subgroup (CL, DL) were conventionally layered by porcelain and (CP, DP) were press veneered. A standardized thickness of metal and porcelain was performed in all specimens as per manufacturer's instructions for techniques ceramometallic restoration construction. Evaluation of internal fit was done with silicone replica technique using stereomicroscope at ×24 magnification where the thickness of silicon layer was measured at 20 reference points on each specimen. Then specimens were subjected to thermocycling. Sectioned specimens were assessed for microleakage using a stereomicroscope at ×12 magnification along die-cement interface with a five scale score. RESULTS: Mean internal gap values of veneering showed a statistically nonsignificant difference between specimens made with layering(L) and pressing(P). Different techniques of wax construction showed a non-significant difference in internal gap values between specimens made with conventional(C) and CAD(D) waxing. However, a significant difference was found in the internal gap at different sites. The highest internal gap was found at the occlusal surface, while the lowest gap was found at the finish line. The highest mean microleakage score was found with CAD wax and press veneering, while the lowest mean microleakage score was found with conventional wax and press veneering. CONCLUSION: Both construction techniques of ceramometallic restoration were considered reliable in restoration production within a clinically acceptable range regarding internal fit and microleakage. There is a strong positive correlation between internal fit and microleakage of ceramometallic restoration constructed.

Comparison of common acute respiratory infection case definitions for identification of hospitalized influenza cases at a population-based surveillance site in Egypt.

BACKGROUND: Multiple case definitions are used to identify hospitalized patients with community-acquired acute respiratory infections (ARI). We evaluated several commonly used hospitalized ARI case definitions to identify influenza cases. METHODS: The study included all patients from a population-based surveillance site in Damanhour, Egypt hospitalized for a broad set of criteria consistent with community acquired ARIs. Naso- and oropharyngeal (NP/OP) swabs were tested for influenza using RT-PCR. Sensitivity, specificity and PPV for influenza identification was compared between the 2014 WHO Severe Acute Respiratory Infection (SARI) definition (fever ≥38°C and cough with onset within 10 days), the 2011 WHO SARI definition (fever ≥38°C and cough with onset within 7 days), the 2006 PAHO SARI definition, the International Emerging Infections Program (IEIP) pneumonia case definition, and the International Management of Childhood Illness (IMCI) case definitions for moderate and severe pneumonia. RESULTS: From June 2009-December 2012, 5768 NP/OP swabs were obtained from 6113 hospitalized ARI patients; 799 (13.9%) were influenza positive. The 2014 WHO SARI case definition captured the greatest number of ARI patients, influenza positive patients and ARI deaths compared to the other case definitions examined. Sensitivity for influenza detection was highest for the 2014 WHO SARI definition with 88.6%, compared to the 2011 WHO SARI (78.2%) the 2006 PAHO SARI (15.8%) the IEIP pneumonia (61.0%) and the IMCI moderate and severe pneumonia (33.8% and 38.9%) case definitions (IMCI applies to <5 only). CONCLUSIONS: Our results support use of the 2014 WHO SARI definition for identifying influenza positive hospitalized SARI cases as it captures the highest proportion of ARI deaths and influenza positive cases. Routine use of this case definition for hospital-based surveillance will provide a solid, globally comparable foundation on which to build needed response efforts for novel pandemic viruses.

Machine Learning of Medical Applications Involving Complicated Proteins and Genetic Measurements.

Motivations. Breast cancer is the second greatest cause of cancer mortality among women, according to the World Health Organization (WHO), and one of the most frequent illnesses among all women today. The influence is not confined to industrialized nations but also includes emerging countries since the authors believe that increased urbanization and adoption of Western lifestyles will lead to a rise in illness prevalence. Problem Statement. The breast cancer has become one of the deadliest diseases that women are presently facing. However, the causes of this disease are numerous and cannot be properly established. However, there is a huge difficulty in not accurately recognizing breast cancer in its early stages or prolonging the detection process. Methodology. In this research, machine learning is a field of artificial intelligence that employs a variety of probabilistic, optimization, and statistical approaches to enable computers to learn from past data and find and recognize patterns from large or complicated groups. The advantage is particularly well suited to medical applications, particularly those involving complicated proteins and genetic measurements. Result and Implications. However, when using the PCA method to reduce the features, the detection accuracy dropped to 89.9%. IG-ANFIS gave us detection accuracy (98.24%) by reducing the number of variables using the "information gain" method. While the ANFIS algorithm had a detection accuracy of 59.9% without utilizing features, J48, which is one of the decision tree approaches, had a detection accuracy of 92.86% without using features extraction methods. When applying PCA techniques to minimize features, the detection accuracy was lowered to the same way (91.1%) as the Naive Bayes detection algorithm (96.4%).

