Effect of twelve-week concurrent aerobic and resisted exercise training in non-dialysis day on functional capacity and quality of life in chronic kidney disease patients.

OBJECTIVE: Several researchers have evaluated the impact of exercise training on patients with chronic kidney disease (CKD). However, few studies have evaluated the impact of concurrent training (aerobic and resisted exercise) on non-dialysis days on the functional capacity and quality of life (QOL) of such patients. Our current study evaluated the effects of concurrent training on functional capacity and QOL of patients with CKD. PATIENTS AND METHODS: Forty-three patients, aged ≥ 25 years, were recruited in this randomized study. They were divided into intervention and control groups (22 per group). The intervention group received concurrent aerobic and resistance exercises (three sessions per week for twelve weeks on alternative days). The control group continued their regular lifestyle practices and medical treatment without any exercise intervention. Before and after twelve weeks of training, the participant's functional capacity and quality of life (QOL) were measured. RESULTS: Compared to the control group, the intervention group displayed a significant improvement in the distance walked in the 6-minute walk test and sit-to-stand test (STS1/s and STS-60) with p<0.001; furthermore, a significant improvement was observed in physical function, body pain, general health, role functioning/physical, vitality, and social functioning (p<0.05) of QOL assessed with the SF-36 questionnaire. CONCLUSIONS: The twelve-week concurrent aerobic and resistance exercise training had a positive impact on functional capacity and QOL in CKD patients. Concurrent exercise training should be recommended as an interventional modality in physical therapy and rehabilitation protocols in CKD patients.

Hematological and histopathological changes of rat's hearts experimentally infected with protoscoleces.

Hydatidosis; is a zoonotic disease caused by Echinococcus granulosus and characterized by infiltration of inflammatory cells. This study was investigated the hematological and histopathological changes in the hearts of rats injected with protoscoleces. Rats were injected with protoscoleces collected from either liver of sheep, goats, and cows (from the abattoir of Al-Muthanna province, south of Iraq) or isolated from infected humans from Al-Hussein Teaching Hospital. Sheep protoscoleces showed a significant increase of lymphocytes that refer to the induction of a high response of the immune system in rats. The numbers of WBC, RBCs, and platelets were generally increased in rats injected with protoscoleces isolated from sheep and goats. These changes could refer to the activation of defense mechanisms against the hydatid injected materials. However, the levels of MCV, MCH, MCHC, MPV and PDW were less than normal values. Heart sections of rats injected with protoscoleces isolated from humans showed clear histological changes. While TSP, TGP and TCP exhibited variant histopathological changes such as infiltration of inflammatory cells, pink glass appearance and congestion of arteries. Thus, these alterations can be considered as additional evidence of how the immune response reacts against the injected materials in the heart.

Giardia duodenalis assemblages in Egyptian children with diarrhea.

Giardia duodenalis is considered the most common cause of parasitic diarrhea worldwide. Genetic studies revealed that at least eight assemblages (A-H) exist. Of these assemblages, A and B are found primarily in human beings and occasionally in animals. The association between clinical symptoms and G. duodenalis assemblages is controversial. The aim of the present study was to determine the assemblages of G. duodenalis prevalent among Egyptian children with diarrhea. Therefore, 96 positive stool samples for Giardia by light microscopy were subjected to multilocus genotyping targeting the triose phosphate isomerase (tpi), ß-giardin (bg), and glutamate dehydrogenase (gdh) genes. Amplified polymerase chain reaction (PCR) products were then purified, sequenced, and aligned with reference strains to determine the assemblages of the Giardia isolates. Out of the 96 microscopically positive stool samples for Giardia, 77 (80 %) were successfully amplified and sequenced at least at one locus. Of these, 21 (27.3 %) were shown to be assemblage A, 54 (70.1 %) assemblage B, while discordant sequence typing results were observed in 2 (2.6 %) samples. AII was the predominant subassemblage of assemblage A, while it was generally difficult to further classify assemblage B. It was concluded that infection with assemblage B was more common than that with assemblage A. No associations between epidemiological information and assemblage were detected, except with age. Although infections with assemblage B were more frequently associated with abdominal pain and acute diarrhea than with assemblage A, the difference was not statistically significant.

