Patients' understanding of cellulitis and views about how best to prevent recurrent episodes: mixed-methods study in primary and secondary care.

BACKGROUND: Cellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately one-third of cases. The only proven strategy to reduce the risk of recurrence is long-term, low-dose antibiotics. Given current concerns about antibiotic resistance and the pressure to reduce antibiotic prescribing, other prevention strategies are needed. OBJECTIVES: To explore patients' views about cellulitis and different ways of preventing recurrent episodes. METHODS: Adults aged ≥ 18 years with a history of first-episode or recurrent cellulitis were invited through primary care, hospitals and advertising to complete a survey, take part in an interview or both. RESULTS: Thirty interviews were conducted between August 2016 and July 2017. Two hundred and forty surveys were completed (response rate 17%). Triangulation of quantitative and qualitative data showed that people who have had cellulitis have wide-ranging beliefs about what can cause cellulitis and are often unaware of risk of recurrence or potential strategies to prevent recurrence. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were more popular potential strategies than the use of compression stockings or long-term antibiotics. Participants expressed caution about long-term oral antibiotics, particularly those who had experienced only one episode of cellulitis. CONCLUSIONS: People who have had cellulitis are keen to know about possible ways to prevent further episodes. Enhanced foot hygiene, applying emollients daily, exercise and losing weight were generally viewed to be more acceptable, feasible strategies than compression or antibiotics, but further research is needed to explore uptake and effectiveness in practice.

Evidence-based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review.

Tinea cruris and tinea corporis are common fungal infections. Most can be treated with a variety of topical antifungals. This review aimed to assess the evidence for the effectiveness and safety of topical treatments for tinea cruris and tinea corporis. Searches included the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase, LILACS and ongoing trials registries (August 2013). One hundred and twenty-nine randomized controlled trials (RCTs) with 18 086 participants evaluated a range of interventions - mostly azoles. Pooling of data for several outcomes was only possible for two individual treatments. In five studies, terbinafine showed a statistically significant higher clinical cure rate compared with placebo [risk ratio (RR) 4·51, 95% confidence interval (CI) 3·10-6·56]. Data for mycological cure could not be pooled owing to substantial heterogeneity. Across three studies, mycological cure rates favoured naftifine (1%) compared with placebo (RR 2·38, 95% CI 1·80-3·14) but the quality of the evidence was low. Combinations of azoles with corticosteroids were slightly more effective than azoles for clinical cure, but there was no statistically significant difference with regard to mycological cure. Sixty-five studies were assessed as 'unclear' and 64 as being at 'high risk' of bias; many were over 20 years old, and most were poorly designed and inadequately reported. Although most active interventions showed sufficient therapeutic effect, this review highlights the need for further, high-quality, adequately powered RCTs to evaluate the effects of these interventions, which can ultimately provide reliable evidence to inform clinical decision making.

Bacterial Causes for Mortality Syndrome in Some Marine Fish Farms with Treatment Trials.

BACKGROUND AND OBJECTIVE: Bacterial fish diseases constitute a major problem in aquaculture, it was found in the environment and under stressors cause severe economic losses to fish. This work aimed to investigate the bacterial causes and suitable treatments of mass mortality in some cultured marine fish farms in Damietta governorate. MATERIALS AND METHODS: The study was performed on 5 farms suffered from mass mortality. Total of 100 diseased fish (10 sea bass and 10 sea bream/farm) and 20 water samples were randomly collected from these farms. Bacteriological examinations were carried out followed by in vitro sensitivity tests. Treatment trial was performed using the most effective antibacterial agent on isolated bacteria. RESULTS: From fish and water samples Pseudomonas spp., Aeromonas spp. and Vibrio spp. were isolated with the rat of (16, 10%), (22, 10%) and (28, 10%) respectively. These results were confirmed biochemically. Some virulence genes of isolated bacteria were detected using PCR; meanwhile, enrofloxacin reduced significantly the mortality rates in examined farms. CONCLUSION: It could be concluded that, Pseudomonas spp., Aeromonas spp. and Vibrio spp. are the main bacterial species causing mass mortality in marine fish farms. These bacteria were highly sensitive to enrofloxacin in vitro and in vivo.

Treatment Trial of Nile Tilapia (Oreochromis niloticus) Experimentally Infected with Vibrio alginolyticus Isolated from Sea bass (Dicentrarchus labrax).

