Effect of antibiotic prescribing in primary care on antimicrobial resistance: a literature review 2020

Our aim is to review the literature and, where appropriate, investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care. Data sources are observational and experimental studies identified through Medline, Embase, and Cochrane searches. Review methods Electronic searches using MeSH terms and text words identified 4373 papers. Results The review included 24 studies, 22 involved patients with symptomatic infection and two involved healthy volunteers, 19 were observational studies (of which two were prospective) and five were randomised trials. The observations concluded that individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic.

Antihyperglycemic and hepatoprotective properties of miracle fruit (Synsepalum dulcificum) compared to aspartame in alloxan-induced diabetic mice / 中西医结合学报

OBJECTIVE@#This study was undertaken to investigate the antihyperglycemic potential of miracle fruit (MF) as well as its hepatic safety as compared to aspartame in alloxan-induced diabetic mice.@*METHODS@#MF extracts were prepared and screened for their phytochemical composition using high-performance liquid chromatography (HPLC). Total phenolic, flavonoid and tannin contents and antioxidant potential were also determined. Additionally, MF was evaluated for its sensory attributes. For in vivo work, MF ethanol extract at high (MFH: 500 mg/kg body weight [BW]) and low (MFL: 250 mg/kg BW) doses as well as aspartame were injected intraperitoneally into alloxan-induced diabetic mice. Blood glucose levels were determined following acute and subchronic treatment. At the end of the study, animals were sacrificed, serum was collected for biochemical analysis and liver tissues were obtained for histopathological examination.@*RESULTS@#MF ethanol extract contained more flavonoids and tannins, and had higher 1,1-diphenyl-1-picrylhydrazyl radical-scavenging activity (79.61%) compared to MF aqueous extract (P < 0.05). HPLC analysis of MF ethanol extract also revealed the presence of 10 antioxidants with quercetin comprising the major polyphenol. Additionally, sensory analysis of MF showed that its intake is effective in masking undesirable sourness. Subchronic administration of MFH proved amelioration of hyperglycemia in mice as compared to aspartame. Moreover, aspartame treatment significantly elevated (P < 0.05) the level of alanine aminotransferase and had destructive effects on the liver histopathology; however, hepatic architecture was restored by low and high doses of MF.@*CONCLUSION@#MF is an effective antihyperglycemic with hepatoprotective properties that can be used as a healthier alternative sweetening agent in place of aspartame for sour beverages.

Autologous Stem Cells Transplantation in Egyptian Patients with Liver Cirrhosis on Top of Hepatitis C Virus

BACKGROUND AND OBJECTIVES: Use of pluripotent stem cells is an ideal solution for liver insufficiencies. This work aims is to evaluate the safety and feasibility of autologous stem cells transplantation (SCT) in Egyptian patients of liver cirrhosis on top of hepatitis C virus (HCV). SUBJECTS AND RESULTS: 20 patients with HCV induced liver cirrhosis were divided into 2 groups. Group I: included 10 patients with liver cirrhosis Child score > or =9, for whom autologous stem cell transplantation was done using granulocyte colony stimulating factor (G-CSF) for stem cells mobilization. Separation and collection of the peripheral blood stem cells was done by leukapheresis. G-CSF mobilized peripheral blood mononuclear cells (G-CSF PB-MNCs) were counted by flow cytometry. Stem cell injection into the hepatic artery was done. Group II: included 10 patients with HCV induced liver cirrhosis as a control group. Follow up and comparison between both groups were done over a follow up period of 6 months. The procedure was well tolerated. Mobilization was successful and the total number of G-CSF PB-MNCs in the harvests ranged from 25x106 to 191x106. There was improvement in the quality of life, serum albumin, total bilirubin, liver enzymes and the Child-Pugh score of group I over the first two-three months after the procedure. CONCLUSION: SCT in HCV induced liver cirrhosis is a safe procedure. It can improve the quality of life and hepatic functions transiently with no effect on the life expectancy or the fate of the liver cirrhosis.

Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

A simple noninvasive test that accurately distinguishes NASH from NAFL as well as determines the disease severity is urgently needed. Recently, it was found that determination of Cytokeratin-18 [CK-18] fragments in the blood, predicts and correlates with histological NASH in which there is development of lobular inflammation, cell ballooning and fibrosis, supporting its usefulness in clinical practice To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients. 90 subjects were divided into 3 groups: group I: including 30 patients with NASH, group II: including 30 patients with NAFL, and group III: including 30 healthy subjects as control. Diagnosis of NASH and its discrimination from NAFL was done by liver biopsy. CK-18 level in plasma was measured for all subjects using ELISA. CK-18 was significantly elevated in patients of group I in comparison to group II and III patients, with mean +/- SD: 460 +/- 279, 167 +/- 56 and 149 +/- 57, respectively, and/3 value: 0.001. The [ROC] curve diagnostic performance of CK18 in diagnosis of NASH shows: cutoff value of >240U/L, with sensitivity 76.7%, specificity 95.0%. Ck-18 was found to correlate with disease severity assessed by NAS scoring system with P value: 0.001. Measurement of CK18 in NASH is a useful screening, diagnostic and staging bio-marker

[Incidence of Thyroid Dysfunction among chronic hepatitis C Egyptian patients treated with Interferon/Ribavirin therapy]

Background/Aim: The use of pegylated interferon-alpha [IFN-alpha] and ribavirin is still an integral part of the standard of care treatment of chronic hepatitis C [CHC] in Egypt until the present time, even after introducing the new era of direct acting antiviral drugs. Such regimens are accompanied by the production of autoantibodies that carries the risk of development of thyroid dysfunction [TD]. The study tries to describe the incidence, long-term outcome, and predictors of TD among Egyptian patients with CHC receiving IFN-based treatment

Patients and Methods: Between January 2013 and August 2014, a prospective study design was conducted to include naive CHC patients [virologically and histopathologically proved] enrolled for INFbased therapy with normal thyroid function profile

Results: A total of 400 patients [mean age was 37.4+9.6 years, 18% were females] were included. At the end of the study period, 12.3% of patients [n=49] developed biochemical TD [TSH<0.3 or >5.0 mIU/L]. At the 12th week after the end of antiviral therapy, 67.3% of them [n=33] were spontaneously normalized. At the 24[th] week, 14.3% of the remaining [n=7] had spontaneously normalized. Female gender was significantly associated with the development of TD

Conclusions: The incidence of TD among the Egyptian patients treated by INF-based antiviral therapy for CHC is not low and more predominant in females. Spontaneous recovery after the end of treatment was common however, it entails a strict follow up

Effective dose from natural background radiation in Keffi and Akwanga towns, central Nigeria

Human is exposed to radiation in their environment with or without their consent; and the exposure to natural background radiation is an unpreventable event on earth. An in situ assessment of the indoor and outdoor background radiation in Akwanga and Keffi towns of Nasarawa state Nigeria was carried out using a halogen-quenched Geiger Muller [GM] detector [Inspector alert Nuclear radiation monitor SN: 3544]. Each of these towns was divided into at least 20 sampling areas where at least ten readings were taken in order to have a reliable data. The mean indoor and outdoor annual effective dose of Akwanga were 1.29 +/- 0.13mSv/yr and 0.31 +/- 0.04 mSv/yr respectively; and that of Keffi were 1.08 +/- 0.15mSv/yr and 0.25 +/- 0.04 mSv/yr respectively. The radiation levels in both highly populated towns were found to be within the safe limit for areas of normal background set by UNSCEAR [2.4 mSv/yr]. These results would serve as a baseline upon which other exposures would be assessed and in the future, serve as reference for dosimetry and decontamination in situations of radiation poisoning of these towns

Leukemia during pregnancy: long term follow up of 32 cases from a single institution

Background and objectives: There is limited information regarding the outcome of patients treated for leukemiaduring pregnancy. This study was performed on all cases of leukemia during pregnancy identified in our institution leukemia database

Patients and Methods: It is a retrospective study from our existing database. Thirty two cases were identified among the cohort of patients treated for acute and chronic leukemia between January 1991 and July 2003

Results: Among the acute leukemia patients [n = 21], 10 patients [47.6%] received chemotherapy during pregnancy, seven had live birth and three had spontaneous abortion. No teratogenicity or congenital malformations or postnatal complication were reported. The remaining 11 [52.4%] were not given chemotherapy while pregnant; three patients presented after 34 weeks of gestation ending in normal live births and then received chemotherapy and eight patients had abortion before starting chemotherapy. Among the chronic myeloid leukemia [CML] patients [n = 11], nine patients received hydroxyurea, one patient received alfa-interferon and one patient was treated with leukapheresis. Eight patients had normal live births and three patients had abortion. Out of the 32 patients, 18 patients [56.2%] subsequently underwent HLA matched sibling allogeneic stem cell transplantation, seven for acute myeloid leukemia [AML], two for acute lymphocytic leukemia [ALL] and nine for CML. After a median follow up of 16 years, five patients [15.6%] are alive in remission [one from chemotherapy group and four from SCT group]

