Somatosensory evoked potential for detection of subclinical neuropathy in Egyptian children with acute lymphoblastic leukaemia.

To evaluate neurological changes developing during paediatric Acute Lymphoblastic Leukaemia (ALL) therapy clinically and through electrophysiological Study of Somatosensory Evoked Potentials (SSEPs) changes in different phases of therapy. Thirty five-ALL patients with age range from 3-14 years were included compared to 30 healthy controls. History, neurological examination, complete blood counts, cytological examination of bone marrow aspirate and cerebrospinal fluid with Measurement of Serum Methotrexate (MTX) were done. The SSEPs were performed and patients subjected to another SSEP with measurement of serum MTX level before and 10 days after intra-thecal injection (IMTX). Clinical neurological findings in patients after induction were depressed deep tendon reflexes (43.3%), hypotonia (28.6%), lost pain sensation (28.6%), muscle weakness (17.1%) and movement disorders (17.1%). Percentage of delayed SSEPs after induction were at levels of brachial plexus (28.6%), spinal cord (68.6%), cortical conduction (31.4%), ERB-N13 Inter Peak Latency (IPL) (74.3%) and N13-N20 IPL (17.1%) in the studied patients. Significant prolonged latency of N13 (p = 0.005), N20 (p = 0.04) and IPL of ERB-N 13 (p = 0.005), N13-N20 (p = 0.01), Inter-Side Difference (ISD) of N13 (p = 0.01), ERB-N13 (p = 0.02) and N13-N20 (p = 0.03) after induction compared to values at diagnosis. Significant positive correlation were found between serum MTX after IMTX with N13-N20 IPL (p = 0.01), N20 ISD (p = 0.03) with significant prolongation in N20 latency, N13-N20 IPL and ISD of N20 compared to values before injection. ALL patients have prolonged latency of SSEPs at cervical cord and cortical levels which increased after IMTX due to axonal injury throughout the cord. SSEPs could be an early diagnostic tool for subclinical neuropathy.

Frequency of inhibitor development in severe haemophilia A children treated with cryoprecipitate and low-dose immune tolerance induction.

The frequency of factor VIII inhibitor development was evaluated in a hundred severe haemophilia A patients < 18 years of age (mean 10.4 +/- 5.1 years); 25 were previously untreated patients (PUPs), with a mean age of 11.2 +/- 2.9 months. All were followed up for 3 years from December 1996. Immune tolerance (IT) was induced with low-dose factor VIII (FVIII); 25-50 IU kg(-1) every other day for the 10 haemophiliacs who developed persistent inhibitors. The incidence of inhibitors for PUPs was 3/25 (12%; 95% confidence interval [CI], 0. 7-24.7%) and were detected after 4, 15 and 20 exposure days (mean 13 +/- 8.2 days; 95% CI, 3.7-22.2%). Children with maximum inhibitor levels of > 40 Bethesda units (BU) per mL (n=4) received IT therapy as 25 U kg(-1) FVIII in the form of cryoprecipitate every other day for 1-4 months (mean 2.4 +/- 1.6 months; 95% CI, 0.8-3.9%), which was successful in all of them. FVIII (50 U kg(-1)) was given every other day for six patients with maximum inhibitor level > 40 BU mL(-1) for 3-9 months (mean 5.4 +/- 3.2 months; 95% CI, 2.9 -7.9%) with success in 4/6 (66.6%; 95% CI, 28.8-104.3%). Patients who showed a good IT response had an inhibitor level < or = 30 BU mL(-1), were < or = 9 years of age at inhibitor development with few exposure days to FVIII and had an early immune tolerance. In conclusion, inhibitor development in severe haemophilia A children exclusively treated with cryoprecipitate is low. Early low-dose IT induction for high responders may be achieved successfully if inhibitor level is < or = 50 BU mL(-1).

Bioactivity of Anagallis arvensis and Calendula micrantha plants, treated with ammonium nitrate, superphosphate and potassium sulphate fertilizers, on Biomphalaria alexandrina.

