Tibial Nerve Repair in a Dog Model: Effect of Local and Systemic Administration of Erythropoietin.

PURPOSE: This study aimed to assess the effectiveness of erythropoietin (EPO) as a novel treatment for peripheral nerve injury after surgical repair of an induced tibial nerve injury in dogs. METHODS: Mongrel dogs (n = 27) were randomly divided into three equal groups. A complete tibial nerve injury was induced and repaired directly by stay sutures and the local application of 1 mL fibrin glue (control group). In the "systemic" group, 20,000 IU of EPO were given subcutaneously immediately after surgery and on the first and second days after surgery. In the "local" group, EPO was mixed with fibrin glue at 1,000 IU/mL. Lameness score, compound muscle action potential of the tibial nerve, and serum biochemical and histopathological examinations were performed to evaluate the treated dogs over the study period (12 weeks). RESULTS: EPO significantly improved the lameness score and compound muscle action potential in both the systemic and local groups. After 12 weeks, systemic and local groups showed earlier improvement in lameness, reaching scores of -1 and 0, respectively, in comparison with the control group, which did not reach a score of -1. The histological study revealed a normal architecture of the nerve bundles within connective tissue. The axons were aligned in a regular pattern, whereas the control group had disrupted and degenerated nerve axons with large gaps in between. CONCLUSIONS: EPO has an accelerating healing effect after tibial nerve surgical repair. Local EPO mimics systemic EPO treatment without systemic adverse effects. These findings indicated that EPO has a potential role in tibial nerve recovery and nerve regeneration. CLINICAL RELEVANCE: The findings of the present experimental study supported the beneficial effects of systemic and local EPO when combined with peripheral nerve surgical repair, potentially improving functional outcomes and enhancing faster recovery.

An Application of Business Process Management to Health Care Facilities.

The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

Mitigation of Toxoplasma gondii-induced ileitis by Trichinellaspiralis infection pinpointing immunomodulation.

The current study sought to investigate the potential role of Trichinellaspiralis infection in the treatment of T. gondii-induced ileitis. Forty male Swiss albino mice were divided into four groups:a normal control group Igiven only phosphate-buffered saline (PBS), Group II givenPBS for 28 days then infected with T. gondii cysts for the induction of gastroenteritis, Group III infected only with T. spiralis larvae, and Group IV concurrently infected with T. spiralis larvae, then 28 days post infection, enteritis was induced by oral inoculation withT. gondii cysts. Histopathologicaland immunohistochemicalassessmentswere performed to determine the levels of inflammatory markers nuclear factor- κB (NF-κB) and myeloperoxidase in the ileum samples.Theconcentrations of cytokinesIFN-γ and IL10 were measured in successive serum samples. Histological assessment revealed severe inflammatory infiltrations in ileum samples of T. gondiimonoinfected mice. In addition, the immunological assessment revealed elevated levels of IFN-γ and decreased IL10 concentrations in blood samples. Clear improvement of inflammations, besidesthe decreasedlevels of IFN-γ and increased IL10 concentrations in blood samples were detected in T. spiraliscoinfected animals.Theileal tissue revealed elevated expression of (NF-κB) and myeloperoxidase signaling, all of which were mitigated by T. spiralis coinfection. There is a possibility that regulatory T cells are immunomodulated, releasing anti-inflammatory cytokines while suppressing pro-inflammatory cytokines, causing its therapeutic impact. Trichinellaspiralis infection has the potential to be used for treatment of T. gondii-induced ileitis. As a consequence of these encouraging results, T. spiralis crude and secretory-excretory antigens coated on nanoparticles are being studied in our future research.

Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study.

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

Incidence of Toxoplasmosis gondii in Najran region, KSA.

Toxoplasmosis is an endemic disease all over the world. In surveying 210 individuals randomly selected from Najran area for anti-Toxoplasma IgG and IgM using ELISA, IgG was detected in 67 cases (31.9%) of the examined sera. The examined group includes (117) male, (75) female and (18) children. Four children (22.2%), 33 females (44%) and 30 males (25.6%) were found positive for IgG with statistically significant sex difference (P< 0.01). All serum samples were found negative for IgM except in one male child (0.48%) who indicates a recent infection. The samples were collected from 3 different localities: the capital city of Narran, and Sharourah and Habona Provinces. The highest anti-Toxoplasma IgG percentage positivity was reported among Sharourah inhabitants (47%) and the least was reported in the city of Najran (19.3%). Moreover, a statistically significant direct increase in the percentage positivity of anti-IgG levels was found with increasing age. The high rate of infected females has to be considered and further expanded study has to be carried out.

Evaluation of protective immunity of 28KD-GST as a vaccine against experimental Schistosoma mansoni.

Schistosoma mansoni GST was purified from adult worm homogenates by affinity chromatography. SDS-PAGE analysis of the purified antigen revealed that SmGST has molecular weight around 28 KD was used as a vaccine in a dose of 25 and 35 microg. Eleven groups of BALB/c mice of 10 mice each were vaccinated by GST. Complete Freund's adjuvant (CFA) and BCG vaccine were used as adjuvant. Booster doses were given after 2 & 4 weeks. Two weeks after the last dose of vaccine, mice were challenged by S. mansoni cercariae. Blood samples were taken 7 weeks post infection for detection of IgGl, IgE and circulating antigens. Then mice were sacrificed for histopathological study of the liver. Highly significant (p > 0.001) increase in the mean optical density of IgGl & IgE in groups vaccinated by 35 microg GST and CFA was demonstrated. On the other hand, highly significant (P < 0.001) decrease in circulating antigen, grnuloma number and size in the same group.