Conclusions: Our report lends credence to the safety and feasibility of administering anti-leukemic therapy in acute and chronic leukemias during pregnancy although acute leukemia patients had possibly a poor long term outcome compared to non-pregnant patients

Assessment of pulmonary hypertension in patients with liver disease pre and post liver transplantation

Both hepatopulmonary syndrome and portopulmonary hypertension are associated with chronic liver disease. Liver transplantation is considered a controversial solution. The aim of this work is to assess pulmonary hypertension in liver disease patients pre and post liver transplantation. Studying the impact of pulmonary hypertension on hemodynamic of the patients in hospital after liver transplantation. Echo cardiographic examination pre and post liver transplantation after at least 3 months was conducted on 20 patients with chronic liver diseases and pulmonary hypertension who underwent liver transplantation to estimate mean PAP and degree of tricuspid regurgitation. The present study was conducted on 20 patients consisting of 18 males [90%] and two females [10%] with mean age 47.8 +/- 8.9. It showed that mean pulmonary arterial pressure improved after liver transplantation 24.65% +/- 17.50.The tricuspid regurgitation before operation was mild in 17 patients [85%] and moderate in three patients [15%] and after operation it become normal in 40% and mild in 60% with improvement in 55% and no improvement in 45% of the patients. There was improvement in dyspnea scale after the operation with one grade change in 35%, two grade change in 55% and three grade change in 10% of patients Liver transplantation was effective in the reduction of pulmonary artery pressure. The degree of pulmonary hypertension affected the functional state according to WHO Classification of pulmonary hypertension patients

Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris

Concomitant hepatitis C virus [HCV] infection and psoriasis vulgaris [PV] are not uncommon coexisting diseases, especially in areas with high viral hepatitis endemicity. To date, data about the interaction between both diseases are scarce. Therefore, we aimed to describe the possible interplay between the HCV viral load and psoriatic activity in concomitant Egyptian diseased patients. Between December 2011 and August 2013, all psoriatic patients attending Assiut University Hospital outpatient clinics were tested for HCV serologic assay. Patients with positively coexisting diseases were further reevaluated for psoriasis area severity index [PASI] score assessment, liver function tests, HCV-RNA-polymerase chain reaction [PCR] assays, and sonographic examination of the liver. For comparative purposes, another matched group [n = 26] with psoriasis only [HCV-negative group] was enrolled as a control. During the period of the study, 20 patients with concomitant PV and HCV infection [HCV-positive group; 50% males, mean age of 44.15 +/- 10.66 years] were recruited. The mean PASI score was 44.75 +/- 10.38 and clinical signs of liver dysfunction were observed in 40% [n = 8], 100% had abnormal liver function tests [n = 20], and 75% had sonographic findings of cirrhosis [n = 15]. The PASI score was significantly higher in the HCV-positive psoriatic group compared to the HCV-negative control [p < 0.001]. Significant correlations were detected between the PASI score and the viral loads, and also with alanine aminotransferase [ALT]. When HCV was found concomitantly with PV, a high possibility of severe disease pattern will be expected that entails special precautions in the treatment process

histological study on the effect of pentoxifylline on acute lung injury induced by renal ischemia reperfusion