BACKGROUND AND OBJECTIVE: In Egypt, Nile tilapia represents the main cultured type due to its economical price, palatability and easy culturing. This study was aimed to elucidate the pathogenicity of V. alginolyticus isolated from diseased sea bass and experimentally infected healthy Nile tilapia fish. MATERIALS AND METHODS: Healthy Nile tilapia fish were injected I/P with V. alginolyticus isolated from diseased sea bass. Symptoms and mortality rates of infected Nile tilapia fish were recorded during the experimental period. Re-isolation of V. alginolyticus was done from infected tilapia fish by bacteriological methods. For confirmation the pathogenicity of Vibrio isolated either from marine fish or tilapia fish, PCR test was done using tdh and bla gens. Liver and kidney function tests with histopathological examinations of some organs were performed. Treatment trial was done according to the antibiotic sensitivity test. RESULTS: The isolated Vibrio is highly pathogenic to Nile tilapia fish causing deterioration in all parameters which finished by severe mortalities. Treatment with florfenicol, enrofloxacin, or oxytetracycline reduced the mortality rate and improved liver and kidney function parameters of infected Nile tilapia fish. CONCLUSION: V. alginolyticus can infect both marine and fresh water fish inducing a high mortality rate. Treatment of infected fish with florfenicol, enrofloxacin, or oxytetracycline reduces the mortality rate.

Alteration parameters affecting the Luxor Avenue of the Sphinxes-Egypt.

Stone alteration in the environment is caused by various extrinsic disintegration agents, besides, their intrinsic properties "mineralogical composition, textures and internal structure". Therefore, the purpose of the current study was to evaluate the weathering state affecting the Luxor Avenue of the Sphinxes by studying its chemical, mineralogical and physio-mechanical characteristics, in addition to morphological features. Scientific techniques, such as X-ray fluorescence (XRF), X-ray diffraction (XRD), Petrographical microscopy (PM), Cathodoluminescence (CL), Environmental Scanning Electron Microscope (ESEM) and micro energy-dispersive X-ray fluorescence (µ-EDXRF) were used. The results showed that quartz represents more than 96% of the sandstones and the main cement of the grains is quartz overgrowth. Alteration and formation of kaolinite was clearly observed. Halite, sylvite and bischofite were the main salts that affected the statues representing approx. 78.40%. The study also provided information about the different deterioration factors affected the Avenue of the Sphinxes namely; burial environment, solar effects, soil moisture and groundwater. These caused some deterioration forms such as soiling & crusting, breaking down most of the statues heads, saturation forms, salt crystallizations and stone abrasion. Cleaning, desalination and consolidation using different materials and techniques, in addition to reducing the human anthropogenic impacts are recommended for future conservation of the Luxor Avenue of the Sphinxes.

Fricke gel dosimeter as a tool in quality assurance of the radiotherapy treatment plans.

Ferrous xylenol gel was evaluated as a dosimeter in verifications of treatment plans for treatments of female breast tumors in external-beam radiation therapy. The dosimeter was calibrated in a cubic wax phantom irradiated with 6 and 15MV beams of an Elekta clinical linear accelerator and then used for measurements of doses in an anthropomorphic phantom of a female torso, which mimicked female breasts after modified radical mastectomy and breast-conserving surgery. Doses measured with the gel in specific locations in the phantom were compared with values predicted by treatment plans created with the XiO treatment planning system (Elekta / IMPAQ) and with results of measurements with an IBA CC13 ionization chamber in the same locations. Differences between the values measured with the gel and predicted by the treatment planning system or measured with the ionization chamber were within 1.5% in most cases. In an area of as steep dose gradient, the difference reached 2.7%, which was explicable in terms of the finite size of the gel dosimeter. The dose response of the gel is dose rate and energy independent in the ranges used in most clinical linacs. The results have shown that ferrous xylenol gels can be used as dosimeters in quality assurance in radiation therapy.

Effect of perchloric acid on the performance of the Fricke xylenol gel dosimeter.

The conventional ferrous xylenol orange (XO) gel (FXG) dosimeter is being wildly investigated for radiotherapy dose measurements. Upon irradiation, its color turns red due to oxidation of Fe(2+) into Fe(3+), which forms a complex with xylenol orange. The effect of perchloric acid (PCA) on the dosimetric properties of the gel in the dose range of 1-15Gy was investigated using visual spectrophotometry. FXG-PCA responds to radiation dose linearly and exhibits higher radiation sensitivity than the conventional gel dosimeter. PCA in a concentration of 20mM enhances the radiation sensitivity ~44%. Stability of the absorbances of both the gels during storage under various conditions was investigated, and the uncertainty of dose measurements was estimated.