The survival rate of B. alexandrina snails maintained in aqueous solutions of the two tested plants (Calendula micrantha and Anagallis arvensis) decreased gradually with time until the 9th week and 10th week where the survival rate was zero in the high concentration of A. arvensis and C. micrantha, respectively, meanwhile, the survival rate of the control was 20%. Also, the two plants caused reduction in hatchability of snails egg masses. Thus, the percent of hatching in A. arvensis (82 ppm) was 46% and in C. micrantha was 72% compared with control (97.29%). Both plants reduced the infection rate of Biomphalaria alexandrina snails with Schistosoma mansoni miracidia to 41.17% and 61.9%, respectively, compared with control (90%). C. micrantha caused much higher reduction in snail infection rate than A. arvensis. The prepatent period was significantly prolonged in snails maintained at higher concentration of both plants. The cercarial output (expressed as mean number/snail) revealed that, A. arevensis caused a significant reduction in cercarial production than control. While, high concentration (120 ppm) of C. micrantha caused a significant elevation in the mean number of cercariae/snail. However, the total number of cercariae produced by all snails in each group showed a reverse relation with the tested concentrations in both plants.

Expression of c-erb B-2 oncoprotein in cancer of the larynx in relation to invasion of the cartilagenous framework and prognosis.

Oncogenes are important cellular genes that in general promote in the normal growth regulatory pathways. The human c-erb B-2 proto-oncogene (HER-2 or neu) encodes a 185 kDa transmembrane putative growth factor receptor of the tyrosine kinase family. This oncogene has been shown to be over expressed and/or amplified in primary carcinoma of the breast, ovary, pancreas and salivary glands. This study was conducted to evaluate a possible link between amplification of c-erb B-2 oncoprotein and cartilage invasion in laryngeal carcinoma. In addition, data concerning overexpression were compared to other clinicopathological parameters as well as clinical outcomes. In all, 34 patients with squamous cell carcinoma of the larynx were studied prospectively. Total laryngectomy specimens were sliced in horizontal sections at 4- to 5-mm intervals. Specimens were preserved in 10% formalin, and histopathological examinations were carried out after embedding tissues in paraffin sections and then staining them with hematoxylin and eosin. Detection of c-erb B-2 oncoprotein overexpression was carried out with a polyclonal antibody and an avidin-biotin kit. The level of c-erb B-2 overexpression was determined using the Quantimet 520 Leica image analyzing system. However, no significant correlation was found between cartilage invasion and clinicopathological parameters and prognosis. Overexpression of c-erb B-2 attained no significant correlation with clinicopathological parameters. In contrast, the correlation of c-erb B-2 overexpression and cartilage invasion was statistically significant (P = 0.034). In general, overexpression of c-erb B-2 oncoprotein was related to the more aggressive tumors with high capability of invading laryngeal cartilages. Patients with +ve c-erb B-2 oncogene had a poor prognosis but this was not statistically significant when compared to the clinical outcomes of patients with the -ve c-erb B-2 oncogene.

Incidence of hip fracture in Kuwait.

BACKGROUND: Hip fracture as a consequence of osteoporosis is an important cause of morbidity and mortality among the elderly. Due to improving life expectancy, the number of elderly individuals is increasing more rapidly in the developing countries of Asia, the Middle East, Africa, and South America. Incidence of hip fracture, which rises exponentially with age, varies substantially between countries and according to the age, sex, and ethnic distribution of the population. Highest rates are observed in Scandinavia and in whites in the US, intermediate in western Europe, and the lowest rates in Asia. Little is known about the epidemiology of hip fractures in the Middle Eastern populations. In particular, there are no published reports from any of the Arab countries. We have therefore estimated the incidence of hip fracture in Kuwait and compared it with other populations. METHODS: The study was conducted at a specialized orthopaedic hospital which provides services to residents in the three governorates--representing about 70% of the total population of Kuwait. All new hip fracture patients who were operated on or treated conservatively during the 4-year period (1992-1995) were included in the study. Hip fracture was defined as clinical and radiological evidence of fracture of the proximal femur. For comparison with other populations, age-specific incidence rates in females and males aged > or =50 years were standardized to the 1985 US population. RESULTS: A total of 513 cases of hip fracture (205 females, 308 males) were recorded during the study period: 293 (57.1%) cases occurred among Kuwaiti nationals and 220 (42.9%) among non-Kuwaitis (expatriates). Age-standardized rates (per 100,000) of hip fractures were, in Kuwaitis, 295 for females (95% CI: 238.8-350.8) and 200 for males (95% CI: 163.3-236.5)--much higher than those observed in other Asian countries such as Korea, Singapore, China, Malaysia, and Japan (41-202 for females, 49-100 for males). Rates in Kuwaiti females were similar to those observed in some of the European countries (Italy, UK, France) and in Asian females in the US. In contrast, rates in Kuwaiti males, which were relatively high, were almost equal to those observed in white males in the US. Rates of hip fracture in non-Kuwaitis (374 for females [95% CI: 247.6-500.8], 215 for males [95% CI: 126.5-302.9]), who predominantly (96%) originate from southeast Asian and Arab countries, were similar to those observed in Kuwaiti nationals. CONCLUSIONS: The incidence of hip fracture in the Kuwaiti population is higher than that reported from other countries in Asia and is comparable to the incidence in some of the western European and North American populations.