Kidney ischemia-reperfusion injury [IRI] occurs under many clinical conditions. It leads to acute kidney injury, which may affect various remote but important organs such as the lung. The aim of the present study was to investigate the effect of renal IRI on the lung structure and evaluate the possible protective effect of pentoxifylline [PTX]. Fifteen adult male Wistar rats aged 8-10 weeks and weighing 150-200 g were used in this study. They were divided into the following groups: group I [the control group] was subjected to sham operation; group II [the IRI group] was subjected to renal ischemia by bilateral clamping of the renal pedicles for 45 min and then allowed 24 h of reperfusion. Group III [the PTX-treated group] was given two doses of PTX [40 mg/kg] intraperitoneally and subjected to an ischemia-reperfusion procedure as performed in group II. Lung specimens were processed for light and electron microscopic examination. The mean thickness of the interalveolar septa and the mean number of type-II pneumocytes were measured. Group II showed diffuse lung injury affecting mainly the alveoli, which appeared flooded with exudate and red blood cells, which also extravasated in the interstitium. There was vacuolation of the cytoplasm of both type-I and type-II pneumocytes with significant increase in the number of type-II cells and depletion of lamellar bodies. Significant increase in the mean thickness of the interalveolar septa was detected and it showed infiltration by macrophages and neutrophils. PTX caused marked improvement in the lung structure after ischemia-reperfusion. Most of the alveoli appeared empty and a few of them showed minimal red blood cells and macrophages. Thin interalveolar septa were detected with thickness comparable to that of the control group. Renal IRI caused alteration in the lung structure, which was ameliorated by PTX administration

Effect of alpha-lipoic acid on fundic gastric mucosal damage induced by acetyl salicylic acid: a histological study

alpha-Lipoic acid [ALA], an endogenous agent, has been shown to combat oxidative stress. The aim of the study was to evaluate the protective effect of ALA on fundic gastric mucosal damage induced by acetyl salicylic acid [ASA]. Fifty adult male albino rats were divided into four groups: group I [the control group], group II that received ALA for 2 weeks [subgroup IIa] and for 4 weeks [subgroup IIb], group III that received ASA for 2 weeks [subgroup IIIa] and for 4 weeks [subgroup IIIb], and group IV that received ALA 30 min before ASA for 2 weeks [subgroup IVa] and for 4 weeks [subgroup IVb]. At the end of the experiment, specimens from the fundus of the stomach were processed for light and electron microscopic examinations. The mean number of proliferating cell nuclear antigen [PCNA]-positive cells, parietal cells, and the mean thickness of the fundic mucosa were measured and the results were statistically analyzed. Examination of sections revealed that ASA for 2 weeks induced widening of the gastric pits and focal mononuclear cellular infiltration. The mucous content of the mucosa was apparently increased and PCNA-positive cells were significantly decreased compared with the control group. ASA for 4 weeks resulted in extensive desquamation, thinning out of the mucosa, and diffuse mononuclear cellular infiltration. The collagen content of the lamina propria showed an apparent increase, whereas the mucous content showed an apparent decrease. The parietal cell count and the PCNA-positive cells were significantly decreased compared with the control group. In ultrathin sections, parietal cells showed cytoplasmic vacuoles, decreased intracellular canaliculi, and mitochondria, whereas the chief cells showed dilated rough endoplasmic reticulum and decreased secretory granules. Concomitant use of ALA showed a histological profile nearly comparable with that of the control group in both subgroups IVa and IVb. ALA administration prevented the structural changes of the gastric mucosa induced by ASA

Effect of zinc-free diet from weaning through puberty on the structure of the testis in albino rats, with a special focus on the Leydig cells

Zinc is an essential trace element. Many physiological processes would be impaired if zinc is not supplied in sufficient quantities in the diet. The aim of the work was to evaluate the effect of a zinc-free diet from weaning through puberty on the testicular structure of rats, with a special focus on the Leydig cells. Twenty weaned rats were divided into three groups. Group I [the control group] was fed a balanced diet. Group II [the zinc-free group] was fed a zinc-free diet for 3 months. Group III [the recovery group] was fed a zinc-free diet for 3 months, followed by a balanced diet for 1 month. At the end of the experiment, rats were weighed and blood samples were collected to measure the level of serum testosterone hormone. The testes were removed, weighed, and processed for light and transmission electron microscopic study. The zinc-free group showed a significant decrease in the mean body weight, testis weight, and serum testosterone level compared with the control group. The light and electron microscopic examination showed loss of most of the spermatogenic cells accompanied by variable degrees of degeneration in the form of karryorhexis and haphazard chromatin content. In the interstitial tissue, there was accumulation of exudate. Many Leydig cells showed dilated smooth endoplasmic reticulum and mitochondria. Others cells showed accumulation of glycogen. Most of these changes were reversed after receiving the balanced diet in the recovery group. A zinc-free diet altered the structure of both the seminiferous tubules and the Leydig cells. Most of these alterations were reversed by zinc replenishment. Zinc is considered an essential element for maintaining testicular structure and spermatogenesis process

Arsenic-induced toxicity in the endometrium of adult albino rat and the possible role of human chorionic gonadotropin hormone: a histological study