Assessment of platelet inhibition by point-of-care testing in neuroendovascular procedures.

Antiplatelet agents are an important component of the preventive strategies currently used in clinical practice to minimize the risk of thromboembolic events during and after endovascular procedures. Because of the variability in the response to antiplatelet agents, measuring the degree of platelet inhibition may help identify and properly treat poor responders. POC testing is defined as diagnostic testing at or near the site of patient care. Knowledge of the specifics of these devices among practicing neurointerventionalists is relatively limited. In this article, the different POC devices available are presented, and their clinical utility in relation to endovascular procedures is discussed.

Laboratory evaluation of Isaria fumosorosea against Spodoptera littoralis.

Isaria fumosorosea (syn. Paecilomyces fumosoroseus) is potentially useful for the biological control of economically important agricultural and forest insect pests. We evaluated efficacy of two strains of this entomopathogenic fungus against last instar larvae and pupae of Egyptian cotton leafworm, Spodoptera littoralis. The first strain was Apopka 97 which is an active ingredient of commercial biopesticide PreFeRal WG (Biobest, Belgium). The second strain was isolated from Cameraria ohridella and is currently deposited under number CCM 8367 as a patent culture in the Czech Collection of Microorganisms in Brno. Blastospores of both strains were obtained after 120 hours submerged cultivation in grow media using orbital shaker. The concentration of blastospores was adjusted to 5 x 10(7) spores/ml of suspension. Soaking agent Tween 80 was added to the suspension at concentration 0.02%. Lethal effects of both fungal strains on S. littoralis were evaluated using standard dip test. Treated insects were individually placed into plastic Petri dishes (diam. 9 cm) and kept at constant laboratory conditions (temperature 23 degrees C, R.H. approx. 100%, 16L:8D photoperiod). Virulence of the strains was expressed as percentages of cumulative daily mortality corrected for mortality in the control variant. Obtained results revealed higher virulence of CCM 8367 blastospores to the last instar larvae of S. littoralis (93.1% mortality) on the 7th day after the treatment compared to Apopka 97 (65.5% mortality). Even more obvious difference was found in pupae, where corrected mortality of CCM 8367-treated pupae was 80.0% while mortality in Apopka 97-treated pupae reached only 3.3% on the 8th day after the treatment. We can conclude that the strain I. fumosorosea CCM 8367 has strong insecticidal effects on S. littoralis and has a potential to be implemented as a novel biocontrol agent.

Point-of-care testing for anticoagulation monitoring in neuroendovascular procedures.

POC testing is defined as diagnostic testing at or near the site of patient care. Rapid measurement of the intensity of anticoagulation and, more recently, platelet inhibition allows dose titration of adjuvant medications such a heparin and antiplatelet agents during neuroendovascular procedures. However, knowledge among practicing physicians regarding the pathophysiologic basis of these measurements and variations in knowledge about the differences among devices is often limited. This review discusses the role of anticoagulation in endovascular procedures and the currently available POC tests for anticoagulation monitoring.

Occurrence and predictors of futile recanalization following endovascular treatment among patients with acute ischemic stroke: a multicenter study.

BACKGROUND AND PURPOSE: Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke. MATERIALS AND METHODS: Data from 6 studies of acute ischemic stroke treated with mechanical and/or pharmacologic endovascular treatment were analyzed. "Futile recanalization" was defined by the occurrence of unfavorable outcome (mRS score of > or = 3 at 1-3 months) despite complete angiographic recanalization (Qureshi grade 0 or TIMI grade 3). RESULTS: Complete recanalization was observed in 96 of 270 patients treated with IA thrombolysis. Futile recanalization was observed in 47 (49%). In univariate analysis, patients with futile recanalization were older (73 +/- 11 versus 58 +/- 15 years, P < .0001) and had higher median initial NIHSS scores (19 versus 14, P < .0001), more frequent BA occlusion (17% versus 4%, P = .049), less frequent MCA occlusion (53% versus 76%, P = .032), and a nonsignificantly higher rate of symptomatic hemorrhagic complications (2% versus 9%, P = .2). In logistic regression analysis, futile recanalization was positively associated with age > 70 years (OR, 4.4; 95% CI, 1.9-10.5; P = .0008) and initial NIHSS score 10-19 (OR, 3.8; 95% CI, 1.7-8.4; P = .001), and initial NIHSS score > or = 20 (OR, 64.4; 95% CI, 28.8-144; P < .0001). CONCLUSIONS: Futile recanalization is a relatively common occurrence following endovascular treatment, particularly among elderly patients and those with severe neurologic deficits.