Study of effect of optimization of dialysis and protein intake on neuromuscular function in patients under maintenance hemodialysis treatment.

This study was carried out on 22 patients on maintenance hemodialysis. Among them, 20 patients were males and 2 were females, their age ranged from 12 to 50 years. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling following the nomographic approach for calculating their Kt/V values. Their nutrition was assessed by measuring skin folds, midarm circumference, laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Also their neuromuscular functions were assessed by clinical examination and neurophysiologic study. Dialysis dose was readjusted to achieve a target Kt/V value of 1.3 for patients on 3 times weekly dialysis and 1.6 for patients on twice weekly dialysis. Also, their nutrition was reviewed to achieve nPCR 1.2 g/kg/day and caloric intake 30-40 kcal/kg/day through diet manipulation and support. The patients were assessed finally after 3 months on targeted dialysis and nutrition by thorough clinical, laboratory and neuromuscular assessment. Analysis of neurophysiologic data showed significant improvement in electromyography. Furthermore, fatigue test showed significant (p = 0.002) decreases in muscle fatigue after optimization of dialysis dose and patients' nutrition. From this study, we may conclude that in dialysis patients, even when asymptomatic and clinically stable, neurologic deficits do exist and using area kinetic modeling to improve dialysis and patients' nutrition is valuable in improving their neuromuscular functions.

The vomeronasal (Jacobson's) organ in adult humans: frequency of occurrence and enzymatic study.

The vomeronasal system in adult humans has commonly been regarded as absent or vestigial, but recently it was found to be more common than previously reported. In this study, a search for the frequency of occurrence of the vomeronasal organ (VNO) was performed by examining the nasal septae of 200 adult patients. The frequency of occurrence was found to vary according to the method of examination. By anterior rhinoscopy, large pits and even deep grooves lined by glistening mucosa were visible in 16% of the people examined. Using nasal endoscopes this ratio increased to 76%. After receiving informed, written consent, from 13 patients undergoing endonasal surgery under general anaesthesia, one VNO was dissected out. Specimens were examined histologically and histochemically for succinic dehydrogenase and alkaline phosphatase enzymes. One specimen was processed for transmission electron microscopy. Two morphologically distinct cell types were differentiated. One cell type was previously suggested to have some of the features associated with nerve cells and could have a sensory function. A possible function for the VNO is postulated.

The effect of ammonia on olfactory epithelium and vomeronasal organ neuroepithelium of rabbits. A histological and histochemical study.

In recent studies, the vomeronasal organ (VNO), although vestigial and with unknown function in humans, was reported to be present in almost every person examined. In rabbits, it is a well-developed organ, one lying on each side of the nasal septum. Histologically it was found to contain neuroepithelium which is considered an accessory olfactory system taking charge of an olfactory discrimination different from that of olfactory epithelium. Experimental removal of the VNO in male animals reduces reproductive performance and aggression. In this study, the effects of prolonged exposure to ammonia vapor on the histological pattern and enzymatic activity of the olfactory epithelium and the VNO neuroepithelium of 30 adult male rabbits were investigated and compared with a control group. In the exposed animals, the supporting cells in both types of epithelia showed hyperplasia which was more marked in the olfactory epithelium. Manifestations of cytotoxicity were found more in the bipolar cells of the olfactory epithelium than in the VNO neuroepithelium. The enzymatic activity in the exposed group supported the histological results. The presence of the VNO neuroepithelium of the rabbit in a narrow duct with a minute nasal orifice could have some protective effects on the cells.

