ENCEPHALOPATHY TREATED AFTER SURGERY FOR GRAVES' DISEASE.

Introduction: This case report is the fourth of its type in the medical literature. It describes total thyroidectomy for recurrent relapses of Graves encephalopathy (GE) despite medical treatment. Case presentation: A 33-year-old male presented with impaired consciousness and convulsions. He had post-thyroid surgery recurrent Graves' disease with a goitre. Based on this fact, high thyroid antibodies titres and the exclusion of other causes of such neurological manifestations, he was diagnosed to have GE. This is a rare variant of "encephalopathy associated with autoimmune thyroid disease" (EAATD). Despite the administration of steroid therapy and other standard therapeutic measures, he developed five relapses within 17 months. Total thyroidectomy was advised. Unfortunately, he got another severe attack that required intensive care admission. After three days of discharging, he had urgent total thyroidectomy. The operation went well and for 18 months' follow-up he had no more attacks. However, thyroid antibodies remained high. Discussion: The report provides details on the diagnosis, standard management and the indication for thyroidectomy for GE. It describes its challenges, precautions, technique and outcomes. It reviews the extent of surgery as well as the clinical and antibody outcomes of the previous three related reports, in comparison with the current one. Conclusion: For medically uncontrolled relapse of GE, thyroidectomy consistently results in ending the attacks. It, therefore, should be put in more consideration in the treatment protocols. On the other hand, one should not depend on antibody levels as a measure of treatment success.

Design, synthesis, molecular modeling and anti-hyperglycemic evaluation of novel quinoxaline derivatives as potential PPARγ and SUR agonists.

In our effort to develop potent anti-hyperglycemic agents with potential agonistic activities toward PPARγ and SUR, three novel series of quinoxaline derivatives bearing sulfonylurea or sulfonylthiourea moieties with different linkers were designed and synthesized. Some of the newly synthesized compounds were evaluated in vivo for their anti-hyperglycemic activities in STZ-induced hyperglycemic rats. Compounds 15a, 15e, 19b and 24a exhibited the highest anti-hyperglycemic activities with % reduction in blood glucose level of (50.58, 43.84, 45.10 and 49.62, respectively). Additionally, eight compounds revealed potent anti-hyperglycemic activities were further evaluated in vitro for their PPARγ binding affinity and insulin-secreting ability as potential mechanisms for anti-hyperglycemic activity. Four compounds (15a, 15b, 15d and 15e) significantly bound to PPARγ with IC50 values of 0.482, 0.491, 0.350 and 0.369µM, respectively. Moreover, Compounds 15a and 15b have demonstrated induction of insulin-secretion with EC50 values of 0.92 and 0.98µM, respectively. Furthermore, molecular docking and pharmacophore generation techniques were carried out to investigate binding patterns and fit values of the designed compounds with PPARγ and SUR, respectively.

Isolation and molecular characterization of Newcastle disease virus genotypes II and VIId in Egypt between 2011 and 2012.

The current study was conducted to isolate and characterize Newcastle disease virus (NDV) from recent outbreaks affecting poultry farms in Egypt between 2011 and 2012. Trachea, spleen, liver, proventriculus and caecal tonsils were collected from clinically infected NDV ten different vaccinated broiler farms in Fayoum, Behira and Giza Provinces. Inoculation of all the collected samples in 10-day-old embryonated chicken specific-pathogen-free eggs resulted in isolation of haemagglutinating agents in three samples. These haemagglutinating agents were confirmed as NDV by real-time reverse transcription polymerase chain reaction (rt RT-PCR) using matrix (M) gene-specific primers. The deduced amino acid sequences of the fusion protein revealed that one isolate possessed the motif (112)RRQKRF(117) at the cleavage site, indicating that this isolate is velogenic genotype, whereas the other two isolates carries the motif (112)GRQGRL(117) indicating they are lentogenic genotype. The phylogenetic analysis revealed that the velogenic genotype isolate clustered with published class II genotype VII sub genotype d NDVs and closely related to Middle East isolates, whereas the other two isolates clustered with published class II genotype II NDVs. The spread of velogenic genotype strain to Egypt via Middle Eastern countries is likely to be the source of infection.

