Associations of human leucocyte antigen class II-DQB1 alleles with hepatitis C virus infection in Egyptian population: a multicentre family-based study.

Hepatitis C infection is a global pandemic. HLA-DQB1 alleles are believed to have an effective role in immune response against HCV including susceptibility to or protection from this infection. The aim of this study was to investigate the contribution of HLA-DQB1 alleles in the outcome of HCV genotype-4 infection through a family-based association study. Egyptian families with HCV (324) were recruited for this study (324 index positive for RNA-HCV, 225 positive relatives representing chronic hepatitis C cases and 582 family members negative for HCV-RNA [control], 63 of whom spontaneously cleared the virus. All subjects were genotyped for HLA-DQB1 alleles by sequence-specific primers (SSP-PCR) and sequence-based typing (SBT) methods. The frequency of DQB1*02:01:01 carriage was significantly higher in infected patients when compared to controls and those who spontaneously cleared virus (OR=5.47, P<.0001 and OR= 6.5234, P<.0001, respectively), and the carriage of the DQB1*03:01:01:01 allele was significantly higher in those who cleared and controls when compared to the infected patients (OR=0.2889, P<.0001 and OR=0.3016, P<.0001, respectively). On the other hand, the frequency of DQB1*06:01:01 and QB1*05:01:01:01 alleles was not associated with infection (comparison of infected and cleared patients showed OR of 2.1598 [P<.01]), but it becomes nonsignificant after adjustments with the Bonferroni formula (PC >0.05) and OR= 1.3523, P>.05, respectively. This study shows that clearance of HCV is associated with DQB1*03:01:01:01 allele and chronicity of HCV infection associated with the risk allele: DQB1*02:01:01.

Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy.

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff.

Parasitological and biochemical parameters in Schistosoma mansoni-infected mice treated with methanol extract from the plants Chenopodium ambrosioides, Conyza dioscorides and Sesbania sesban.

This study aims to detect the antischistosomal properties of the plants' Chenopodium ambrosioides, Conyza dioscorides and Sesbania sesban methanol extract against Schistosoma mansoni in infected mice, including determination of total protein and albumin levels and the activities of alanine and aspartate transaminases (AlT, AsT) and acid and alkaline phosphatases (AcP and AkP) enzymes in the serum of infected treated mice. Male Swiss albino mice were infected with S. mansoni and orally treated with methanol extract of the plants C. ambrosioides (1250 mg/kg/day), C. dioscorides and S. sesban (1000 mg/kg/day from each) for 2 consecutive days 7 weeks post infection (PI). In addition, treatment of mice with the tested dose of each plant extract was successively done (i.e. the 1st extract followed by the 2nd and 3rd one with an hour interval). Parasitological and biochemical parameters were assessed. Nine weeks PI, the reduction rates of worm load/mouse treated with either C. dioscorides (1000 mg/kg), C. ambrosioides (1250 mg/kg) or S. sesban (1000 mg/kg) were 40.9%, 53.7% and 54.4%, respectively. Successive treatment raised the reduction rates of worm load/mouse to 66.3% and the ova/g tissue in liver to 76.9%. Moreover, serum total protein and albumin levels and activities of AlT, Ast, AcP and AkP enzymes of infected treated mice were improved in comparison with those of infected untreated ones. It is concluded that administration of C. dioscorides, C. ambrosioides and S. sesban methanol extract to infected mice exhibited a moderate antischistosomal effect. Successive treatment improved the antischistosomal properties of these plant species, hence ameliorated the liver functions of treated mice that may suggest degenerations of liver granulomas and regenerative changes.

Benchmarking of percutaneous injuries at a teaching tertiary care center in Saudi Arabia relative to United States hospitals participating in the Exposure Prevention Information Network.