Mastitis in dairy buffalo and cattle in Egypt due to Clostridium perfringens: prevalence, incidence, risk factors and costs.

Although Clostridium perfringens is recognised as an important cause of clostridial enteric diseases, there is only limited knowledge about the association of particular C. perfringens toxinotypes (types A to E) with mastitis in domestic animals. In this study, mastitis was detected in 213/623 (34.12%) and 8/83 (9.64%) of the quarter milk samples collected from cases of clinical mastitis in cows and buffalo, respectively. The micro-organism was isolated in an incidence of 16/357 (4.48%) of milk samples from cows and 1/25 (4.0%) of samples from buffalo. Infection in one quarter was the most typical situation found (83% in cows and 87% in buffalo). Clostridium perfringens infection was also correlated to the season, with the highest proportion of isolates being found during spring (10.71%) and winter (7.07%). Using the classical toxin neutralisation typing method, 17 strains, isolated from cow and buffalo milk, were identified as C. perfringens type A, and selected for molecular analysis. Polymerase chain reaction detected the oecpa gene while the P/cpb and e/etx genes went undetected. The authors believe that C. perfringens has the potential to produce disease on its own or to predispose the udder to disease caused by major mastitis and environmental pathogens.

Endovascular interventions following intravenous thrombolysis may improve survival and recovery in patients with acute ischemic stroke: a case-control study.

BACKGROUND AND PURPOSE: Since the introduction of recombinant tissue plasminogen activator (rtPA) into clinical practice in the mid 1990s, no adjunctive treatment has further improved clinical outcomes in patients with ischemic stroke. The safety, feasibility, and efficacy of combining intravenous (IV) rtPA with endovascular interventions has been described; however, no direct comparative study has yet established whether endovascular interventions after IV rtPA are superior to IV rtPA alone. A retrospective case-control study was designed to address this issue. MATERIALS AND METHODS: Between 2003 and 2006, 33 consecutive patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores >/=10 were treated with IV rtPA in combination with endovascular interventions (IV plus intervention) at a tertiary care facility. Outcomes were compared with a control cohort of 30 consecutive patients treated with IV rtPA (IV only) at a comparable facility where endovascular interventions were not available. RESULTS: Baseline parameters were similar between the 2 groups. We found that the IV-plus-intervention group experienced significantly lower mortality at 90 days (12.1% versus 40.0%, P = .019) with a significantly greater improvement in NIHSS scores by the time of discharge or follow-up (P = .025). In the IV-plus-intervention group, patients with admission NIHSS scores between 10 and 15 and patients /=10, there was a suggestion of incremental clinical benefit among patients receiving endovascular interventions following standard administration of IV rtPA.

Competitive exclusion of Yersinia enterocolitica biotype 4, serotype O:3 by Yersinia enterocolitica biotype 1A, serotype O:6,30 in tissue culture and in pigs.