Machine Learning Implementation of a Diabetic Patient Monitoring System Using Interactive E-App.

Lifestyle influences morbidity and mortality rates in the world. Physical activity, a healthy weight, and a healthy diet are key preventative health behaviours that help reduce the risk of developing type 2 diabetes and its complications, such as cardiovascular disease. A healthy lifestyle has been shown to prevent or delay chronic diseases and their complications, but few people follow all recommended self-management behaviours. This work seeks to improve knowledge of factors affecting type 2 diabetes self-management and prevention through lifestyle changes. This paper describes the design, development, and testing of a diabetes self-management mobile app. The app tracked dietary consumption and health data. Bluetooth movement data from a pair of wearable insole devices are used to track carbohydrate intake, blood glucose, medication adherence, and physical activity. Two machine learning models were constructed to recognise sitting and standing. The SVM and decision tree models were 86% accurate for these tasks. The decision tree model is used in a real-time activity classification app. It is exciting to see more and more mobile health self-management apps being used to treat chronic diseases.

Anti-mutagenic potential of algal extracts on chromosomal aberrations in Allium cepa L.

In the present study, sodium azide (SA) toxicity and the anti-mutagenic effects of different algal extracts at 0.1% and 0.2% concentrations were studied on the mitotic index (MI), chromosomal and nuclear aberrations using Allium cepa L. root assay. Moreover, phytochemical screening of photosynthetic pigments, antioxidants compounds, total antioxidant, DPPH scavenging activity, polysaccharides, and phenolic contents were done for two red seaweeds (Laurencia obtusa (Hudson) Lamouroux and Polysiphonia morrowii Harvey) and for one brown seaweed (Dictyopteris delicatula Lamouroux). Treatment with 300 µg/ml sodium azide (SA) induced the highest number of aberrations in A. cepa root. A highly significant decrease in the MI appeared after treatment with SA, whereas its value increased following different algal extracts treatments. The highest anti-mutagenic inhibition activity of Dictyopteris delicatula added at 0.2% concentration was 72.96%, 69.84%, 56.89% and 43.59% with the algal polyphenol, polysaccharide, aqueous and methanol extract treatments, respectively. The different algal extracts minimized the genotoxicity and exhibited anti-mutagenic potential against SA in a dose-dependent manner. Phytochemical studies showed that Dictyopteris delicatula contained the highest total phenol, chlorophyll-a and carotenoid quantity. Moreover it exhibited the highest total antioxidant and DPPH scavenging activities. Total polysaccharides and the weight percentage of sulphated polysaccharides were relatively higher in Polysiphonia morrowii followed by Laurencia obtusa. Hydroquinone and bromophenol were detected only in the studied brown and red seaweeds, respectively. Polysiphonia morrowii and Laurencia obtusa contained the highest quantity of galactose, rhmnose and xylose, while Dictyopteris delicatula contained fucose and mannitol as main monosaccharide units. In conclusion, the studied seaweeds may be considered as rich sources of natural antioxidants. Meanwhile the investigated different algal extracts can minimize the genotoxicity in a dose-dependent manner and exhibit anti-mutagenic potential against the mutagenic substance sodium azide.

Incidence and etiology of hospitalized acute respiratory infections in the Egyptian Delta.

INTRODUCTION: Acute Respiratory Infections (ARI) are responsible for nearly two million childhood deaths worldwide. A limited number of studies have been published on the epidemiology of viral respiratory pathogens in Egypt. METHODS: A total of 6113 hospitalized patients >1 month of age with suspected ARI were enrolled between June 23, 2009 and December 31, 2013. Naso- and oropharyngeal specimens were collected and tested for influenza A and B, respiratory syncytial virus, human metapneumovirus, adenovirus, and parainfluenza viruses 1-3. Blood specimens from children 1-11 months were cultured and bacterial growth was identified by polymerase chain reaction. Results from a healthcare utilization survey on the proportion of persons seeking care for ARI was used to calculate adjusted ARI incidence rates in the surveillance population. RESULTS: The proportion of patients with a viral pathogen detected decreased with age from 67% in patients age 1-11 months to 19% in patients ≥65 years of age. Influenza was the dominant viral pathogen detected in patients ≥1 year of age (13.9%). The highest incidence rates for hospitalized ARI were observed in children 1-11 months (1757.9-5537.5/100 000 population) and RSV was the most commonly detected pathogen in this age group. CONCLUSION: In this study population, influenza is the largest viral contributor to hospitalized ARIs and children 1-11 months of age experience a high rate of ARI hospitalizations. This study highlights a need for surveillance of additional viral pathogens and alternative detection methods for bacterial pathogens, which may reveal a substantial proportion of as yet unidentified etiologies in adults.