Arsenic is a toxic mutagenic metalloid and a major pollutant of water. Exposure to arsenic produces various adverse reproductive effects. Human chorionic gonadotropin [hCG] has an important role in the female reproductive system. The aim of the study was to investigate the effects of sodium arsenite on the structure of the endometrium of adult rats and evaluate the possible role of hCG in the amelioration of these changes. Thirty-six adult female rats were used in this study. They were divided into three equal groups: group I [the control group]; group II, in which the animals received sodium arsenite orally for 28 days; and group III, in which the animals were subcutaneously injected with hCG for 28 days, together with the previous dose of sodium arsenite. Specimens of the endometrium were taken at diestrous phase and prepared for light and scanning electron microscopic examinations. Moreover, morphometric measurements were taken to measure the height of the surface epithelium and the diameter and number of endometrial glands, and the results were statistically analyzed. Arsenite treatment prolonged the diestrous phase. The surface epithelium showed a significant reduction in height as compared with the control group and some parts showed focal degeneration and shedding. The endometrial stroma showed irregularly shaped cells and an apparent increase in collagen fibers. Small and atrophied glands were seen. Scanning electron microscopic examination revealed a decrease in the number of cells with pinopodes and a decrease in the number of pits of glands. Concomitant administration of arsenite and hCG resulted in regular estrous cycles. The structure of the endometrium was improved as compared with that of the arsenic-treated group. Sodium arsenite altered the structure of the endometrium and the phases of the estrous cycle. Concomitant administration of hCG with arsenic improved the structure of the endometrium and the regularity of the estrous cycle

Role of thyroxin versus Brewer's yeast supplementation in amelioration of pancreatic alterations induced by hypothyroidism in adult male albino rats

Induction of hypothyroidism by carbimazole could affect many glands including the pancreas. Brewer's yeast, a herbal product, is recently under research for its possible uses. The aim of the study was to study the microscopic, morphometric, and biochemical changes in the pancreas of hypothyroid rats and to evaluate the role of thyroxin versus Brewer's yeast in amelioration of these changes. Sixty adult male albino rats were randomly divided into five groups. Group I rats served as a control group. Group II rats received carbimazole. Group III rats received carbimazole followed by thyroxin. Group IV rats received carbimazole followed by Brewer's yeast. Group V rats received only Brewer's yeast. At the end of the experimental period, specimens from the pancreas were processed for light and transmission electron microscopic examinations and immunostaining for Ki-67. Biochemical analysis for T3, T4, and insulin was performed. In addition, body mass gain and pancreatic mass were measured. All parameters were statistically analyzed. Group II specimens revealed congestion of blood vessels and cellular infiltration. Acinar cells showed pyknotic nuclei, hyalinization, and vacuolation of the cytoplasm, with few zymogen granules. beta Cells of the islets of Langerhans revealed depletion of organelles and small granules without their characteristic halo. Immunostaining revealed significant decrease in the percentage of Ki-67-positive nuclei. In group III, the acini revealed numerous secretory granules, few vacuoles, and euchromatic nuclei. beta Cells showed secretory granules with the characteristic halo. Group IV revealed less improvement in the histopathological changes as compared with group III. T3, T4, and insulin levels were significantly lower in hypothyroid rats in comparison with the control group, whereas administration of thyroxin showed restoration of these levels to near control values. Hypothyroidism showed a deleterious effect on the histological structure of rat's pancreas. Administration of thyroxin minimized these effects more than administration of Brewer's yeast

Stent thrombosis is a major concern in clinical practice: a single Saudi center experience

Drug-eluting stents [DES] are used in the majority of patients who undergo percutaneous coronary intervention [PCI], and have reduced the rate of in-stent restenosis and repeated revascularization in comparison to bare metal stents. However, stent thrombosis [ST] is an uncommon but serious complication of coronary artery stents that is mostly fatal or presents as a large non-fatal myocardial infarction [MI], usually with ST elevation. To study the incidence of stent thrombosis in Middle Eastern Saudi patients who underwent PCI using both drug-eluting stents [DES] and bare metal stents [BMS]. ST can occur acutely [within 24 h], sub acutely [within 30 days], or as late as one year [late] or even more than one year [very late]. In an observational, single center study in catheterization [cath] lab a total of 1386 patients underwent PCI between January 2008 and September 2010. The study included all patients in that period who had acute coronary syndrome and stable coronary artery disease [CAD]. A total of 1386 patients had PCI and stent deployments; 19 [1.3%] patients had stent thrombosis, four patients [21%] received BMS and 15 patients [79%] received DES. Four patients had acute ST; five had subacute ST; eight patients had late ST; while two patients had very late ST. Nine patients [47%] had DM and eight patients [42%] had hypertension. The incidence of ST in Saudi patients who received DES at our center is similar to internationally reported numbers. Almost half of ST patients are diabetics and there is increasing concern that the risk for late stent thrombosis is slightly higher with DES than BMS.