Studying the etiology of deafness in the "deaf" schools of Alexandria.

Two hundred and twenty three children with childhood deafness were included in this study. They were collected randomly from pupils of Al-Amal schools for the deaf in Alexandria. They were subjected to complete audiological examinations. One hundred and three cases had genetically determined deafness, 12 cases were due to prenatal causes, 20 cases to perinatal causes, 45 cases to postnatal causes, and 43 cases with undefined etiology. One hundred and ninety cases had prelingual deafness, 25 cases had perilingual deafness, and only 8 cases had postlingual deafness. Consanguinity with positive family history for deafness was found to be the most important factor in the genetically determined deafness. Rubella was the most important prenatal cause, while perinatal hypoxia was the most important perinatal cause, and meningitis was the most important postnatal cause. The results were compared with another study that was conducted 25 years ago in the same schools. The comparison was done in view of the changes that occurred in the Egyptian society in the last quarter of a century.

Study of neuromyopathy in amyloid kidney transplant patients.

Neuromuscular status of amyloid and control groups of kidney transplant recipients was assessed through complete neurological examination, assay for serum levels of muscle enzymes (CPK and LDH), electromyography and nerve conduction velocity studies. Neuromyopathic findings were detected in both groups but without severe disabling clinical manifestations. These findings were more prominent in the amyloid group, evidenced by a more significant increase in polyphasicity detected by electromyography and longer prolongation of terminal latency measured in the median nerve. From this study, we concluded that amyloid kidney transplant recipients are more prone to neuromyopathy than the general kidney transplant population, which is mostly due to the amyloidosis itself and/or the colchicine therapy.

Study of the effect of birth spacing on maternal health.

This study aims at identifying the effect of birth spacing on maternal health. The study was carried out on a representative sample of 324 married women at the fertile age period and having at least two children. The result of this study revealed that women practicing birth spacing were 33.3% of the studied sample. The mean age was 34.4 +/- 5.3 years and 31.3 +/- 5.7 years for improper and proper birth spacing respectively. Improper birth spacing women constituted 70.2% of low social class. Out of the total number of improper birth spaced women, 41.7% were overweight, 25.9% were hypertensive, 57.4% had varicose veins, and 18.1% had low limb oedema. Concerning Gynecological findings; vaginal discharge and cervical erosion were 70.4% and 19.4% of improper birth spacing women respectively, laboratory investigations revealed that anaemia and glucosuria were 88.4% and 12.5% of improper birth spacing women respectively. Good knowledge and favorable attitude were 88% and 100% of properly birth spaced women. The mean number of gravidity, number of abortions and number of infant deaths were 6.6 +/- 2.8; 0.9 +/- 1.3 and 1.36 +/- 1.63 of improperly birth spaced women respectively and 4.2 +/- 1.7; 0.6 +/- 1.1 and 0.41 +/- 0.81 of properly birth spaced women respectively. It could be concluded that young women were practicing birth spacing more properly. Rural origin women are less practicing birth spacing. Medical and Gynecological disorders were more among improper birth spacing women. Pregnancy wastage are more among improper birth spacing. It is to be recommended that more efforts should be done among low social class. Encouraging young women to practice pre-natal care. Emphasizing on the practice of proper birth spacing and small family size.

