Comparison of serum antibody responses to Giardia lamblia of symptomatic and asymptomatic patients.

The circulating anti-parasite antibody response against Giardia lamblia in symptomatic and asymptomatic Egyptian children with confirmed giardiasis was examined. Symptomatic patients were identified using the following criteria: presence of only G. lamblia cysts in the feces, and one or more of the following symptoms, diarrhea, abdominal pain, loss of weight, vomiting and/or nausea, and abdominal distention. The anti-parasite humoral response was measured using indirect immunofluorescence (IFA), ELISA, and immunoblotting. There was a significant difference in the anti-parasite antibody response measured by IFA of asymptomatic and symptomatic patients, in which more than 34% of the asymptomatic patients had a titer equal to or less than 1:500, and more that 29% of the symptomatic patients had a titer of 1:8,000 or higher. The circulating anti-parasite total IgM and IgA but not IgG, measured by ELISA, was significantly higher in symptomatic than in asymptomatic patients, and were related to higher cyst output observed in symptomatic individuals. Although total anti-parasite IgG response was similar in symptomatic and asymptomatic patients, the analysis of the IgG isotype responses revealed that both IgG1 and IgG3 were significantly higher in symptomatic patients. The antigen recognition by anti-parasite IgM, IgA, IgG1, and IgG3 of symptomatic and asymptomatic individuals, determined by immunoblotting, was heterogeneous and revealed only minor differences in the response of the two groups.

Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position?

OBJECTIVE: To determine the chronic complication rate of anterior hypospadias repair and to explore whether the practice of placing the neomeatus at the tip of the penis should be applicable to all cases in our community where urination is in a sitting/squatting position. METHODS: Over a 10-year period commencing 1st September 1987, 312 patients had hypospadias repair of whom 72% had anterior hypospadias. The meatus was advanced to the tip of the penis in all repairs. The location of the meatus was also determined in 281 non-complaining men with a straight penis and normal sexual and reproductive functions. Following prior information that anterior hypospadias was not associated with sexual and reproductive dysfunction, 51 patients were given a choice between repair or no repair. RESULTS: Urethrocutaneous fistula occurred in 5% of patients, urethral stricture in 3% and meatal retraction in 3%, with 92% of patients having no complications. Forty six percent of non-complaining men had the meatus in locations other than the tip of the penis. Of 51 patients with the benefit of informed consent, 73% opted for no repair. CONCLUSION: Our results of anterior hypospadias repair compare favourably with those of other centers. Placement of the meatus at the tip of the penis for anterior hypospadias should not be applicable to all patients in this community where urination is in a sitting/squatting position. Before such repairs, an informed consent is warranted by making the patients and their parents aware of the non-association of sexual and reproductive disorders with these anomalies.

Hand and distal forearm replantation--immediate and long-term follow-up.

Six cases of traumatic amputation of hand and/or forearm were treated by replantation over the last 20 years at this hospital. Reattachment was successful in all of the cases. Success was largely due to proper selection of cases, meticulous technique and availability of skilled manpower and technological help. Although survival of replanted part was achieved in all cases, functional success was not uniform as revealed by subjective and objective criteria used during evaluation and follow-up. Tamai method of scoring the functional aspect of a replanted part not only indicates the functional ability of a replanted part but also creates uniformity in data collection for easier comparison with other reported series.

The use of island radial forearm flap for local hand coverage.

Extensive skin loss of the hand often necessitates creation of a flap for reconstruction and cover. At King Fahd Hospital of the University in Al-Khobar, we have treated 13 cases of hand injury with radial forearm flaps. We found it easy to reconstruct the tissue loss by a reliable flap of optimal thickness which has a good arc of rotation and provides a supple surface. The donor site morbidity is minimal in our hands. The procedure should be adopted for extensive and tedious hand injuries when the appearance and function are both important after reconstruction.

Polymerase chain reaction versus conventional methods in the diagnosis of vaginal trichomoniasis.

A total of 200 females of whom 120 had manifestations of vaginal trichomoniasis and 80 asymptomatic ones were studied. In 54/120 symptomatic female (45%) and in 28/80 asymptomatic ones (35%), T. vaginalis was diagnosed by wet mount of bedside vaginal swab samples. Of 120 samples from symptomatic females, T. vaginalis was detected in 93 (77.5%) when cultured onto InPouch & 95 (79.16%) in modified thioglycolate media. Culturing 80 samples of asymptomatic females showed T. vaginalis in 35 (43.75%) onto either media. T. vaginalis genomic DNAs was amplified by PCR from 130 (65%) by using TVA5-TVA6 primer pair in 95 (79.16%) samples of 120 symptomatic females, and in 35 (43.75%) samples of 80 asymptomatic ones. Difference between groups was statistically significant. The motile trichomonads was detected by wet mount in 82/130 positive cultures giving 63.07% sensitivity & 100% positive predictive value (PPV). Flagellates were not detected by wet mount in any negative culture, giving 100% specificity & 59.32% negative predictive value (NPV). The wet mount diagnostic accuracy (DA) was 76%, without false-positive, but false negative was 48/130 (36.93%). DNA was amplified from 129/130 positive culture by TVA5-TVA6 primer pair, giving 99.23% sensitivity. No amplification was detected from one positive culture. DNA was not amplified from 69/70 negative culture using TVA5-TVA6 primer pair, giving 98.57% specificity, 99.23% PPV, 98.57% NPV and 99% DA.