Schistosoma mansoni: Antiparasitic effects of orally administered Nigella sativa oil and/or Chroococcus turgidus extract.

Schistosoma mansoni is one of the parasites causing schistosomiasis, a disease which threatens millions of people all over the world. Traditional chemical drugs are not fully effective against schistosomaisis due to the evolving drug resistant worm strains, so exploring new remedies derived from natural products is a good way to fight schistosomiasis. In the present investigation two natural products, Nigella sativa oil and Chroococcus turgidus extract were used separately or in a combination to explore their effect on S. mansoni. The infected mice treated with Chroococcus turgidus extract or/and sativa seed oil showed a significant decrease in the total worm burden. The total number of deposited eggs by females of S. mansoni was significantly decreased in the liver of mice treated with Chroococcus turgidus extract or/and sativa seed oil. However, in the intestine, the number of eggs was significantly reduced in mice treated with algal extract and those treated with both algal extract and oil. Fecundity of female S. mansoni showed a significant decrease from mice treated with algal extract or/and sativa seed oil. According to SEM investigations the tegmental surface, oral and ventral suckers of worms also showed considerable changes; as the tubercles lost their spines, some are swollen and torn out. The suckers become edematous and enlarged while the tegmental surface is damaged due to the treatment with Chroococcus turgidus extract or/and sativa seed oil. In conclusion, the Nigella sativa oil and Chroococcus turgidus extract are promising natural compounds that can be used in fighting schistosomiasis.

Host and viral determinants of the outcome of exposure to HCV infection genotype 4: a large longitudinal study.

OBJECTIVES: The objective of this study was to characterize the factors that influence the outcome of exposure to hepatitis C virus (HCV) genotype 4 (HCV-G4) and the course of recent infection. METHODS: In this longitudinal study, we prospectively assessed the clinical, genetic, virological, and immunological parameters and retrospectively determined single-nucleotide polymorphisms at interleukin-28B (IL-28B) rs12979860 in a well-characterized large cohort recently exposed to HCV-G4. RESULTS: A total of 136 subjects with acute HCV (new viremia, seroconversion, and HCV-specific T-cell responses) were identified. Forty-eight subjects (35%) had spontaneous viral clearance and 88 subjects developed chronic HCV of which 42 subjects were treated with pegylated interferon monotherapy, with a sustained virologic response (SVR) rate of 88%. Twenty-six subjects developed HCV-specific T-cell immune responses without detectable viremia or seroconversion. IL-28B-CC (odds ratio (OR) 14.22; P<0.0001), multispecific T-cell responses (OR=11.66; P<0.0001), >300 IU/l alanine aminotransferase (ALT) decline within 4 weeks (OR=6.83; P<0.0001), jaundice (OR=3.54; P=0.001), female gender (OR=2.39; P=0.007), and >2.5 log10 HCV-RNA drop within 8 weeks (OR=2.48; P=0.016) were independently associated with spontaneous clearance. ALT normalization and undetectable HCV-RNA predicted SVR. Exposed apparently uninfected participants had a higher frequency of IL-28B-CC than patients with unresolved acute HCV (P<0.001). IL-28B-CC was associated with multispecific T-cell response (r(2)=0.0.835; P<0.001). CONCLUSIONS: IL-28B-CC genotype, multispecific HCV T-cell responses, rapid decline in ALT, and viral load predict spontaneous clearance and response to acute HCV-G 4 therapy. IL-28B-CC genotype correlates with developing early multispecific T-cell responses. These findings have important implications for predicting the outcome of HCV exposure and acute infection and identifying patients likely to benefit from therapy.

Typing of Salmonella Typhi strains isolated from Egypt by RAPD PCR.