AIMS: To study the adhesion properties of a biotype 4, serotype O:3 (human pathogenic) strain of Yersinia enterocolitica and to determine if adhesion in vitro and colonisation in vivo can be prevented by competition with a biotype 1A, serotype O:6,30 (non-pathogenic) strain. To study interaction between Y. enterocolitica biotype 4, serotype O:3 and cultured epithelial cells using the synthetic tripeptide arginine-glycine-aspartic acid (RGD). METHODS: The human intestinal epithelial (HEp-2) cell line was used for in vitro studies. Inocula of Y. enterocolitica biotype 4, serotype O:3 radiolabelled using tritium were incubated with HEp-2 cells and RGD tripeptide, or with Y. enterocolitica biotype 1A, serotype O:6,30 sequentially or concurrently, then washed and lysed, and radioactivity measured to determine the effect of RGD on adhesion, and competitive exclusion of pathogenic by non-pathogenic bacteria. For in vivo studies, two groups of 5-week-old piglets (n=5/group) were sequentially inoculated orally with 5 x 10(9) colony forming units (cfu) of either a non-pathogenic biotype 1A, serotype O:6,30 strain of Y. enterocolitica followed by a pathogenic biotype 4, serotype O:3 strain, or vice versa. Pigs were monitored for carriage of strains using bacterial culture and a multiplex polymerase chain reaction (PCR). RESULTS: The RGD tripeptide significantly inhibited adherence of the pathogenic Y. enterocolitica strain to cultured epithelial cells, suggesting that adhesion involved the RGD tripeptide sequence. The non-pathogenic biotype 1A, serotype O:6,30 strain of Y. enterocolitica prevented adhesion of the pathogenic strain to cells in vitro when allowed to adhere first. Pathogenic Y. enterocolitica was consistently isolated from rectal swabs from 80-100% of pigs on all sampling occasions but not from oral swabs after 14 days in pigs first inoculated with the non-pathogenic strain or at 26 days in pigs first inoculated with the pathogenic strain. CONCLUSIONS: A non-pathogenic strain of Y. enterocolitica reduced adhesion of a human pathogenic strain in vitro but not in vivo.

Occurrence and distribution of Fusarium species in maize fields in New Zealand.

Fusarium populations were investigated in maize grains and their husks about six weeks before harvest in three maize fields in the Manawatu region of New Zealand. The role of litter and soil as reservoirs for these fungi was also examined. Two techniques were used to examine populations, dilution plating and direct plating. Using the dilution plating technique the highest overall populations were found in husks (mean 2.2 x 10(5)/g) and litter (mean 1.4 x 10(5)/g), while similar lower numbers of viable propagules were obtained from grain (mean 2.1 x 10(3)/g) and soil (2.8 x 10(3)/g). With this technique five Fusarium spp. were commonly isolated; F. graminearum (Gibberella zeae), F. culmorum, F. subglutinans, F. oxysporum and F. acuminatum, of which F. graminearum was the most abundant. With the direct plating technique 87% of grains were infected with Fusarium spp., with some grains being infected with more than one species. Segments from husks and litter, 70% and 43% respectively, were colonised by Fusariumr spp. F. graminearum was the most frequent species isolated from maize grain and husk segments (48.3 and 37.7% colonisation respectively). Other species, particularly F. culmorum and F. acuminatum, were also found to be common contaminants. A total of 15 Fusarium spp. was recovered from all material examined by both techniques. Cultures with characteristics resembling those of F. moniliforme were rarely observed.

Leiomyoma of the urinary bladder: case report.

A case of leiomyoma of urinary bladder, a rare benign tumour, is presented. The patient was a 42 year old female who presented with dysuria and frequency of micturition. The radiological features, diagnosis and management are discussed and the literature on this subject is briefly reviewed.

A rapid and sensitive method for the detection of Yersinia enterocolitica strains from clinical samples.

AIMS: To compare three culture methods to detect Yersinia enterocolitica from oral or rectal swabs from experimentally infected pigs. METHODS AND RESULTS: The three methods used were: direct plating on Cefsulodin-Irgasan-Novobiocin (CIN) agar, cold enrichment in phosphate buffered saline (PBS) followed by plating on CIN agar and selective enrichment with Luria-Bertani-Bile Salts Irgasan (LB-BSI) followed by plating on CIN agar. Selective enrichment with LB-BSI produced the highest recovery rate (63%), when compared with cold enrichment (52%) and plating on CIN agar alone (43%). Selective enrichment with LB-BSI was significantly (P < 0.02) more sensitive than direct plating on CIN agar and more sensitive than cold enrichment (P < 0.1). CONCLUSIONS, SIGNIFICANCE AND IMPACT OF THE STUDY: Selective enrichment with LB-BSI was more sensitive than the widely accepted method of cold enrichment and it reduced the time required for detection of Y. enterocolitica by three weeks. Selective enrichment with LB-BSI was also compatible with a multiplex PCR technique.