Ultra structural studies of the surface of Hymenolepis nana by scanning and transmission electron microscopy.

Scanning electron microscopy of the surface of Hymenolepis nana indicated that dense populations of microtriches occur on scolex proper, suckers and strobila, with an average density of 20/micron2. The excellent preservation of microtriches proves the efficacy of the critical point drying method for preparing cestodes for study of SEM. The cytological structure of the tegument of H. nana corresponds in general to that of other tapeworms.

Cheatotaxic characters of an Egyptian strain of Schistosoma mansoni cercariae.

The pattern of argentophilic sensory papillae of an Egyptian human strain of Schistosoma mansoni cercariae was studied by light microscopy and their cheatotaxic characters were described.

Electron microscope and histochemical studies on the oncosphere of Hymenolepis nana.

The ultra and histochemical structures of the oncosphere of Hymenolepis nana were studied. The oncosphere is surrounded by several protective layers. The outer envelope appears to be cellular in origin and consist of an electron dense outer zone and an inner granular zone, mucoprotein in nature. The inner envelope and embryophore are a continuous morphological unit of a protein structure. Within the oncosphere, apart from hooks, there are two germ cells, two somatic cells and a large penetration gland. The oncospheral hooks consist of three layers and elicit a positive reaction for keratin. The penetration glands fill the posterior region of the embryo and contain granules of varying density and shape.

An electron microscope study on spermatogenesis in Hymenolepis nana.

Only on the basis of nuclear size, spermatogonia can be easily identified by their relatively large prominent nuclei. Further meiotic division occur resulting in primary spermatocytes. The nuclei become smaller, placed peripherally forming the spermatids. A membrane-bound clefts develop in the cytoplasm in the region of spermatid nuclei and that such clefts eventually enclose the elongated nuclei to become the plasma membrane of the sperm. There is a common general pattern of spermatogenesis in cestodes which follows the pattern typical of the platyhelminthes.

The mechanism of acquired immunity in experimental giardiasis.

Giardia-spontaneously cured mice were rendered resistant to challenge infection. This was documented by the decreased cyst excretion rate comparable to the control ones. Endoxan and irradiation treatment caused a breakdown in both humoral and cellular immunity. Immune-depressed mice were more susceptible to Giardia infection, thus proving the active role of antibodies and cell-mediated immune response in giardiasis.

Axenic growth in vitro of Ancylostoma duodenale to the filariform (resting) larvae.

Large numbers of free-living stages of Ancylostoma duodenale can be grown in vitro on formalin-killed Escherichia coli supplemented with cholesterol and Dulbecco's minimum essential medium (DMEN). Eggs at 28 degrees C hatched and released first-stage larvae in 24 hr. First-stage larvae molted in 36 hr. at 28 degrees C. Second-stage larvae, molted in 2-3 days at 28 degrees C, but retained the old cuticle. Third-stage larvae characterized by the presence of a buccal cap capsule; sheath; filariform esophagus and absence of lips. Lateral alae were observed in all free-living stages.

Identification of low-molecular-mass coproantigens of Cryptosporidium parvum.

Cryptosporidium parvum coproantigens (CCAg) of 18 and 20 kDa were identified in the stool eluates of calves and humans infected with Cryptosporidium species. Monospecific antibodies raised against the 20-kDa antigen recognized both 18- and 20-kDa CCAg in all positive but no negative control samples. These antibodies reacted with C. parvum sporozoites in an immunofluorescence assay. Human immune sera recognized the 20-kDa antigen in infected calf stool eluates. Both 18- and 20-kDa CCAg remained intact in commonly used preservatives and at various temperatures. These CCAg may be useful in designing sensitive, reliable methods for diagnosing cryptosporidiosis.

Cell-mediated immune response in experimental infection with H. heterophyes.

Experimental infection of puppies with Heterophyes heterophyes was associated with marked cell-mediated immune response that manifested itself by increase of T-cell count and leucocyte migration. The degree of cell-mediated immune response was inversely proportional to the intensity of infection. The significance of the results was discussed.

Serum and intestinal immunoglobulins in heterophyiasis.

Serum and intestinal immunoglobulins are determined in 50 patients with heterophyiasis. The most outstanding findings were highly elevated IgE levels in serum but not in intestinal contents. Increased serum IgM, IgG and IgE were detected, while only intestinal IgM, IgG and IgA were elevated. An inverse relationship between serum and intestinal IgM, IgG and IgA and the load of infection was proved.

Some histopathological and histochemical aspects of human ancylostomiasis.

Using Watson's intestinal capsule small intestinal mucosal biopsies were taken from 30 patients with parasitologically proved pure ancylostomiasis and 12 normal controls. Biopsies were examined pathologically and histochemically for the enzymes, Alkaline phosphatase, succinic dehydrogenase, non specific esterases and acid phosphatase. The study revealed normal histological as well as normal enzymatic activity of the intestinal mucosa.

Fresh water malacologic fauna in Dakahlia Governorate.

Ten snail species representing the snail fauna in Dakahlia were identified as P. acuta, B. unicolor, L. carinatus, Cleopatra species, B. alexandrina, M. tuberculatus, H. duryi, B. truncatus, N. nilotica and L. caillaudi. The density of snail population has had a major peak at July and August while a minor peak was found at the winter closure period during the winter months.