Comparisons of Toxoplasma gondii Prevalence in Rural and Urban Areas of Al-Najaf Province of Iraq Using Serological Methods.

Toxoplasma gondii (T. gondii) is an intracellular protozoan parasite that multiplies within the host cell and causes the disease toxoplasmosis. T. gondii is distributed worldwide and is capable of infecting almost all warm-blooded animals. The current study was conducted in several urban and rural regions in AL-Najaf province of Iraq from September 2020 to April 2021. In total, 190 blood samples were collected and screened for T. gondii IgG and IgM antibodies using Rapid Diagnostic immunochromatographic test and the enzyme-linked immunosorbent assay (ELISA). These two tests were performed on 5 ml of blood samples. The results of the ICT test showed that 80 (42.1%) samples were positive for IgG; however, no IgM positive sample was recorded. The results of ELISA revealed that 27 (33.7%) and 4 (5%) samples were positive for T. gondii IgG and IgM antibodies, respectively. The estimated incidence of toxoplasmosis increased significantly in the 21-30 years age group and females (P<0.05), compared to other groups. The wide prevalence of toxoplasmosis was observed in Iraq, especially in Najaf province, which was reflected in the results of the study after taking random samples from different places with no symptoms of the disease. Therefore, all members of the community should undergo periodic examinations to diagnose possible infection through the most accurate tests.

Aggravating factors for melasma: a prospective study in 197 Tunisian patients.

BACKGROUND: Melasma is a frequent cause of consultations at dermatology departments by dark-skinned patients in Tunisia. OBJECTIVE: To investigate factors that influence melasma severity in a large Tunisian population. METHODS: A total of 197 patients (188 women and 9 men), who attended Tunis Military Hospital for a consultation were included prospectively from August 2005 to August 2006. Disease severity was estimated using the Melasma Area and Severity Index (MASI). Aggravating factors were investigated using multiple logistic regressions. RESULTS: Of the women included, 14% presented phototype III, 45% phototype IV and 41% phototype V; 76% presented a centrofacial melasma phenotype, 23% a malar and 1% a mandibular phenotype. About 60% developed melasma before thirty. Sun exposure was reported as a triggering factor by 51% of women and as an aggravating factor by 84%. Pregnancy was reported as an aggravating factor by 51% of women who had been pregnant, and oral contraceptive use reported by 38% of women exposed to oral contraceptives. The risk of severe melasma was about three times higher for women with age at onset under 30, phototype V and major lifetime sun exposure and about 8 times higher for women exposed to oral contraceptives. CONCLUSION: This study identifies a number of factors associated with the severity of melasma. Further epidemiological studies in this type of population, in particular, to investigate triggering factors, are justified by the aesthetic damage caused by melasma in dark-skinned patients, lack of efficacy of existing treatments, non-compliance with photoprotection recommendations and the challenge of treatment.

[Non-Hodgkin's lymphoma and pustular psoriasis: a case report]. / Lymphome malin non hodgkinien et psoriasis pustuleux : à propos d'un cas.

Psoriasis has been hypothesized to be associated with lymphoma. Several studies demonstrated an epidemiological relationship between these two entities. Patients with psoriasis are at increased risk for developing lymphoproliferative malignancies. This risk can be also the consequence of immunosuppressive therapies (methotrexate or cyclosporine). We report a 65-year-old man who presented with diffuse erythematous plaques with pustular or squamous borders. Histopathologic evaluation concluded to a pustular psoriasis. We discover simultaneously a stage 4 bone marrow B lymphoma of low grade of malignancy. This case report highlights the relationships between psoriasis and lymphoma.

[Management of severe psoriasis: about 50 cases]. / Modalites therapeutiques dans les formes severes de psoriasis: a propos de 50 cas.