BACKGROUND: Despite recent improvements in policies, practices, and device design, percutaneous injuries (PIs) from needles and sharp instruments continue to expose health care workers to the risk of bloodborne pathogens. METHODS: Prospective surveillance was instituted to study the epidemiologic characteristics of PIs at King Abdulaziz Medical City, Riyadh, Saudi Arabia (KAMC-R) from 2004 through 2008 and to benchmark these characteristics relative to those of a network of US hospitals participating in the Exposure Prevention Information Network (EPINet) research group (2004-2007). RESULTS: The mean PIs rate per 100 daily occupied beds in KAMC-R was significantly lower than that reported by teaching and nonteaching US EPINet hospitals. Similar to US EPINet hospitals, nurses at KAMC-R reported more PIs than physicians. Compared with US EPINet hospitals, nurses at KAMC-R experienced more PIs (52.8% vs 38.1%, respectively), whereas physicians experienced fewer PIs (18.4% vs 28.6%, respectively). The majority of PIs happened in patient wards (50.6%) in KAMC-R and operating rooms (34.1%) in US EPINet hospitals. Suturing, which was involved in only 10% of PIs at KAMC-R, was the most frequent PIs mechanism in US EPINet hospitals (23.3%). In both KAMC-R and US EPINet hospitals, disposable syringes were the most frequent devices involved, the left hand was the most common site of injury, and the source patient was largely identifiable. CONCLUSION: We have lower rates of PIs at KAMC-R relative to US EPINet hospitals. Whereas it is difficult to fully explain such differences, this could be due to variations in health care systems, underreporting, or the impact of the PIs prevention activities.

Determinants of maternal adaptation to mentally disabled children in El Minia, Egypt.

This study was carried out in a governmental school for mentally disabled children in El Minia. We assessed maternal adaptation and the relationship between maternal sociodemographic factors and adaptation as well as examining maternal distress. All 100 mothers with children aged 6-18 years attending the school were recruited in the study. Three tools were used: demographic data sheet, adaptation scale to assess the nature of mothers' interaction and patterns of psychosocial adaptation and depression scale to detect the presence of psychiatric disorders among the mothers. Only 35.0% of the mothers adapted positively to their child's condition; 62.9% of those had female children. Negatively adapted mothers were slightly older than positively adapted mothers and had more children. Maternal education and occupation were significantly associated with psychosocial adaptation. Knowledge of mothers about their child's condition significantly affected adaptation as well as the dependency of children in eating, drinking and sleeping. Two-thirds of mothers had high levels of psychopathology.

Tinea capitis in adults in Tunisia.

OBJECTIVE: To determine the pattern of infectious agents causing tinea capitis (TC) in adult patients in the center of Tunisia. METHODS: From January 1990 to December 2005, we have retrospectively collected all cases of adult TC, confirmed by the mycological examination. RESULTS: Sixty patients (18 male, 42 female) with a mean age of 34.5 years were diagnosed as having adult TC among a total number of 1137 cases of TC (5.27%). Clinical features were polymorphic and diagnosis was made on mycological examination. Culture identified Trichophyton violaceum in 36 cases (60%), Microsporum canis in 12 cases (20%), Trichophyton schoenleini in 7 cases (12%), Trichophyton verrucosum in two cases (3.5%), and Trichophyton mentagrophytes and Trichophyton rubrum in one case (each 1.77%). Culture was negative in one case (1.77%). Treatment consisted of administration of Griseofulvin(20­25 mg/kg/d) during 6­8 weeks associated with antifungal topics. A complete recovery was noted in 55 cases (92%) and a relapse occurred in two patients (3.5%). A scary alopecia was observed in one patient (1.77%) and two patients were lost to follow-up. CONCLUSION: Trichophyton violaceum remains the most common etiological agent of adult TC in Tunisia. Microsporum canis is rising rapidly most notably due to the high frequency of asymptomatic carriage by domestic animals [corrected].

Prevalence of hepatitis B virus markers among blood donors in a tertiary hospital in Tabuk, northwestern Saudi Arabia.