[ immediate effect of knee brace on the activity of selected lower limb muscles during stance phase of walking in females with patellofemoral pain syndrome]

Background and Aims: The purpose of this study was to determine the immediate effect of patella support brace on co-contraction and electromyographic activity of selected lower limb muscles in females with patellofemoral pain syndrome during stance phase of gait

Methods: EMG activity of vastus lateralis, vastus medialis, rectus femoris, gastrocnemius, biceps femoris, semitendinosus, gluteus medius and gluteus maximus of 16 females with patellofemoral pain syndrome [mean age: 23.94+/-1.93 years] before and after wearing the patella support brace were compared using paired t-test

Results: EMGrms activity of vastus medialis significantly increased after using patella support brace during stance phase of walking [p=0.049]. Semitendinosus muscle showed significantly lower EMGrms activity in bracing condition during loading response phase [P=0.045] and total stance phase [P=0.03]. During midstance and propulsion, none of the selected muscles showed significant difference between before and after wearing the knee brace conditions. The results showed no significant differences in co-contraction between vastus lateralis and vastus medialis [P=0.497] and between medial [vastus medialis, semitendinosus] and lateral muscles [vastus lateralis, biceps femoris, gastrocnemius] of the knee [P= 0.088] in with versus without brace use condition

Conclusion: Because of increase of vastus medialis activity and decrease of semitendinosus activity in bracing condition during stance phase, it is possible to peak knee extensor moment increase during stance phase of gait by using Patella support brace

Virologic and histologic characterisation of dual hepatitis B and C co-infection in Egyptian patients

Background and study aims: Data about dual hepatitis C [HCV] and B [HBV] co-infection are still scarce, especially in endemic areas such as Egypt. Therefore, we aimed to characterise the virologic and histologic pattern of dual B/C co-infection in a tertiary care centre in Egypt

Patients and methods: After obtaining approval from the review board, a retrospective design to evaluate the data registry between January 2009 and December 2012 of patients with dual HCV and HBV seropositivity [BC-group] at the Viral Hepatitis Unit in Ministry of Health and Assiut University Hospital, Egypt was conducted. Data for hepatitis B e antigen [HBe-Ag] and anti-HB core status, anti-hepatitis delta virus [anti-HDV], HBV-DNA and HCV-RNA assays and liver biopsy [METAVIR scoring] results were collected. Two other matched groups of mono-HCV [C-group] and HBV [B-group] were selected as controls. All patients were naive for antiviral therapy

Results: A total of 3300 patients were enrolled. Dual infection was observed in 25 [0.7%] patients [all males, mean = 35.2 +/- 10.2 years]. Four patients [16%] were HBe-Ag-positive. Six [24%] patients were HBV-DNA-negative and all were positive for HCV RNA. Between groups, raised alanine aminotransferase [ALT] was found in 76%, 41.7% and 49.2% of the BC, B and C groups, respectively [p = 0.023]. HBV DNA >2000 IU ml[-1] was more in the B-group than in the BC-group [63.9% vs. 36%; p = 0.042] and HCV RNA >800,000 IU ml[-1] was more in the BC-group than in the C-group [28% vs. 12.3%; p = 0.009]. Histologically, there is no statistical significant difference between the three groups

Conclusion: Dual hepatitis B/C infection is not uncommon and their virologic and histologic profile is modest. Further evaluation with regard to treatment and long-term follow-up is warranted

Batch and flow injection potentiometric monitoring of ceftriaxone sodium in pharmaceutical reparations using two novel membrane sensors