Oxidized Low-density Lipoproteins and Lipopolysaccharides Augment Carotid Artery Plaque Vulnerability in Hypercholesterolemic Microswine.

Atherosclerosis is a chronic inflammatory disease and hypercholesterolemia is a risk factor. This study aims to compare the potency of lipopolysaccharide (LPS) and oxidized low-density lipoproteins (oxLDL) to induce plaque formation and increase plaque vulnerability in the carotid artery of hypercholesterolemic Yucatan microswine. Atherosclerotic lesions at the common carotid artery junction and ascending pharyngeal artery were induced in hypercholesterolemic Yucatan microswine at 5-6 months of age with balloon angioplasty. LPS or oxLDL were administered intraluminally at the site of injury after occluding the arterial flow temporarily. Pre-intervention ultrasound (US), angiography, and optical coherence tomography (OCT) were done at baseline and just before euthanasia to assess post-op parameters. The images from the US, OCT, and angiography in the LPS and the oxLDL-treated group showed increased plaque formation with features suggestive of unstable plaque, including necrotic core, thin fibrous caps, and a signal poor region more with oxLDL compared to LPS. Histomorphology of the carotid artery tissue near the injury corroborated the presence of severe lesions in both LPS and oxLDL-treated pigs but more in the oxLDL group. Vascular smooth muscle and endothelial cells treated with LPS and oxLDL showed increased folds changes in mRNA transcripts of the biomarkers of inflammation and plaque vulnerability compared to untreated cells. Collectively, the results suggest that angioplasty-mediated intimal injury of the carotid arteries in atherosclerotic swine with local administration of LPS or ox-LDL induces vulnerable plaques compared to angioplasty alone and oxLDL is relatively more potent than LPS in inducing vulnerable plaque.

Influence of nano-silica additions on hydration characteristics and cytotoxicity of calcium aluminate as biomaterial.

Composites of nano-calcium aluminate 'CA' biocement, synthesized by a solid state reaction, were prepared with 5, 10 and 20 wt.% of nano-SiO2 particles. The influence of nano-SiO2 particle additions on the physico-mechanical properties and hydration characteristics of CA biocement was studied. Calcium ion concentrations and, pH values of the curing medium were measured. The hydration characteristics of pure and composite CA phase were studied by determining the X-ray diffraction (XRD) and scanning electron microscopy (SEM) coupled with energy dispersive spectroscopy (EDS). Evaluation of cytotoxicity against the skin normal human cell line BJ-1 was carried out. The results showed that the bulk density and micro-hardness of the composite CA containing 10 wt.% of nano-SiO2 were better than those of pure CA and composite prepared with higher weight percentages of nano-SiO2. Both pure and composite CA bio-cements showed no cytotoxicity, making these materials suitable for medical applications.

Physico-mechanical characteristics of tri-calcium silicate pastes as dentin substitute and interface analysis in class II cavities: effect of CaCl2 and SBF solutions.

The influence of using simulated body fluid (SBF) as a curing medium on some characteristics of pure single tri-calcium silicate (C3S) bio-cement was investigated. CaCl2 salt solution was used as an accelerating liquid for setting and hardening of C3S pastes in comparison with distilled water (DW). Solid state reaction was applied to synthesis C3S phase at elevated temperature followed by rapid cooling. The results showed that 10 wt.% CaCl2 solution was the optimum concentration that showed the lowest setting time (106 min). C3S pastes prepared with CaCl2 solution have better physical and mechanical properties than those mixed with DW even after curing under SBF solution for the different curing ages. However, SBF solution has an adverse effect on the hydrated compound C-S-H that results in a little decrease in strength and hardness values. The elemental analysis emphasized the presence of apatite layer on the surface of the hardened C3S paste. Scanning electron microscopy (SEM) photomicrographs and elemental analysis revealed reliable adaptation of the experimentally prepared C3S paste to the tooth structure, in addition to its bioactivity makes it a consistent material to be used as dentin substitute.