Assessment of vinyl chloride-induced DNA damage in lymphocytes of plastic industry workers using a single-cell gel electrophoresis technique.

DNA damage and the formation of stable carcinogen-DNA adducts are considered critical events in the initiation of the carcinogenic process. This study was carried out to assess whether exposure of plastics industry workers to the vinyl chloride monomer (VCM) for different periods of time would cause DNA damage, using the single-cell gel electrophoresis (SCGE) technique. Levels of DNA damage was assessed by both extent of DNA migration and numbers of DNA damaged spots in the peripheral blood lymphocytes from 32 plastics workers with different periods of exposure to VCM; they were evaluated by comparison with a group of non-exposed individuals. It was found that plastics workers who were exposed to VCM for different periods of time showed significantly increased levels of DNA damage compared with the non-exposed subjects. There was a significant correlation between the severity of DNA damage and duration of exposure. However, no significant correlation was found between the age of all subjects and DNA damage. Concentrations of VCM in the air inside the factory were found to be significantly higher than values in non-exposed areas, despite being lower than the threshold limit value (TLV). Our results encourage the application of SCGE as a sensitive, simple, fast and useful technique in the regular health screening of workers occupationally exposed to VCM (even at concentrations below the TLV) to assess the possibility of any DNA damage.

Deltamethrin-induced testicular apoptosis in rats: the protective effect of nitric oxide synthase inhibitor.

This study is the first to examine and characterize the testicular apoptosis which might be induced due to exposure of male rats to deltamethrin. Furthermore, the role which might be played by nitric oxide (NO), as well as the other reactive oxygen species (ROS) in controlling this testicular apoptosis was assessed. Apoptosis was evaluated by DNA fragmentation detected by agarose gel electrophoresis and cellular morphology on testicular tissue sections. It was found that administration of deltamethrin (1 mg/kg daily for 21 days) to animals resulted in characteristic DNA migration patterns (laddering), thereby providing evidence that apoptosis is the major mechanism of cell death in the testicular tissues. In addition, histopathological examination of testicular tissue sections showed that apoptosis was confined to the basal germ cells, primary and secondary spermatocytes. These changes, in addition to the appearance of Sertoli cell vacuoles in deltamethrin-intoxicated animals, indicates the suppression of spermatogenesis. At the same time, the plasma levels of both NO and lipid peroxides measured as malondialdehyde (MDA) were found to be significantly increased in deltamethrin-treated animals. Administration of NO synthase (NOS) inhibitors such as N(G)-nitro monomethyl L-arginine hydrochloride (L-NMMA, 1 mg/kg) to rats 2 h before exposure to deltamethrin was effective in the reduction of the typically testicular apoptotic DNA fragmentation pattern and the associated histopathological changes. These findings may suggest that deltamethrin-induced testicular apoptosis is mediated by NO. Therefore, the pharmacological manipulation of apoptosis by selective NOS inhibitors such as L-NMMA may offer new possibilities for the control of deltamethrin-induced testicular dysfunction and infertility in the future.

In vivo and in vitro evaluation of the mutagenic potential of carbamazepine: does melatonin have anti-mutagenic activity?

The mutagenic potential of carbamazepine (CBZ) therapy has been evaluated both in vivo and in vitro. Analysis of chromosome aberrations (CA), sister chromatid exchanges (SCEs), mitotic and proliferation indices (PRI) were performed. The in vivo study was carried out on 30 patients with idiopathic epilepsy end undergoing treatment with CBZ for different periods starting from 6 months up to 15 years. Plasma CBZ levels were also determined for each patient. The results showed that the total CA and SCEs were significantly increased in CBZ-treated patients. There was no significant correlation between CA and either duration of treatment or the plasma CBZ levels for each patient. The mitotic and proliferation indices were found to be slightly but non-significantly decreased compared to control values. On the other hand, in vitro analysis showed a significant dose-dependent increase in CA and SCEs in human lymphocyte cultures treated with CBZ (4-12 microg/ml). The mitotic and proliferation indices were also found to be decreased but only significantly in case of high doses of CBZ (12 microg/ml). Pretreatment of human lymphocytes with melatonin (0.5 mM) exhibited a significant decrease in the frequencies of CBZ-induced CA and SCEs as compared with non-treated cultures. The depressed mitotic and proliferation indices were also found to be improved in cultures pretreated with melatonin. In conclusion, these observations suggest that CBZ monotherapy may lead to chromosome damaging effects (genotoxic) and the use of melatonin as anti-mutagenic agent for human protection against CBZ-induced chromosome damage should be considered.