PCR-based fingerprinting using random amplified polymorphic DNA (RAPD) has been used widely for genome identification. In this study, 13 Salmonella Typhi strains were isolated from typhoid patients from Aswan, Cairo, Fayoum, and Monofya Governorates of Egypt. The isolates, along with three reference strains, i.e., O901, H901, and Ty2 were subjected to whole genome typing by RAPD PCR. Three RAPD-PCR 10-mer primers generated a total of 85 RAPD bands (81 polymorphic bands), 12 distinct PCR profiles, and proved to be useful for discriminating the isolates and strains studied. Interestingly, the B(1) and C(1) PCR profile were found only in Cairo and Monofya, respectively; and some PCR types appeared only in certain Governorates of Egypt. By combining the profiles obtained with the primer trio used in this study, an excellent discrimination index (D) of 0.942 was reached. Pairwise comparisons of Jaccard's similarity coefficients calculated among the 12 PCR types identified three major clusters; i.e., O901 branch and Ty2 and H901 sub-branches. Principal component analysis adequately resolved each of these three major clusters. Three principal components accounted for about 72% of the variation, with the first two components accounting for about 62% of the total variance among the genotypes studied. Biclustering improved the display of groups of RAPD amplicons (markers) that cluster similarly across the genomes and could delineate features pertaining to genome structure. In conclusion, RAPD PCR provided a fast method with high potentials in surveillance and epidemiological investigations of Salmonella Typhi infections.

Antiviral effect of edaphic cyanophytes on rabies and herpes-1 viruses.

Five cyanophyte species (Amorphonostoc punctiforme, Gloeocapsa turgidus, Sphaeronostoc coeruleum, Stratonostoc linckia f. spongiaeforme and Synechococcus cedrorum) were isolated and identified from sandy Egyptian soils. Polysaccharides extracted from these species showed a pronounced antiviral activity against Rabies and Herpes-1 viruses represented by the absence of the characteristic cytopathic effects of these viruses. It was found that 100 µg polysaccharide/ml induced 100% inhibition of the two viruses which, depending on the polysaccharide concentration. Both of Gloeocapsa turgidus and Synechococcus cedrorum showed higher antiviral activity against rabies virus than that against herpes-1 virus. Amorphonostoc punctiforme showed nil to weak antiviral activity against both viruses. It was suggested that polysaccharides of such species of cyanophyte react against human and animal viruses. So, it could be concluded that there is a need for further studies to explain the mode of action of these substances on the replication of different viral origins to know how one deals with cyanophyte polysaccharides as antiviral substances in the most suitable and effective manner.

Pegylated interferon alpha-2b plus ribavirin in patients with genotype 4 chronic hepatitis C: The role of rapid and early virologic response.

UNLABELLED: In patients chronically infected with hepatitis C virus (HCV) genotype 4, the optimum duration of therapy and the predictors of sustained virologic response (SVR) have not been adequately determined. In this study, 358 patients with chronic hepatitis C genotype 4 were randomly assigned to pegylated interferon (PEG-IFN) alpha-2b (1.5 mug/kg/week) plus oral ribavirin (10.6 mg/kg/day) for a fixed duration of 48 weeks (control group, n = 50) or for a variable duration (n = 318). In the variable-duration group, patients with undetectable HCV RNA at week 4 were treated for 24 weeks (group A, n = 69), patients with undetectable HCV RNA at week 12 were treated for 36 weeks (group B, n = 79), and the rest of the patients were treated for 48 weeks (group C, n = 160). The primary endpoint was SVR (undetectable HCV RNA 24 weeks after treatment cessation). Groups A-C and the control group had SVR rates of 86%, 76%, 56%, and 58%, respectively. After the study was controlled for predictors, a low baseline histologic grade and stage were associated with SVR (P < 0.029) in all groups. In addition, among patients in group C, older age (P = 0.04), a higher baseline body mass index (P = 0.013), and low baseline HCV RNA (P < 0.001) were also associated with SVR attainment. The incidence of adverse events and the rate of discontinuation were higher in patients in the variable-duration and fixed-duration groups treated for 48 weeks. CONCLUSION: In patients with chronic hepatitis C genotype 4 and undetectable HCV RNA at weeks 4 and 12, treatment with PEG-IFN alpha-2b and ribavirin for 24 weeks and 36 weeks, respectively, is sufficient.

Hospital-based surveillance for acute febrile illness in Egypt: a focus on community-acquired bloodstream infections.