BACKGROUND: With its varied clinical presentation, psoriasis is actually considered as a public health care problem. Severe psoriasis remains difficult to treat. METHODS: Our study was retrospective involving 50 patient with severe psoriasis treated in the dermatology unit of military hospital of Tunis from January 1990 to December 2003. Aim of our study was to evaluate actual different therapeutic attitudes and new treatments in case of severe psoriasis. RESULTS: During the 14 years studied the frequency of severe psoriasis was about 19.5%. Extended psoriasis was noticed on 64% of the patients. Arthropatic psoriasis was found on only 6% of the patients. Erythrodermic psoriasis, pustular psoriasis and palmoplantar psoriatic keratoderma were equally noticed in 10% of the patients. PUVA-therapy was firstly prescribed on 96.6% of the patients with extended psoriasis, bettering was noticed on 71% of all them during the 3 first cures. From the 20 patients that have received acitretin, 65% have noticed improvement. Méthotrexate and Re-PUVA was secondarily used (only for the cases of psoriasic arthritis amd méthotrexate) on respectively 18% and 10% of the patients. All our patients reported worsening on thems quality of life. CONCLUSION: Cyclosporin is more and more used initially in cases of rebellious psoriasis. Actually therapeutic hope leans on biological therapies.

Use of artificial diet system to assess the potential bio-insecticide effect of a fungal lectin from Xerocomus chrysenteron (XCL) on Myzus persicae.

Lectins are carbohydrate binding proteins which are widely distributed in nature: they have been isolated from microorganisms, fungi, plants and animals. Many of these proteins were tested for their potential biocide effect on lot of pests. Indeed, lectins can cause dramatic changes in the cellular morphology and metabolism, particularly on the digestive system of insect having ingested them, by lectin binding to membrane glycosyl groups of the digestive tract cells. A fungal lectin, namely Xerocomus Chrysenteron lectin (XCL) was previously purified and was shown to be toxic to several pests including aphids. At the cell level, an increase in the endocytosis, the induction of morphological changes such as the actin cytoskeleton shape was determined. In this work, the recombinant XCL was produced and was tested for its potential aphicide effect on Myzus persicae, a polyphagous aphid found on more than 400 host plant species and transmitting more than 100 viral diseases. We developed bioassays using different artificial diets incorporating a broad range of XCL concentrations (from 10 microgx ml(-1) to lmg.ml(-1)) to assess the potential negative effects of XCL on the development and reproduction of the M. persicae aphid. Significant mortality rates, changes of developmental durations and nymph production were observed depending on the XCL concentration in the artificial diet. Concanavalin A lectin was also used in a new range of experiments to compare the effects of the two lectins on the aphid biological parameters. According to the observed dose responses toward the XCL and Con-A lectins included in the artificial diet and the action mode of this kind of proteins, the perspectives of lectin use in pest control will be discussed.

Posttransplantation acute tubular necrosis: risk factors and implications for graft survival.

Previous studies aimed at identifying the causes, risk factors, and outcome of kidney transplant recipients with delayed graft function (DGF) have yielded controversial results. We retrospectively analyzed the causes and risk factors for DGF in 263 cadaveric kidney transplantations from November 1988 to March 1997 in one center. Causes of DGF were assessed by postoperative graft evolution and graft biopsy. Univariate and multivariate analysis were used to investigate the risk factors for DGF induced by acute tubular necrosis (ATN). Seventy-six patients (29%) had DGF, which was caused by ATN in 70 patients (92.1%) and acute rejection (AR) in 6 patients (7.9%). Therefore, we focused on risk factors and consequences for ATN-induced DGF. In monofactorial analysis, ATN was significantly associated with greater weight and presence of an atheromatous disease in both donor and recipient. Other risk factors for ATN were older age of donor, recipient American Society of Anesthesiology (ASA) physical status category IV, cold ischemia time (CIT), and transplantation using the right kidney. The multivariate analysis showed that donor and recipient weight, donor age, transplantation using the right kidney, preservation in Eurocollins solution, ASA score, and CIT were associated with ATN. The incidence of rejection and renal function were not different at 3 months or 1 and 5 years. ATN is the main cause of DGF in kidney transplant recipients. ATN is caused by donor and recipient vascular background, grafting the right kidney, and CIT. ATN does not appear to have an adverse effect on long-term kidney function.