OBJECTIVE: This study was carried out to determine the prevalence of hepatitis B virus (HBV) markers among blood donors in a tertiary hospital in Tabuk, northwestern Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey was done among male Saudi voluntary blood donors at the blood bank of the King Khalid tertiary care hospital in the northwest region of Saudi Arabia. A total of 3192 subjects were included in the study over the period from June 1, 2005 to May 31, 2006. Subjects were tested for evidence of HBV infection plus other relevant blood-borne pathogens. A questionnaire sheet for the collection of personal information (such as name, age, and sex), socioeconomic data (such as marital status, education, and occupation), family history of HBV infection, history of immunization against HBV, and history of past exposure to a high risk procedure or behavior, was prepared and used for each subject. Data were tabulated and statistically analyzed. RESULTS: Among the studied sample, the prevalence of HBsAg (hepatitis B surface antigen) was found to be 3.0% and the prevalence of anti-HBc (anti-hepatitis B core antigen) was found to be 18.7%. Blood donors with positive HBV markers showed significant association with increased age, being married, lower educational level, specific occupations such as blue collar worker and the military, family history of HBV infection, and lack of immunization. However, there was no significant association with history of exposure to high-risk procedure or behavior. CONCLUSIONS: The prevalence of HBV infection among male Saudi blood donors in the northwest region of Saudi Arabia is high compared to that reported from the central capital area (Riyadh). Public health education programs on HBV infection, adult hepatitis B immunization programs, and raising socioeconomic standards should be initiated in order to target the high-risk groups found in this study. Furthermore, a community-based study is recommended to investigate HBV infection in the northwest region of Saudi Arabia.

Overexpression of selenoprotein H reduces Ht22 neuronal cell death after UVB irradiation by preventing superoxide formation.

Selenoproteins have been shown to exhibit a variety of biological functions, including antioxidant functions, maintaining cellular redox balance, and heavy metal detoxification. UV irradiation-induced damage is partially mediated by increased oxygen radical production. The present study is designed to examine the antioxidative effects of human selenoprotein H (hSelH) after brief period of UVB irradiation on the murine hippocampal neuronal cell line Ht22. Ht22 cells were stably transfected with the hSelH gene or with MSCV empty vector and exposed to UVB irradiation with or without the presence of serum. The results showed that cell viability was significantly higher in hSelH-transfected cells compared to the MSCV vector-transfected cells after 24 h of recovery with or without the presence of serum in the media. Further studies revealed that while the number of superoxide anion (O2*-) positive cells was increased following a 7 mJ/cm(2) of UVB irradiation and 5 h of recovery, overexpression of hSelH significantly reduced superoxide production. These results suggest that hSelH overexpression protects cells from UVB irradiation-induced cell death by reducing the O2*- formation.

[Prognosis of severe trauma outcome using noninvasive monitoring]. / Predskazanie iskhoda tiazheloi travmy s pomoshch'iu neinvazivnogo monitoringa.

The purpose of the case study was, firstly, to evaluate (starting from the time the patients are admitted to the intensive care unit--ICU) a type of cardiac, pulmonary and peripheral microcirculation in patients with severe traumas by using a multi-component and invasion-free monitoring; the second purpose was to measure quantitatively the changes in the cardiac, pulmonary and peripheral hemodynamics leading to recovery or death; and finally, it was to investigate the effectiveness of applying the discriminative analysis for the sake of assessing the biological value of the controllable changes and of forecast outcome. The invasion-free monitoring system comprising the below tools was in use: an improved bio-impedance method (evaluation of the cardiac output), pulsometry (examination of the pulmonary function), transcutaneous oxygen pressure (tissue perfusion function) and arterial blood pressure (ABP--general circulation status). The results of continuously controllable invasion-free measurements were used for a prospective evaluation at the emergency unit of the county hospital, which was supervised by the university. The accumulated integral values of the deficit or excess of each controllable parameter were calculated by using the differences between the normal values and the values obtained for each patient and for the groups of survivors and dead. A probable outcome and a degree of the deficit of the pulmonary and cardiac functions as well as of the tissue-perfusion function were analyzed by using the discriminant function. The values of pure aggregate deficits (-) or excesses (+) were for the survivors and dead, respectively, as follows: cardiac index--(+)93 +/- 49.8 l/m2 versus -232 +/- 138 l/m2 (p < 0.07); mean ABD(-)-12 +/- 12.4 mm Hg versus -57 +/- 23.5 mm Hg (p < 0.066); arterial saturation(-)-1 +/- 0.09% h versus -9 +/- 2.6% h (p < 0.001): and tissue perfusion--(+)311 +/- 87 tor/h versus 793 +/- 175 tor/h (p < 0.0001). The pure aggregate value of reduced circulation, tissue perfusion and of hypoxemia degree was found to be higher in the dead versus the survivors. The invasion-free monitoring systems secure a constant real-time control over the data, which makes the circulatory malfunction revealed as soon as possible in emergency settings. The mentioned systems can be used to describe, for each patients, a temporal hemodynamic model and to evaluate quantitatively a functional-deficit severity; they also provide for composing a clear-cut and successive treatment scheme from the emergency stage to the intensive care unit.