Design, synthesis, molecular modeling and anti-proliferative evaluation of novel quinoxaline derivatives as potential DNA intercalators and topoisomerase II inhibitors.

New series of [1,2,4]triazolo [4,3-a]quinoxaline and bis([1,2,4]triazolo)[4,3-a:3',4'-c]quinoxaline derivatives have been designed, synthesized and biologically evaluated for their cytotoxic activities against three tumor cell lines (HePG-2, Hep-2 and Caco-2). Compounds 16e, 21, 25a and 25b exhibited the highest activities against the examined cell lines with IC50 values ranging from 0.29 to 0.90 µM comparable to that of doxorubicin (IC50 ranging from 0.51 to 0.73 µM). The most active members were further evaluated for their topoisomerase II (Topo II) inhibitory activities and DNA intercalating affinities as potential mechanisms for their anti-proliferative activities. Interestingly, the results of Topo II inhibition and DNA binding assays were consistent with that of the cytotoxicity data, where the most potent anti-proliferative derivatives exhibited good Topo II inhibitory activities and DNA binding affinities, comparable to that of doxorubicin. Moreover, the most active compound 25a caused cell cycle arrest at G2/M phase and induced apoptosis in Caco-2 cells. In addition, Furthermore, molecular docking studies were performed for the novel compounds against DNA-Topo II complex to investigate their binding patterns. Based on these studies, it was concluded that DNA binding and/or Topo II inhibition may contribute to the observed cytotoxicity of the synthesized compounds.

Influence of saline solution on hydration behavior of ß-dicalcium silicate in comparison with biphasic calcium phosphate/hydroxyapatite bio-ceramics.

The influence of using saline solution as mixing and curing liquid on some characteristics of ß-dicalcium silicate (ß-C2S) and biphasic compound tri-calcium phosphate/hydroxyapatite (TCP/HAp) bio-ceramics was investigated. ß-C2S (27-30 nm) was prepared by solid state reaction at 1450°C, while biphasic compound TCP/HAp (7-15 nm) was synthesized from an aqueous solution of Ca(NO3)2·4H2O and (NH4)2HPO4·12H2O by chemical precipitation method. Setting times, compressive strength, pH values, X-ray diffraction analysis, infrared spectroscopy, scanning electron microscopy (SEM) were investigated. The evaluation of cytotoxicity of both calcium silicate and biphasic compounds to human gingival fibroblasts was carried out. The use of saline solution as mixing and immersing liquid shortened the setting time for the two bio-cements. TCP/HAp did not show any mechanical strength but ß-C2S showed good strength values. Both synthesized compounds showed a moderate cytotoxicity and both materials were effective in a no significant way.

Breast-feeding in Egypt.