Timing of nephrology referral: influence on mortality and morbidity.

To assess the influence of the timing of nephrology referral on the short- and long-term outcome of hemodialysis patients, we retrospectively studied 309 patients who had end-stage renal failure and entered the chronic hemodialysis program in Sainte-Marguerite University Hospital between January 1, 1989, and December 31, 1996. We excluded from the analysis five patients without available data on referral pattern and 34 patients with irreversible acute renal failure. Of the remaining 270 patients, 177 patients (58%) had an early referral (ER) 16 or more weeks before the start of dialysis, and 93 patients (31%) had a late referral (LR) of less than 16 weeks before dialysis. Short-time morbidity (initial emergent dialysis, pulmonary edema, severe hypertension, temporary vascular access placement for first dialysis, prolonged initial hospitalization) was significantly more frequent in LR patients. Long-term evolution (mean follow-up, 26.5 +/- 26 months) did not differ between the two groups. The number of days of hospitalization per patient-year at risk beyond the third month was 21.5 +/- 33.7 days for ER and 21.1 +/- 36 days for LR patients. Survival analysis showed no difference between the two groups: 3-month survival rates were 96% in both groups, 1-year survival rates were 90% in the ER and 89% in the LR group, and 5-year survival rates were 52% in the ER and 56% in the LR group. In a Cox hazards regression model, referral pattern was not associated with a greater risk for death. In conclusion, delayed nephrology referral generated strikingly greater initial morbidity, but long-term outcome of hemodialysis patients was not modified by delayed nephrological care.

Delayed-type hypersensitivity and lymphocyte proliferation in response to Leishmania major infection in a group of children in Jericho.

The cellular response to Leishmania major was evaluated in vitro with a lymphocyte proliferation microtest, performed on 100 microliters of whole blood obtained by finger prick. The maximum time and optimum conditions for storage of fresh blood before testing were determined, and the ability of the assay to evaluate cellular immunity to Leishmania was compared to that of the classical Montenegro skin test. A positive correlation between the diameter of the skin induration and the stimulation index was demonstrated. Defining a positive skin test by induration greater than or equal to 5 mm, and a positive proliferation assay by a stimulation index greater than 2.6 and a response greater than or equal to 3000 ct/min, we found a significant correlation between the 2 tests. The proliferation assay was less sensitive than the skin test, but somewhat more specific. Diagnostic specificities and sensitivities did not differ for the 2 tests.

Potential interest of anti-ischemic agents for limiting cyclosporin A nephrotoxicity.

Chronic administration of cyclosporin A induces nephrotoxicity in humans. This is related to a cyclosporin A-induced constriction of afferent glomerular arterioles and mesangial cells, which leads to a decrease in filtration pressure and creatinine clearance. Afterwards, cellular lesions are observed involving mainly tubular atrophy and interstitial fibrosis, both of which are nonspecific. The initial mechanism of its toxicity is not clearly explained. The current pharmacological approach is symptomatic in order to counteract or minimize the consequences of a prime cause, which still remains to be defined. However, cyclosporin A has a deletereous effect on mitochondrial functions and mainly on ATP synthesis, which occurs when Ca2+ accumulates in matrix mitochondria. The effects of trimetazidine, an antischemic drug used in the treatment of angina pectoris, have been assessed. This drug is effective in experimental models of hypoxia induced by cyclosporin A: it restores ATP synthesis previously decreased by Ca2+ and cyclosporin A, and releases a part of Ca2+ excess accumulated by mitochondria at concentrations reached in humans at usual dosage regimens. At higher concentrations, it reverses the mitochondrial permeability transition previously generated (opened) by Ca2+ and a pro-oxidant such as terbutylperoxide (t-BH). It was also observed that trimetazidine does not modify the immunosuppressive effects of cyclosporin A in various models. These data suggest that nephrotoxicity of cyclosporin A is not irrevocably linked to its immunosuppressive effect but that it may be possible to counteract at least partly its nephrotoxic effects without altering its effectiveness in preventing graft rejection.