Two novel potentiometric sensors are prepared, characterized and successfully used for static and continuous determination of ceftriaxone sodium [CRXN]. Both sensors are based on the use of plasticized PVC matrix membranes incorporating tetradodecylmethyl ammonium bromide [TDMAB], ortridodecylmethyl ammonium chloride [TDMAC] ion-exchangers and used for quantitative determination of CRXN at concentration level down to 29 micro M using both sensors with a good accuracy. Both sensors offer the advantages of fast response, reasonable selectivity, elimination of drug pre-treatment or separation steps, low cost and possible interfacings with computerized and automated systems. The use of plasticized membrane electrodes were used for continuous monitoring of CRXN offers the advantages of simple design, ease of construction and possible applications to small volumes of drug solutions with little manipulation and without pre-treatment. Both detectors display a wide dynamic measurement range of the drug under continuous mode of operation with a flow rate of 2.0 ml.min[-1] and used for quantitative determination of CRXN. The developed sensors were utilized in static continuous modes successfully for the determination of CRXN in pure powders and in dosage forms. It is worth noting that the developed membrane electrodes exhibited good selectivity toward CRXN over other cephalosporins such as; cefradine, ceftazidime, cefadroxil, cefaclor and cefoperazone, as well as other additives found in the pharmaceutical preparations such as; glucose, fructose and maltose

Cardiac effects of bee venom in rats

To elucidate the possible effects of bee venom [BV] on cardiac electrophysiological properties in vivo, the inotropic and chronotropic properties of the isolated hearts in vitro, and the cardiac responsiveness to progressive adrenergic stimulation by isoproterenol. This randomized control study was conducted in the Physiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt, from April to June 2010. This work was carried out on 22 female Wistar rats. Rats were allocated into 2 groups; BV-treated group [rats were treated with BV in a dose of 20 micro g/kg body weight, administered subcutaneously for 4 days], and the control group. Prior to sacrifice, the studied animals underwent electrocardiographic [ECG] assessments under anesthesia. Thereafter, isolated hearts were studied in a Langendorff preparation for their intrinsic properties, and their responses to beta-adrenergic stimulation. Following recovery, heart tissues were used for assessment of myocardial calcium content, and for histological examination. No abnormal ECG findings were observed in the BV-treated group. The BV treatment enhanced tension generation in the cardiac muscle in response to beta-adrenergic stimulation, and improved the inotropic cardiac reserve. Calcium content of the myocardial tissue of BV-treated group was significantly increased. Histological examination of the cardiac tissue of BV-treated group demonstrated preserved myofilament and mitochondrial ultrastructural integrity. The BV enhanced the cardiac inotropic reserve to beta-receptor agonists. Meanwhile, BV protected the heart against calcium overload-induced injury

Evaluation of the complement [C3] in patients with acute coronary syndrome

To evaluate complement activation [C3] levels in all forms of acute coronary syndrome [AC S] and to find whether there is any significant changes in C3 concentration at the 1[st] and 4[th] day after admission and its relation to clinical outcome. Comparing the degree of complement activation [C3 level] between ACS and stable pectoris. To know whether there is any significant difference between the level C3 at first and fourth day. Any correlation between CRP and C3 in patients with ACS. 129 subjects [94 male and 35 female] age range [41-72 years, mean age 57 + 10.6] were admitted in this study over the period of Feb 2009-Jan 2010 categorized into three groups; 76 patients with acute coronary syndrome [group A], 25 patients with stable angina [group B] and 28 healthy control [group C]. Full clinical, biochemical, electrocardiographic and echocardiographic studies liveredone. All patients were followed to the fourth day of admission, Blood samples from peripheral veins were collected centrifuged and Serum C3 levels were measured using immunokit based on single immunodiffision. The sample of patients was [129] subjects [94 male 72.9%] and [35 female 27.1%]. TropoIlin [I] was positive in 35.7% and negative in 64.3% of the study sample [p. value 0.0005]. C-reactive protein [CRP] was significantly correlated with different groups [p. value 0.0004].the same with diabetes mellitus [p. value 0.0003] but not in hypertensive and smokers [p. value 0.486 and 0. 368 respectively].C3 levels was significant in correlation to clinical status in both STEMI and NSYEMI 1[st] and 4[th] day. Correlation between C3 and C-reactive protein level was insignificant with different groups. C3 levels was significantly elevated in correlation between ACS compared to patient with stable angina and healthy control subjects. Also C3 level was significant at the fourth day of admission in patients with NSTEMI in correlation to its level at the first day. However no significance associations between C3 levels and CRP in different studied groups