Detection of altered secondary lymphoid-tissue chemkine responsiveness in Balb/c mice infected with Schistosoma mansoni.

To determine the extent to which Balb/c mice splenic T cells were affected by S. mansoni infection, this study aims to investigate the ability of the T cells to produce interferon (IFN)-&, and their chemotactic ability at 7 weeks post-infection. The splenic T cells were capable of producing levels of IFN-& comparable with splenic T cells from naive mice. However, the T cells exhibited altered chemotactic activity, as evidenced by an inability to respond to secondary lymphoid-tissue chemokine (SLC/CCL21). Although no difference in chemokine expression was found between the spleens of infected versus control mice, chemokine production was greater in the livers of infected versus control mice. Collectively, these data indicate that Balb/c mice with 7-wk S. mansoni infection possess splenic T cells with altered chemotactic activity and that the alterations may be a consequence of granulomatous response in the liver.

Assessing the morbidity of schistosomiasis by measuring eosinophil cationic protein in serum.

Eosinophil cationic protein (ECP) was recently used for assessment of Schistosoma haematobium morbidity. In this study, the level of (ECP) in sera of schistosomiasis patients was significantly higher than control group, and this significance was higher in S. haematobium than S. mansoni groups. No association between level of (ECP) in serum and egg count in S. mansoni and S. haematobium patients was found. Comparing the correlation of ECP level in serum with Schistosoma antigen in both serum and urine, in S. mansoni there was a positive association between (ECP) in serum and serum schistosomal antigen but not with schistosomal antigen level in urine among S. mansoni infected patients. On the other hand, in-patients with S. haematobium infection there is strong association between (ECP) level in serum and the level of antigen in urine, but not with schistosomal serum antigen level. These results suggest that serum (ECP) may be useful and more sensitive and accurate marker of morbidity in S. haematobium infection than indirect measures.

Detection of anti-Fasciola isotypes among patients with fascioliasis before and after treatment with Mirazid.

Stool examination using modified Kato thick smear method was performed to detect Fasciola eggs and other parasites. Abdominal pain was the major presenting symptom (87.7%) followed by pallor (83.3%) and fever (16.7%). Anaemia and hepatomegaly were recorded in 77.7% of patients compared to 27.7% with splenomegaly. Abdominal ultrasonography revealed hepatomegaly and common bile duct dilatation in 77.7% of patients. Moreover, 5 cases showed diagnostic. Olympic game rings All patients had positive IgG4 levels, 55 cases were positive for specific total IgG and IgG1, whereas, only 24 cases had positive IgG2 levels (26.6%). All negative control group showed no cross reactions. On the other hand, ELISA detecting IgG4 showed the highest specificity (95%), followed by IgG2 (85%) and the least specific test was obtained with detection of IgG (70%) and IgG1 (65%). One month after treatment, 91.1% of patients (82/90) were completely cured and even after another two months follow-up. In completely cured patients none of anti-Fasciola isotypes was significantly changed. So, detection of anti-Fasciola isotypes especially IgG4 is very specific for the accurate diagnosis of human fascioliasis.

Dot ELISA for measuring anti-Fasciola IgG isotypes among patients with fascioliasis.

Stool examination using modified Kato thick smear method was performed to detect Fasciola eggs and other parasites. Forty-five patients were proved to have Fasciola infection by passing eggs in their stool samples. Pallor was the major presenting symptom (95.5%) followed by abdominal pain (93.3%) and fever (15.5%). Hepatomegaly was recorded in 86.6% of patients compared to 33.3% with splenomegaly. Abdominal, ultrasonography revealed hepatomegaly in 38 cases (84.4%) and common bile duct dilatation in 35 patients (77.7%). Moreover, 4 cases showed Olympic game rings which are diagnostic. All of patients had positive IgG4 levels, 40 cases were found positives for specific total IgG and 42 cases for IgG1, whereas, only 30 cases had positive IgG2 levels (66.6%). Dot-ELISA showed that IgG2 and IgG4 giving the highest specificity (>99%), followed by IgG1 (90%) and the least specific test was obtained with detection of IgG (85%). From the present work, it was concluded that detection of anti-Fasciola isotypes especially IgG4 is very specific for accurate diagnosis of fascioliasis.

Detection of E. histolytica, G. lamblia and Cryptosporidium copro-antigens in stool samples.

A double antibody sandwich ELISA technique, using a chromatography purified antisera against E. histolytica, G. lamblia and Cryptosporidium antigens, was applied to detect copro-antigens of the corrosponding parasites in 90 patients. All positive cases were diagnosed by parasitological examination and proved to have the infection solely. Beside the 90 positive cases, 40 age-matched controls were included in the study, of which 20 individuals were infected with other parasites but not Cryptosporidium, E. histolytica or G. lamblia (acted as an infected control group) and the other 20 individuals with no intestinal parasites (normal control group). The assay could detect 100% of those infected with both of G. lamblia and E. histolytica and 96.6% (29/30) of patients with Cryptosporidium infection. False positive reactions were detected in 3 cases using G. lamblia antisera (92.5%), 5 cases using E. histolytica antisera (87.5%) and 2 cases using Cryptosporidium antisera (95%). A direct increase in the mean antigen level was observed with the increasing intensity of infection in the 3 parasites, so higher mean O.D. readings was observed in heavily infected cases than moderately infected cases than lighter intensity of infection. Only those in elder age group (> 20 years) infected with E. histolytica were found to have statistically higher O.D. readings of the antigen than middle age group (10-20 years). On the other hand, no statistically significant difference was observed between different age groups and antigen level in cases with either G. lamblia or Cryptosporidium.