Using ultrapure water in hemodialysis delays carpal tunnel syndrome.

Since 1977, our patients have undergone chronic HD with ultra-pure dialysate (UPD), defined as having endotoxin levels below 0.008 ng/ml and less than 1 bacteria/ml of dialysate. We evaluated the incidence of carpal tunnel syndrome (CTS) in three groups of patients. Group I (GI), 84 patients, dialysed for 6.1 +/- 3.2 years (mean +/- SD) with UPD only; Group II (GII), 39 patients, first dialysed for 3.7 +/- 2.3 years with non-UPD and afterwards for 8.4 +/- 2.1 years with UPD; Group III (G III), 103 patients treated for 6 +/- 5.9 years exclusively with non-UPD. All patients were dialysed with cuprophan or cellulose acetate membranes. Results, expressed by Kaplan-Meier actuarial survival curves as the percent of patients without CTS, show that CTS occurred significantly less in GI than in GIII. This may be due to less stimulation of monocytes resulting from the absence of bacteria, endotoxins and pyrogens in the dialysate, which would reduce the stimulation of cytokines release, interleukin 1 and 6, and tumor necrosis factor, known to stimulate beta 2 microglobulin synthesis.

[Familial hyperkalemia syndrome (Gordon's syndrome)]. / Syndrome d'hyperkaliémie familiale (syndrome de Gordon).

Hyperkaliema at 6 mmol/l was discovered in a 30-year old man during routine examination. Further investigations showed that the hyperkaliaemia was associated with hyperchloraemic acidosis, stimulable hyporeninaemia and relative hypoaldosteronism in relation to the hyperkaliaemia. Renal and adrenal functions were normal. The finding of 3 identical cases in a French family of 9 persons led to the diagnosis of Gordon's syndrome, a rare hereditary metabolic disorder with a controverted physiopathology.

Cutaneous malignant melanoma: Tabuk experience.

Cutaneous melanoma (CM) has a rising morbidity and mortality in the western world but is rare in certain geographical areas including the Middle East. The aim of this study is to define the pattern of CM in this environment over a period of about two decades. A review of associated histological reports, dermatology, plastic general surgical admissions and outpatient census statistic of the North West Military Hospital (N.W.A.F.H.) were carried out from January 1978 to June 1996. The clinico-therapeutic information from both the review case and newly discovered CM was then studied. The result shows that CM is probably rare in the Tabuk military environment and possibly has a low mortality among the affected individuals. The presence of only 2 cases of CM among 73,955 patients over about 20 years suggests that this neoplasm is rare in N.W.A.F.H. Surgery, with localised expert reconstruction, probably offers the best cure for uncomplicated CM in this area. It is suggested that the geographical environment, genetic attributes, custom, attitude, presence of white, painted, sun-reflecting buildings, traditional dress-code and behaviour of the indigenes probably contribute to the suppression of and protection against CM in Tabuk. It is recommended that regular, antimlanoma education awareness programmes among the indigenes and avoidance of sunbathing attitude of the expatriate community should be encouraged in order to maintain this suggested natural selection protection.

[Increased serum and urinary levels of silver during treatment with topical silver sulfadiazine]. / Elévation des taux sériques et urinaires d'argent au cours d'un traitement topique par sulfadiazine argentique (Flammazine(R)).