Acute febrile illness (AFI) is a common syndrome in Egypt. However its etiologies are not well characterized. To determine the relative frequency of pathogen etiologies and possibly improve diagnostic, clinical management and public health measures, we implemented laboratory-based surveillance in a network of infectious disease hospitals throughout Egypt. Admitted patients with AFI provided background details and a blood sample for bacterial culture and serologic analysis. Case definitions were based on laboratory results. Of 10,130 patients evaluated between 1999 and 2003, 5% were culture positive for Salmonella enterica serogroup Typhi, 3% for Brucella, and 2% for other pathogens. An additional 18% of patients had positive serologic results for typhoid and 11% for brucellosis. Risk factor analysis identified availability of municipal water to be significantly (P < 0.05) associated with protection against typhoid. Animal contact and consumption of raw dairy products were significantly associated with brucellosis. The surveillance network identified typhoid fever and brucellosis as the most common bacterial causes of AFI in Egypt, allowed better description of their epidemiology, and may lead to the development of targeted prevention strategies.

The changing epidemiology of meningococcal meningitis after introduction of bivalent A/C polysaccharide vaccine into school-based vaccination programs in Egypt.

BACKGROUND: The strategy recommended by the World Health Organization (WHO) to curtail outbreaks of meningococcus in Africa is enhanced surveillance with administration of oily chloramphenicol as well as vaccination when incidence thresholds are exceeded. The role of capsular polysaccharide meningococcal vaccine in outbreak prevention has been the subject of considerable debate. The Egyptian Ministry of Health and Population initiated a school-based vaccination program with bivalent A/C capsular polysaccharide vaccine in 1992. This investigation reviews data on meningococcal meningitis in Egypt comparing years before and after introduction of the vaccine. METHODS: This is a retrospective review of several sources to examine the rates and serogroups of meningococcal meningitis before and after the introduction of the meningococcal A/C vaccine in Egypt. FINDINGS: Between 1967 and 1991, outbreaks of meningococcal disease were documented with a periodicity of 8 years in Egypt. However, there has not been an outbreak since 1991 and over the same period, there has also been a progressive decline in the baseline incidence of meningococcus. Also, a shift from a serogroup A to serogroup B predominance in meningococcal disease was noted during the study period. These data suggest that there has been an alteration in the epidemiology of meningococcal disease in Egypt that coincided with the implementation of the school-based vaccination program. INTERPRETATION: Routine use of the bivalent A/C meningococcal vaccine may be an alternative for the control and prevention of meningococcal disease in high-risk areas including the "meningitis belt".

Etiology, antimicrobial susceptibility profiles, and mortality associated with bacterial meningitis among children in Egypt.

PURPOSE: Surveillance for patients with meningitis is a high priority in order to determine the etiology of disease and design prevention strategies. This study presents data on the causes of bacterial meningitis among children <6 years of age treated in a network of hospitals throughout Egypt. METHODS: Training was provided to standardize the collection of clinical information and optimize recovery of bacterial pathogens. Bacterial isolates were tested for antimicrobial resistance patterns using Kirby Bauer disk diffusion, E-test and/or Beta-lactamase (BL) testing methods. RESULTS: Patients with culture-confirmed bacterial meningitis (228 children<6 years) were identified including 89 (39%) patients with H. influenzae (HI), 68 (30%) with Streptococcus pneumoniae (SP), 30 (13%) with N. meningitidis (NM), 18 (8%) with Mycobacterium tuberculosis (MTB) and 23 (10%) with other bacteria. The overall case fatality ratio was high (24%) and increased among children with TB meningitis (56%). The susceptibility for HI to ampicillin (AMP), chloramphenicol (C) and ceftriaxone (CRO) was 21%, 13%, and 100% respectively. The susceptibility for SP to C and CRO was 79% and 100%, respectively. CONCLUSIONS: HI and SP are the leading causes of bacterial meningitis among children in Egypt. The majority of HI strains tested were resistant to AMP or C suggesting the need for routine use of CRO as first line therapy. Among older children TB emerges as a significant cause of bacterial meningitis in Egypt.

Trends of multiple-drug resistance among Salmonella serotype Typhi isolates during a 14-year period in Egypt.

A total of 853 isolates of Salmonella serotype Typhi recovered from patients with typhoid fever who were admitted to a major infectious disease hospital in Cairo, Egypt, from 1987 through 2000 underwent antibiotic susceptibility testing to determine multiple-drug resistance. The observed resurgence of chloramphenicol susceptibility (P=.002) may suggest reuse of this drug for the treatment of typhoid fever in Egypt.