Distribution of D1S80 alleles in the Bahrainian population.

This study demonstrates that the locus D1S80 is highly polymorphic in the Bahrainian population. There were 24 different D1S80 alleles and 51 distinct genotypes observed in 198 Bahrainians. There was one allele observed that was smaller than the 14 repeat allele. This data set meets the Hardy-Weinberg expectations (HWE) and could be a useful marker for parentage testing and forensic applications.

Boyhood varicocele: an overlooked disorder.

Varicocele is a common, but often overlooked, disorder. It appears in pre- and para-pubertal boys as well as adults. Between 1954 and 1982 23 boys with varicocele were referred to Alder Hey Children's Hospital. This small number (less than a patient a year) does not represent the true incidence of varicocele in the community as is evident from a review of the world literature. The reasons for this infrequent referral rate are discussed and a plan for treatment is proposed. The word Varicocele is derived from the latin 'varix' which means dilated vein and the Greek 'kele' meaning a tumour or swelling. In 1889 Bennet (1) described a varicocele as, 'a condition of varicosity of the veins of the spermatic cord, of congenital origin, resulting in, or associated with, a deficient development or functional imperfection of the corresponding testis in the majority of cases'. Very little attention has been paid to this disorder in children (only one paper has been published in the British literature over the past 20 years (2]. The aim of this paper is firstly to increase awareness of the prevelance of this condition and secondly to suggest a plan of treatment in the light of our experience and other reported series.

Laparoscopic versus open high ligation of the testicular veins for the treatment of varicocele.

The purpose of this study is to determine the relative advantages of laparoscopic varicocelectomy compared to the conventional open high ligation of Palomo. We studied 193 patients who presented with varicocele. While 65 patients were treated by open high ligation of the testicular veins, 128 patients had laparoscopic varicocelectomy. In addition to varicocele ligation, 14 patients (11%) had laparoscopy-assisted right orchidopexy, and 5 patients (4%) had laparoscopic repair of concomitant right inguinal hernia. The mean hospital stay was 3.5 days and 1.3 days, respectively, and the recurrence rates were 10.8% and 3.9%, respectively. Return to normal activity was significantly earlier in Group II (mean 4.5 days) compared to Group I (mean 8.9 days). There was no incidence of testicular atrophy in any case in the study, regardless of whether the testicular artery was ligated or preserved during surgery. We conclude that laparoscopic varicocelectomy is safe, effective and minimally invasive. In addition to its better cosmetic results and advantage in case of bilateral disease, it allows excellent exposure and control of the affected vessels. Furthermore, the shorter hospital stay and the earlier return to normal activities are very important advantages in recommending this technique as an efficient alternative to the open surgical method.

Influence of magnetic field on brain activity during administration of caffeine.

The aim of the present work is to evaluate the effect of caffeine, the world's most popular psychoactive drug, on the electric activity of the rat's brain that exposed to extremely low-frequency magnetic field (ELF-MF), during 15 days. The obtained results showed that administration of caffeine in a group of rats by dose of 10 mg/kg (equivalent to human daily consumption) caused a reduction in the mean power amplitude of electroencephalogram (EEG) trace for almost all frequency bands especially α (8-12 Hz). It was observed that the influence of caffeine was more evident in motor cortex than in visual cortex. While the exposure of another group to ELF-MF of intensity 0.2 mT during the same period caused an enhancement in the mean power amplitude of most EEG frequency bands; this was more observed in the right hemisphere of the brain than that of the left hemisphere. The administration of caffeine while rats were exposed to ELF-MF, led, after 5 days of exposure, to a great increase in the mean power amplitude of α band at all places of recording electrodes. It may be concluded that caffeine administration was more effective in reducing the hazardous of ELF-MF in motor cortex than in visual cortex.

Failure of fusion of epididymis and testis: a rare laparoscopic finding.

A case of complete separation between an abdominal testis and the epididymis discovered during diagnostic laparoscopy for impalpable testis is presented. A 13-year-old boy with impalpable testis underwent diagnostic laparoscopy for impalpable testis. The vas on the left side was seen entering a closed internal ring while a small testis was found completely separated and medial to the internal ring.