BACKGROUND: Argyria, induced by prolonged absorption, is often of professional or medical origin. We report two cases of per cutaneous intoxication with topical silver sulfadiazine. CASE REPORTS: A 64 year-old hypertensive, diabetic woman presented bilateral venous ulcers on the legs. She had applied 100 g of silver sulfadiazine 1 p. 100 cream per week for the past 18 months. Silver concentration in blood high: 38 microgram/l (N<0.5) and led to renal dysfunction, without ocular or hepatic abnormality. A 19 year-old woman was treated with topical silver sulfadiazine for thermic cutaneous burns on legs. Renal and hepatic function was normal but silver concentration in blood was high at 440 microgram/l (N<0) with urinary excretion of silver at 12 microgram/l (N=0). DISCUSSION: Silver, from prolonged and excessive use of topical silver sulfadiazine, deposits in large amounts throughout the body: skin, labial mucosa, gingiva, kidney, liver and cornea. Monitoring concentration of silver in blood and/or urine is necessary, especially in patients treated with silver sulfadiazine cream for cutaneous burns. Indeed, silver is rapidly absorbed through the burn wound. It provokes hepatic, renal and neurologic tissue toxicity. Renal and hepatic function tests are not correlated with serum silver levels. CONCLUSION: The potential for silver toxicity is a direct consequence of applying silver sulfadiazine to extensive burn wounds. Hence monitoring concentrations of silver in blood and/or urine of patients receiving this treatment is recommended.

[GAPO syndrome]. / Le syndrome GAPO.

INTRODUCTION: The GAPO syndrome is a rare but distinct genetic disorder. GAPO is an acronym for the manifestation of Growth retardation, Alopecia, Pseudoanodontia and Optic atrophy. The syndrome was first reported in 1947; to date, 24 cases have been reported. We report the first Tunisian case. OBSERVATION: We studied a 12 year-old boy with GAPO syndrome which was associated with peculiar facial appearance, umbilical hernia, hemangiomatous plaques of the neck, depigmented maculae arranged in a splashed pattern located in the trunk and the right upper limb. He had a pulsated mass in the right mastoid area and a bruit was audible, he had a second flaccid mass of the vertex. These tumefactions correspond to very developed commissure veins. DISCUSSION: In addition to the classical manifestations of the GAPO syndrome, the patients have a strikingly characteristic facial appearance and may also have umbilical hernia, skin redundance and prominent dilatation of scalp veins. Our case had depigmented maculae suggestive of incontinentia pigmenti achromians. This has never been reported previously. The pathogenesis of this syndrome is unknown and inheritance is considered to be autosomal recessive.

The toxic effect of lead on seed germination, growth, chlorophyll and protein contents of wheat and lens.

Lead is a heavy metal which is believed to be toxic when present in excessive amount. Excess Pb in Triticum sativum and Lens esculanta alters several physiological and biochemical processes in both species. Seed germination of both species grown on soaked filter paper with Pb (NO3)2 was highly inhibited (about 60% at 20 mM Pb (NO3)2). Results obtained from measurement of lead content in the roots and shoots of both species indicated that most of the lead accumulated in the roots of both species with a lower degree within the shoots. Lead uptake by both species whether grown in perlite medium or on filter paper soaked with Pb (NO3)2, was correlated with lead concentration. These results indicate a passive process of lead translocation. These results also show that lead inhibits the growth of both plant species, but root growth inhibition was more pronounced than shoot growth inhibition at different lead concentration. Total chlorophyll content was found to be decreased in both species after treatment with Pb (NO3)2. Total protein content in the seedlings, as our results have indicated, was found to be increased with increasing lead concentration in both species.

Apoplexia uteri: a rarely described post-mortem finding.

We present a case of apoplexia uteri, a rarely described condition of haemorrhagic necrosis in an atrophic endometrium and myometrium associated with terminal stress. This entity is well recognised in older literature but few recent publications have addressed this condition. It is thought to occur in association with hypoperfusion with passive hyperaemia and reperfusion injury. This case serves to highlight this rarely encountered entity as a possible cause of haemorrhage in an atrophic endometrium in the 'perimortem' period. Incidental findings are occasionally observed in the course of forensic autopsy practice and knowledge of rarely encountered entities, such as that described in this case, is essential to prevent diagnostic uncertainty and misdiagnosis.