Planning, implementation and evaluation of programmes to promote appropriate infant feeding practices require detailed, current information about these practices in the target populations. To estimate the prevalences and identify the correlates of overall breast-feeding and of exclusive breast-feeding in different age periods during infancy, a cohort of 152 apparently healthy neonates and their mothers were followed during October 1987 through April 1989 in rural Bilbeis, Sharqiya Governorate, Egypt. Feeding data were collected through twice weekly home visits thus reducing the potential for bias in our findings due to respondent recall errors. The prevalence of overall breastfeeding in the infants declined from 100% in age period 0-11 weeks to 89% in age period 36-47 weeks. Mothers with previous living children were associated with significantly higher (odds ratio [OR]: 6.53, 95% confidence interval [CI]: 1.33-32.09) and ownership of refrigerators was associated with significantly lower (OR: 0.18, 95% CI: 0.05-0.67) overall breast-feeding prevalences in age periods 24-35 and 36-47 weeks, respectively. The prevalence of exclusive breast-feeding in breast-fed infants dropped from 20% in age period 0-11 weeks to 0% in age period 36-47 weeks. After multivariate adjustment, prelacteal feeding was significantly negatively (OR: 0.12, 95% CI: 0.04-0.37) associated with exclusive breast-feeding in age period 0-11 weeks. Nearly 90% of Bilbeis infants were breast-fed at age 47 weeks, but the initiation of supplementation at 0-11 weeks in 80% of breast-fed infants is contrary to current recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: To estimate the prevalence of breast feeding in rural Egypt, a prospective cohort study involving 152 healthy neonates from four villages in Bilbeis was conducted. Infant feeding data were collected at twice weekly home visits from October 1987-April 1989; new infant-mother pairs were added to the study each month during the first year of research. The study infants represented 57% of the total births in the four villages during the recruitment period. All infants were exclusively or partially breast-fed during the first 11 months of life; this prevalence dropped to 98% in weeks 12-23 and to 89% in weeks 36-47. However, only 20% of infants were exclusively breast-fed in the first 11 weeks of life. Multivariate analyses indicated that involvement of a wet nurse, avoidance of prelacteal feeds, previous living children, non-ownership of a refrigerator, delivery by traditional birth attendants, and an uncomplicated labor and delivery were associated with higher prevalences of partial or exclusive breast feeding. There was no association of maternal ability to read and write, prenatal care use, and television ownership to breast feeding patterns. Mothers of higher socioeconomic status tended to terminate breast feeding significantly earlier than their less well-off counterparts. These findings point to a need for programs that discourage the supplementation of breast milk in the first four months of life.

Anti-apolipoprotein A-1 antibodies and carotid intima-media thickness in Egyptian women with systemic lupus erythematosus.

The objective of the study was to evaluate anti-apolipoprotein A-I (Apo A-I) and carotid intima-media thickness (cIMT) as cardiovascular risk factors in Egyptian women with systemic lupus erythematosus (SLE). The study included 160 subjects, 80 women with SLE and 80 healthy women as a control group. Disease activity score (SLEDAI), disease damage index (SLICC/ACR), lipid profile, complement C3 and C4, high-sensitivity CRP (hsCRP), anti-dsDNA and anticardiolipin antibodies were evaluated in addition to anti-Apo A-I antibodies and cIMT. The mean age of patients was 28.35 ± 7.06 years with mean disease duration of 4.58 ± 3.36 years. Anti-Apo A-I antibody titer was significantly higher in SLE patients than in controls (mean 35.3 ± 6.8 vs. 21.4 ± 5.91 U/L; P = 0.000). Carotid ultrasound showed significantly thickened intima in SLE patients compared with control subjects (mean thickness, 0.5 ± 0.08 vs. 0.45 ± 0.06 mm; P = 0.003). Correlation studies with other cardiovascular risk factors demonstrated significant associations between anti-Apo A-I and SLEDAI, SLICC/ACR, C3 and C4. On the other hand, cIMT showed significant association with age, systolic blood pressure, hsCRP and body mass index. Thus, SLE disease activity is associated with a significant increase in anti-Apo A-I titer. Also, increased cIMT might be a cardiovascular risk factor in Egyptian patients with SLE.

Prelacteal infant feeding practices in rural Egypt.

Data collected during a prospective cohort study of infant feeding and health in rural Bilbeis, Egypt, were analysed to define prelacteal infant feeding practices, identify their determinants, and assess whether these practices were predictive of breastfeeding and supplementation patterns and diarrhoea incidence during infancy. Sixty per cent (89/149) of study infants were prelacteally fed sugar-water, teas, or both. Lack of milk in the mother's breast (74 per cent), and maternal exhaustion or illness following labour (29 per cent) were the two most commonly stated reasons for prelacteal feeding. After multivariate adjustment, significantly higher incidence of prelacteal feeding was associated with childbirth during the warmer months [odds ratio (OR): 2.4; 95 per cent confidence interval (CI): 1.1-5.1], birth attendants with modern training (OR: 5.5; 95 per cent CI: 1.7-17.5), and labour lasting > 8 hours (OR: 2.3; 95 per cent CI: 0.1-4.9). Prelacteally fed infants were significantly less likely to be exclusively breastfed in age periods 0-3, 4-7, and 8-11 weeks. Diarrhoea incidence was higher among prelacteally fed infants in age periods 0-11, 12-23, and 36-47 weeks. Indiscriminate practice of prelacteal feeding and early supplementation of breastfeeding need to be discouraged.