Schistosoma mansoni egg specific antibodies and circulating antigens: assessment of their validity in immunodiagnosis of schistosomiasis.

A total of 127 individuals of different age and sex; 92 from Kafr-Sendewa, Qualyobia Governorate, Egypt, in comparison to 23 cases with hydatidosis and fascioliasis as a parasitic control group, and 12 healthy control group from non-endemic area. All cases were screened by clinical examination, urine, stool, rectal snip, abdominal ultrasonographic examination and indirect haemagglutination test (IHAT). Accordingly, they were grouped into active intestinal schistosomiasis group, seropositive group by (IHAT), normal control group from the same endemic area, parasitic control group and normal control group. All cases were subjected to detection of IgG, IgM, IgG4, anti-soluble egg antigen (SEA) and anti-excretory-secretory egg antigen (ESEA) by ELISA tests; and circulating egg antigens by double-sandwich ELISA techniques. The results showed that IgG4 anti-SEA is the best diagnostic test, as it gave the best diagnostic efficacy (90%). Also, it is a good screening test which can be used in endemic area as it gave significant difference between the active intestinal schistosomiasis cases with each of the endemic control group (P < 0.001) and the seropositive cases (P < 0.05). Other valid diagnostic egg specific antibodies tests were IgM anti-SEA and IgG anti-SEA as their diagnostic efficacy were 80% and 76.6% respectively (P < 0.05). The diagnostic efficacy of circulating antigen detection (C.Ag) test was 70% (P < 0.05). In addition, it was the most specific test with 100% specificity. IG4-anti-ESEA gave the least cross-reaction with other parasites (17.3%). The mean optical density (OD) level of circulating antigen detection test was significantly higher in the organomegalic (hepatosplenomegaly) cases than the non-organomegalic cases (P < 0.05).

Host and parasite determinants of morbidity in Egyptian children with schistosomiasis.

The relation of morbidity due to schistosomiasis in Egyptian children to egg count, eosinophilic count, antibodies mediating eosinophil damage to schistosomula, total immunoglobulins and specific antischistosomal antibodies IgG and IgM anti-cercarial antigen preparation (CAP), anti-soluble worm antigen preparation (SWAP) and anti-soluble egg antigen preparation (SEA) were evaluated. The behavior of the immune parameters after treatment was also determined. The studied children were 78 males, aged 9-11 years. They were classified to control (14), simple intestinal (26) and hepatosplenic schistosomiasis (38) groups according to the clinical, parasitological and sonographic basis. The egg count was found higher in hepatosplenic schistosomiasis compared to that in simple group. Eosinophilic count did not differ between the two groups. Studies of immune responses revealed that antibodies mediating eosinophil adherence and damage to schistosomula rose in both groups particularly in hepatosplenic group. The levels of total and specific immunoglobulins were not significantly differed in both groups. The immune response was measured 2 months after treatment. The level of total IgA was increased in simple and decreased in hepatosplenic group. Total IgG and IgM were not affected by treatment in simple but IgM increased in hepatosplenic after treatment. Total IgE was decreased after treatment in both groups. This denotes that the behavior of the two groups after treatment was similar as regards the levels of IgG and IgE and differed as regards IgA and IgM. IgG anti-CAP and anti-SEA were declined after treatment but IgG- anti SWAP was elevated after treatment in both groups. The treatment has no effect on the levels of specific IgM against all used antigens. The antibodies mediating eosinophil adherence and damage to schistosomula rose in both groups after treatment. These indicated consistency of specific immune responses after treatment in schistosomal children. It is concluded that high intensity of infection may be one of the determinants of morbidity due to Schistosoma mansoni infection in Egypt. The elevated response of antibodies mediating adherence and damage to schistosomula may be associated or play a role with morbidity. Eosinophilic count, total IgA, IgG, IgM, IgE and specific antischistosomiasis IgG and IgM (Anti-CAP, anti-SWAP and anti-SEA) are not related to morbidity.