[Clinical impact of 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of brain diseases]. / Einsatz der 18F-Fluorodeoxyglukose-Positronenemissionstomographie in der klinischen Hirndiagnostik.

In this review it will be discussed in which neurological disorders positron emission tomography can yield important diagnostic information. Because positron emission tomography is an expensive method indications have to be clearly defined. One important question concerns the differentiation of tumor recurrence and scar due to radiation therapy or an operation. The grading of brain tumors is another application. In HIV patients fluorodeoxyglucose positron emission tomography can separate lymphoma and toxoplasmosis. In the evaluation of dementia positron emission tomography can help to clarify the differential diagnosis. Another important area is the presurgical evaluation of epilepsy patients and patients with cerebrovascular disease in whom a surgical revascularisation procedure is planned. In extrapyramidal disorders, positron emission tomography can often help to establish the final diagnosis.

PET-CT-guided percutaneous puncture of an infected cyst in autosomal dominant polycystic kidney disease: case report.

An infected cyst in autosomal dominant polycystic kidney disease was identified with a combined positron emission tomographic (PET) and computed tomographic (CT) system, an experimental setup mimicking an integrated CT-PET scanner. Image fusion of fluorine 18 fluorodeoxyglucose PET and CT images allowed exact localization of the infected cyst among many cysts identified on previous CT and magnetic resonance images. Confirmation was obtained instantly, followed by CT-guided percutaneous puncture. Integrated imaging systems hold promise for direct PET-guided puncture of areas of increased fluorodeoxyglucose uptake by using the anatomic accuracy of CT.

Amelioration of NaCl stress in Pisum sativum Linn.

Activity of endogenous auxins and growth inhibitors, gibberellins and cytokinins was observed in the extracts of seedlings of Pisum sativum under NaCl stress. After 6 days of germination, when Pisum sativum seedlings were subjected to low concentration of NaCl (50 mM) or boron (10 ppm) increased the endogenous growth regulating substances. Higher concentration of NaCl (150 mM) decreased endogenous level of growth regulators, length of the root and shoot, and fresh and dry weights of seedlings, whereas boron increased the parameters except endogenous growth regulators. Mitotic index and some abnormalities were observed in the treated plants. SDS-PAGE banding pattern of Pisum sativum seedlings extracted in tris-glycine and tris-HCl showed that lower concentration of NaCl increased the number of protein bands, while the higher concentration decreased these protein bands. Combination of boron and NaCl (150 mM) caused an increase in total number of protein bands compared with the total number of bands recorded by using NaCl (150 mM) alone.

Outcome prediction of emergency patients by noninvasive hemodynamic monitoring.