The timing of breastfeeding initiation and its correlates in a cohort of rural Egyptian infants.

Recent data on the patterns and correlates of the timing of breastfeeding initiation in newborns are scanty for many countries including Egypt. To obtain such data in four villages in rural Bilbeis, we recruited apparently healthy, single neonates and their apparently healthy mothers within 4 days of child birth, and followed them prospectively during 1987 through 1989. All 150 neonates included in the analyses were breastfed for some duration. At the time of the first breastfeed, 36, 37, and 27 per cent of the neonates were aged < 2, 2-5, and > or = 6 hours, respectively. All neonates had received the first breastfeed by age 72 hours. In a multivariate, polytomous logistic regression model, modern birth attendants and longer ( > 8 hours) duration of labour were significantly associated with deferment of breastfeeding initiation till the neonate was aged > or = 6 hours. Breastfeeding initiation appeared to be unduly delayed in our study mothers and infants given that they were apparently healthy during the early post-partum period. Later initiation of breastfeeding was associated with indiscriminate prelacteal feeding, earlier termination of breastfeeding, and unwelcome supplementation practices. Our findings emphasize the need to initiate and/or strengthen programmes to promote appropriate breastfeeding practices in Bilbeis and other comparable areas.

Hysterographic orientation of IUDs in relation to menstrual blood loss.

PIP: To correlate the position and orientation of different models of MLCu IUDs in utero with incidence of side effects, 35 married, nonlactating, and sexually active women, 18-24 years of age and with regular menstrual periods were studied. All had been pregnant at least once and had had at least 3 menstrual periods after the last delivery or 2 periods after the last abortion. A physical and gynecological examination was performed. The women were divided into 4 groups: 30 women (3 groups of 10 patients) were fitted with standard MLCu 250, short MLCu 250, and MLCu 375 IUDs. The 4th group consisted of 5 women in whom MLCu 250 mini was inserted. Menstrual blood loss collected in cotton pads of constant weight provided by the investigator. The women were carefully instructed on how to collect their menstrual blood, and polyethylene bags were supplied to them. Menstrual blood loss was calculated. Follow-up visits were planned at monthly intervals, and questions about side effects were asked. In 30 women hysterography was done twice. Initially, it was performed following the 1st postinsertion menstruation. A 2nd hysterogram was performed following the 3rd postinsertion menstruation. The IUD was properly oriented in utero in 20 cases (67%). These were fitted with short MLCu 250 (8 cases), MLCu 375 (6 cases), Standard MLCu 250 (4 cases), and mini MLCu 250 (2 cases). The other 2 patients had small uterine cavities fitted with mini devices. Device displacement was noted in 10 cases among those fitted with MLCu 250, Standard (2 cases), MLCu 250 mini (3 cases), MLCu 375 (2 cases). Subjective increased menstrual blood loss was reported in 11 cases. There was no significant difference between pre- and postinsertion menstrual blood loss. Intermenstrual bleeding was reported in 3 cases, 1 fitted with a short MLCu 250 and 2 cases fitted with MLCu 375. Hysterographically the device was properly oriented in 2 cases with a large uterus. 5 cases had a moderate degree of dysmenorrhea, 1 case fitted with short MLCu 250, 3 cases with standard MLCu 250, and 1 case with MLCu 375. Hysterographically the device was displaced in utero in 2 cases, and most of the cases had a large size uterus. All these patients experienced no dysmenorrhea prior to IUD insertion. Moderate deep seated pelvic pain and low abdominal cramps were experienced in 3 cases, a case in each group of those fitted with different models of MLCu 250. Pain was not reported in patients fitted with MLCu 375.^ieng