Evaluation of the effectiveness of dipstick haematuria and proteinuria in screening Schistosoma haematobium infection among school children in upper Egypt.

This study aimed at evaluation of validity and reliability of dipstick haematuria and proteinuria in screening school children for Schistosoma haematobium infection. It included a random sample of 400 school children aged 6-15 years in rural area of Fayoum Governorate, upper Egypt. Urine samples of the studied children were tested parasitologically by urine filtration technique as a reference test and semiquantitatively for haematuria and proteinuria using urine reagent strips as screening tests. Results of the study revealed that haematuria was a better indicator for Schistosoma haematobium infection than proteinuria, as it was more sensitive (85.5% 73.4%, respectively), specific (94.4% 82.9%, respectively) and reliable (kappa=92% 80%, respectively). Moreover, it had stronger relationship with intensity of infection (r=0.88 & 0.67, respectively). A combination of different grades of haematuria and proteinuria did not significantly increase either sensitivity or specificity. Dipstick haematuria could be a valuable technique in screening rural Egyptian school children who are at risk of urinary schistosmiasis.

Time factor and eosinophil count in relation to experimental Schistosoma mansoni infection.

The effects of diurnal variations of eosinophils on hostparasite relationship was studied in mice primarily exposed to S. mansoni infection. The eosinophil counts of 20 control normal mice showed different variations at different hours of the day with maximum level at midday and the minimum level at midnight. At these times, 2 groups of mice, each consists of 30 mice, were infected by about 100 S. mansoni cercariae. The infected mice in both groups showed more or less the same results as regards the worm burden, egg counts in tissues and histopathological changes in livers. Both infected groups showed marked eosinophil elevation versus normal control group yet the difference in-between them was insignificant. This means that the normal physiological variation in eosinophils in normal mice is useless in protection against infection. Complete ablation of eosinophils from animal using antieosinophilic sera, is essential for any study on eosinophils in relation to infection.

Adiaspiromycosis in suspected cases of pulmonary tuberculosis in the common brushtail possum (Trichosurus vulpecula).

Pulmonary adiaspiromycosis was diagnosed in 15 of 17 common brushtail possums (Trichosurus vulpecula) examined for bovine tuberculosis. Emmonsia crescens was isolated from two of the affected animals. This is the first reported isolation of this dimorphic fungus in New Zealand. The infections varied from light to heavy with sparsely distributed, focal, 1-2 mm diameter, grey-white spherical granulomas in the lightly infected cases to innumerable foci throughout the lungs in the heavily infected cases. Histologically, the lesions were characterised by a central fungal adiaspore consistent in morphology with E. crescens located in alveolar spaces or bronchioles. These were surrounded by a cuff of granulomatous inflammation which varied in density and extent in proportion to the degree of degeneration exhibited by the organism. The lesions in most cases of adiaspiromycosis in the possum are sufficiently distinctive to allow their differentiation from tuberculosis by gross examination, but where any doubt exists over the possibility of dual infection by Emmonsia and Mycobacterium species differentiation should be made on the basis of a histological examination of the tissue and culture for mycobacterial organisms.

Evaluation of cercarien hullen reaction (CHR) as a diagnostic test in chronic schistosomiasis and as a parameter for reinfection in acute cases.

CHR was evaluated as a serodiagnostic test in relation to stool analysis, rectal snip and indirect haemagglutination test (IHA) in 25 cases with chronic active mansonian schistosomiasis. Sensitivities of CHR, IHA, rectal snip and stool analysis, respectively, proved to be 68%, 48%, 84% and 52%. Rectal ship showed higher diagnostic efficacy 90% followed by CHR (77.5%), while IHA showed 67.5% diagnostic efficacy. To study CHR as parameter for pattern of reaction after treatment, 120 school children with acute mansonian schistosomiasis were examined CHR was done before and one month after treatment. These children were followed up for one year by stool examination. Results of CHR test after treatment showed that the children who were not reinfected gave the highest degree of reaction, while those of high reinfection showed decrease in reaction. This denotes that anticercarial antibodies may play a role in resistance to reinfection and CHR test could be used as parameter for reinfection in such cases.