Effect of maternal lead exposure on craniofacial ossification in rat fetuses and the role of antioxidant therapy.

Lead exposure during intrauterine life was found to result in reduced birth weight, impaired skeletal development and post-natal neurotoxic effects. In this study, the effect of pre-natal exposure to different doses of lead on the development of craniofacial skeleton in rat fetuses was investigated. Vitamin E was tested as a concomitant treatment, aiming to improve the fetotoxic effects of lead. Positively pregnant female rats were randomly divided into four groups; groups I and II (L250 and L500), exposed to lead acetate in doses of 250 and 500 mg/l respectively, group III (L500 + E), exposed to lead acetate (500 mg/l) wit concomitant vitamin E and group IV (Control) which was given sodium acetate only. All the treatments started from the first day of gestation till the 20th day, where all rats were sacrificed and the fetuses were recovered. Fetuses were processed to alizarin red staining for ossified components. Twenty-seven bones of the craniofacial skeleton were studied in each fetus where the ossification was scored as being complete, delayed or absent. In all studied fetuses from all groups, changes were found only in eight bones while the remaining craniofacial bones were normally ossified. In affected bones there was a significant decrease in the number of completely ossified bones; associated with a significant increase of both partially ossified and absent bones in L(250) and L(500) treated groups when compared to the control group. These differences were more significant in the L(500) treated group. Giving vitamin E improved the percentage of completely ossified craniofacial bones and decreased the percentage of both partially ossified and absent bones. The most affected bone was presphenoid, then to a lesser extent supraoccipital, squamosal, parietal, interparietal and frontal bone respectively. In conclusion, lead exposure to rats during pregnancy led to varying degrees of fetal growth retardation as well as delayed ossification of some craniofacial bones which were dose dependent and the concomitant supplementation with vitamin E greatly improved the deleterious effect of lead.

Non-descent of the testis: An overlooked laparoscopic finding.

The purpose of this report is to bring attention to a rare variety of non-descended testis which may be easily overlooked. Between 1996 and 2006 diagnostic laparoscopy was performed for non-palpable testes in 209 children with 229 impalpable testes. Eight abdominal testes were encountered in seven patients located in the sub-renal position; the vas was found to be looping in an upward direction to join the epididymis. Laparoscopic Fowler-Stephen procedure was attempted in all these cases, with the loss of two testes and salvage of six.

Duplicate bladder exstrophy: a case report.

A newborn male presented with what appeared to be classic bladder exstrophy. He had a well-formed penis with an epispadiac urethral plate. Inability to identify the ureteral orifices during surgical repair led to the discovery of a normally positioned external urethral meatus joining a closed bladder posterior to the exstrophic one. The closed bladder had a thin distensible wall into which both ureteric orifices opened. There was divergence of the recti and diastases of the pelvic bones. As the only muscular component was the exstrophic wall, it was decided to excise an elliptical strip of the muscular wall in the midline and establish a communication between the two bladders. The exstrophic wall was then closed, converting the two bladders into one shared cavity, and the urethral plate was tubularized to construct a new urethra. The cosmetic result was acceptable and the child has normal control of urine from the normally positioned urethra.

Laparoscopic management of persistent müllerian duct syndrome.

Between 1993-2002 we used both diagnostic and operative laparoscopy in the management of five cases of persistent müllerian duct syndrome (BMDS). Two siblings from two different families accounted for four of the cases. They presented with cryptorchidism and inguinal hernias. The diagnosis was established during diagnostic laparoscopy. The impalpable testes were on the left in three, on the right in one and bilateral in one. The latter case had been managed previously in another hospital by an open technique, and the diagnosis was missed. Transverse testicular ectopia was present in two unrelated boys. All the cases were managed by splitting the uterus in the midline and then bringing the testis with the vas and attached uterine tissue into the scrotum. Three of the five cases were managed laparoscopically. Follow-up of 6 months to 10 years showed satisfactory results in four of the five cases.

Boyhood varicocele.

Boyhood varicocele is a common disorder which appears in prepubertal and parapubertal boys as well as adults. Few clinicians are aware of its actual prevalence among boys, hence, the infrequent referrals of this disorder to the specialist centres. This article highlights the importance and prevalence of the disorder in boys, discusses its management and stresses the need for prospective studies regarding its relation to future subfertility.