OBJECTIVES: We used noninvasive hemodynamic monitoring in the initial resuscitation beginning in the emergency department (ED) for the following reasons: (1) to describe early survivor and nonsurvivor patterns of emergency patients in terms of cardiac, pulmonary, and tissue perfusion deficiencies; (2) to measure quantitatively the net cumulative amount of deficit or excess of the monitored functions that correlate with survival or death; and (3) to explore the use of discriminant analysis to predict outcome and evaluate the biological significance of monitored deficits. METHODS: This is a descriptive study of the feasibility of noninvasive monitoring of patients with acute emergency conditions in the ED to evaluate and quantify hemodynamic deficits as early as possible. The noninvasive monitoring systems consisted of a bioimpedance method for estimating cardiac output together with pulse oximetry to reflect pulmonary function, transcutaneous oxygen tension to reflect tissue perfusion, and BP to reflect the overall circulatory status. These continuously monitored noninvasive measurements were used to prospectively evaluate circulatory patterns in 151 consecutively monitored severely injured patients beginning with admission to the ED in a university-run county hospital. The net cumulative deficit or excess of each monitored parameter was calculated as the cumulative difference from the normal value vs the time-integrated monitored curve for each patient. The deficits of cardiac, pulmonary, and tissue perfusion functions were analyzed in relation to outcome by discriminant analysis and were cross-validated. RESULTS: The mean (+/- SEM) net cumulative excesses (+) or deficits (-) from normal in surviving vs nonsurviving patients, respectively, were as follows: cardiac index (CI), +81 +/- 52 vs -232 +/- 138 L/m(2) (p = 0.037); arterial hemoglobin saturation, -1 +/- 0.3 vs -8 +/- 2.6%/h (p = 0.006); and tissue perfusion, +313 +/- 88 vs -793 +/- 175, mm Hg/h (p = 0.001). The cumulative mean arterial BP deficit for survivors was -10 +/- 13 mm Hg/h, and for nonsurvivors it was -57 +/- 24 mm Hg/h (p = 0.078). CONCLUSIONS: Noninvasive monitoring systems provided continuously monitored on-line displays of data in the early postadmission period from the ED to the operating room and to the ICU for early recognition of circulatory dysfunction in short-term emergency conditions. Survival was predicted by discriminant analysis models based on the quantitative assessment of the net cumulative deficits of CI, arterial hypoxemia, and tissue perfusion, which were significantly greater in the nonsurvivors.

Change in intra-abdominal adipose tissue volume during weight loss in obese men and women: correlation between magnetic resonance imaging and anthropometric measurements.

OBJECTIVE: To compare the changes in intra-abdominal adipose tissue (IAAT) measured by magnetic resonance imaging (MRI) with changes in central abdominal fat (CAF) measured by dual-energy X-ray absorptiometry (DXA) and anthropometric measurements in obese subjects before and after a weight loss programme. DESIGN: Longitudinal, clinical intervention study of a 600 kcal/day deficit diet with 10 mg/day sibutramine per day for six months. SUBJECTS: Nineteen women (age: 42+/-8.7 y, BMI: 33.3+/-1.9 kg/m2) and 17 men (age: 41.8+/-5.3 y, BMI: 32.6+/-2.4 kg/m2). MEASUREMENTS: MRI was used to measure the effect of weight loss on IAAT. Changes in IAAT were compared with changes in CAF by DXA and anthropometry. RESULTS: The percentage of changes in IAAT was greater than that in subcutaneous adipose tissue (SCAT) in both women and men (P<0.01). Changes in IAAT were significantly correlated with changes in weight and BMI in both women and men. In women and not in men, changes in CAF by DXA, waist circumference and WHR were also significantly correlated with the changes in IAAT. CONCLUSION: Estimation of the change in IAAT was better in obese women than obese men. In both sexes the changes in weight and BMI had the highest correlation coefficients with the change in IAAT.

Nonoperative management of splenic injuries: have we gone too far?