PIP: A survey conducted among 324 married women with at least two living children in Cairo's Mansheit-Naser District revealed numerous significant differences between those who spaced their births at least two years apart and those with improperly spaced births. The 108 women who met the criterion of proper birth spacing were younger (mean age, 31.3 years) than their counterparts (mean age, 34.4 years), more likely to be of urban origin (58.2% versus 29.5%, respectively), and significantly more likely to be from the middle class (62.9% versus 37.1%, respectively). In terms of maternal health characteristics, the women whose births were well spaced were significantly less likely to be overweight (29.6% versus 41.7%), hypertensive (10.2% versus 25.9%), and to have edema (5.6% versus 18.1%). Other gynecologic and laboratory findings that were more frequent among women whose births were less than two years apart included vaginal discharge, cystorectocele, cervical erosion, anemia, and glucosuria. Finally, women with properly spaced births averaged 4.2 +or- 1.7 births compared to 6.6 +or- 2.8 births among those with close birth spacing and had experienced 0.41 +or- 0.81 infant deaths compared to 1.36 +or- 1.63. These findings underscore the health benefits, to mother and infant, of adequate birth spacing.

Effect of treatment of anaemia with erythropoietin on neuromuscular function in patients on long term haemodialysis.

To study the effect of treatment of anaemia with recombinant human erythropoietin (r-HUEPO) on neuromuscular function in patients undergoing haemodialysis for chronic renal failure, six patients were given r-HUEPO in an initial dose of 50 u/kg three times a week and their haemoglobin concentration was measured. The dose was increased by 25 u/kg every four weeks if the response was not satisfactory. In five patients anaemia had been corrected within 12 weeks of initiation of treatment. Neuromuscular function was evaluated before treatment, half way through, and after correction of anaemia by clinical examination and neurophysiological studies including motor nerve conduction velocity, distal latency, electromyography and test for neuromuscular fatigue. After correction of anaemia there was a significant increase in motor nerve conduction velocity, a decrease in the duration of motor unit action potential, and a lessening of neuromuscular fatigue. We conclude that treatment of anaemia with r-HUEPO in patients with chronic renal failure undergoing haemodialysis may improve neuromuscular function.

Synthesis of certain 2-aminoadamantane derivatives as potential antimicrobial agents.

1-(2-Adamantyl-3-(5-arylhydrazono-6-methyl-4-oxopyrimidin -2-yl)guanidines, 2-(2-adamantylamino)-4-amino-s-triazine and its 6-chloromethyl derivative were prepared by cyclization of 1-(2-adamantyl)biguanide.HCl with ethyl 2-arylhydrazono-3-oxobutyrates, ethyl formate and ethyl chloroacetate, respectively. 1-(2-damantyl)-3-(4,5-dioxo-2-imidazolidinylidene)guanidine was used as intermediate for the synthesis of amides, hydrazide and azomethine derivatives of alkyl 2-(2-adamantylamino)-4-amino-s-triazine-6-carboxylates. The antimicrobial testing of the prepared compounds proved that an azomethine derivative was the most active. It showed a marked bacteriostatic effect against Staphylococcus aureus and Bacillus subtilis.

Synthesis and biological testing of certain 2-(5-substituted-2-thienylthio)benzoic acid derivatives.

The syntesis of a number of 2-(5-substituted-2-thienylthio)benzoic acid derivatives is described. The synthesized compounds were screened for their muscle relaxant and parasympatholytic activities and the results are reported.

Preparation of alkoxyquinoline derivatives and their evaluation as potential central nervous system stimulants.

A variety of substituted amides of 6,7-dimethoxy-2-hydroxyquinoline-3-carboxylic acid were synthesized. Three of these compounds, tested as potential central nervous system stimulants, showed no marked biological activity.

[Antiviral agents. 22. N-aliphatic, N-alicyclic and N-polycyclic substituted N'-(2-adamantyl)ureas and -thioureas]. / Antivirale Wirkstoffe. 22. Mitt.: N-Aliphatisch, N-alizyklisch und N-polyzyklisch substituierte N'-(2-Adamantyl)harnstoffe und -thioharnstoffe).

With reference to the role that (2-adamantyl), urea, and thiourea moieties play in antiviral drugs, these structural elements have been included in the present investigations aimed at the development of the N-substituted N'-(2-adamantyl)-thioureas 3a-d through the reaction of 2-aminoadamantane (1) with the isothiocyanates 2a-d. In an analogous manner, the interaction of 1 with the isocyanates 2e-f has led to the N-substituted N'-(2-adamantyl)ureas 3e-f. Within structure type 3 there occur representatives exhibiting antiviral, antimycotic, and herbicidal activity.