HYPOTHESIS: Patients with severe blunt injuries to the spleen have a high likelihood of failing nonoperative management of splenic injuries (NOMSI). DESIGN: Review of medical records, helical computed tomographic imaging data, and trauma registry data. SETTING: Academic level I trauma center at a large county hospital. PATIENTS: A total of 105 patients with blunt trauma to the spleen, admitted between January 1995 and December 1998, who survived more than 48 hours and had complete records. Of these patients, 53 (56%) were selected for NOMSI. The splenic injury was graded by the Organ Injury Scale of the American Association for the Surgery of Trauma (grades I to V, with grade V being the worst possible injury). MAIN OUTCOME MEASURES: Failure of NOMSI, defined as the need for operation to the spleen after a period of nonoperative management. RESULTS: Compared with patients who had successful NOMSI, the 29 patients (52%) in whom NOMSI failed were older and more severely injured. They also required extra-abdominal operations more frequently, underwent transfusion with more units of blood while being managed nonoperatively, and had higher grades of splenic injury. Splenic injury grade III or higher and transfusion of more than 1 U of blood were identified as independent risk factors for failure of NOMSI. The existence of both risk factors predicted failure in 97% of cases. The grading by computed tomography correlated well with the actual injury to the spleen as seen at operation. CONCLUSIONS: In patients with high-grade splenic injuries who require a transfusion of more than 1 U of blood, NOMSI is very likely to fail. Decreasing the threshold for operation or intensifying the monitoring is highly recommended for such patients.

Usefulness of anthropometry and DXA in predicting intra-abdominal fat in obese men and women.

OBJECTIVE: To investigate the usefulness of anthropometry and DXA in predicting intra-abdominal fat (IAF) in obese men and women. RESEARCH METHODS AND PROCEDURES: Observational, cross sectional study of 22 women and 18 men with a body mass index of 30 or above. IAF from 20 cm above and 10 cm below the L4 to L5 intervertebral disc was measured by magnetic resonance imaging (MRI) as a reference method. Central abdominal fat was measured from the upper border of L2 to the lower border of L4 by DXA. Waist and hip circumferences were also measured. RESULTS: In obese women DXA, waist circumference and waist-hip ratio were equally well correlated with IAF (r = 0.74, 0.75, and 0.70, respectively). In obese men DXA was moderately correlated with IAF measured by MRI (r = 0.46), whereas waist circumference and waist-hip ratio were not significantly correlated with IAF. DISCUSSION: The prediction of IAF in obese subjects was highly dependent on sex more than in non-obese persons. Anthropometry and DXA were equally useful in obese women, whereas anthropometry had no predictive power and DXA was the only acceptable predictor of IAF in obese men.

Synthesis of new pyridoquinoxalines, thienopyridoquinoxalines and pyrimidothienopyridoquinoxalines.

Synthesis of 3-chloro-2-cyanoquinoxaline (1) and its reactions with sodium azide, guanidine hydrochloride, semicarbazide and thioheterocycles have been investigated (2-7). Also, the reaction of the chloro compound 1 with cyanoacetamide or cyanothioacetamide gave the pyrido[2,3-b]quinoxaline derivatives 8, 9. Compound 9 was used as a key intermediate to produce the more polyheterocyclic systems 10-18.

Complex repair for the management of duodenal injuries.

The management of duodenal injuries is a subject of ongoing debate. In this study we attempt to describe duodenum-related morbidity (DRM) after primary repair or complex repair (CR) and to identify risk factors for development of complications. The medical records of 145 consecutive patients admitted to Los Angeles County + University of Southern California Medical Center with duodenal injuries between January 1991 and December 1997 were reviewed. Fifty-four (37%) died within 24 hours of admission because of associated injuries. The remaining 91 were subjected to univariate and multivariate analysis. Of them, 66 (72.5%) developed complications and 3 (3%) died. CR was used in 32 (35%) patients and with increasing frequency as the grade of duodenal injury increased. DRM rate was overall low (9%) and not different between low-grade and high-grade duodenal injuries. This occurred despite a significant increase in Injury Severity Score and abdominal Abbreviated Injury Score in patients with more severe duodenal injuries. Patients with overall complications had higher Injury Severity Scores, higher abdominal Abbreviated Injury Scores, and more severe duodenal injuries. We conclude that duodenal injuries are frequently associated with other highly lethal injuries. Liberal use of CR in patients with more severe duodenal injuries prevents DRM.