Successful Management of Severe Unresponsive Snake Bite Envenomation Using Plasmapheresis and Corticosteroid at Egyptian National Environmental and Clinical Toxicology Research Center: A Case Report.

Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient's general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.

Studying the Association Between Occupational Stress and Urinary Levels of Oxidative Stress Biomarkers (8-OHdG and Biopyrrins) in Brickfield Workers.

OBJECTIVES: The aims of the study are to measure the prevalence and level of occupational stress (OS) and to explore its association with oxidative stress among some brickfield workers. METHODS: Eighty-six brickfield workers and 90 administrative controls were assessed using the Arabic validated version of the Occupational Stress Index. The urinary levels of oxidative biomarkers; 8-hydroxy-2'-deoxyguanosine and biopyrrins were also measured. RESULTS: The prevalence of moderate and severe OS in addition to the urinary levels of both oxidative biomarkers was significantly higher among the brickfield workers compared with their controls. Both biomarkers levels were significantly and positively correlated with scores of Occupational Stress Index, duration of employment, and with each other. The receiver operating characteristic analysis showed significant specificity and sensitivity of both biomarkers for determining the level of OS. CONCLUSIONS: A significant association between occupational and oxidative stresses was detected in brickfield workers.

Exploring the Link Between the Serum/Blood Levels of Heavy Metals (Pb, As, Cd, and Cu) and 2 Novel Biomarkers of Cardiovascular Stress (Growth Differentiation Factor 15 and Soluble Suppression of Tumorigenicity 2) in Copper Smelter Workers.

OBJECTIVE: Studying the association between the occupational exposure to Pb, As, Cd, and Cu with the serum levels of 2 novel biomarkers of cardiovascular stress; growth differentiation factor 15 and soluble suppression of tumorigenicity 2, in some Egyptian Cu smelter workers. METHODS: Forty-one exposed workers and 41 administrative controls were clinically evaluated. Serum/blood levels of heavy metals and biomarkers were measured for both groups. RESULTS: The smelter workers showed significantly elevated levels of heavy metals and biomarkers compared with controls. The elevated serum levels of both biomarkers were significantly and positively correlated with each other, the levels of heavy metals, and the duration of employment of the exposed workers. CONCLUSIONS: There was a significant association between the levels of heavy metals and both biomarkers among the smelter workers. Further prospective studies should be performed.

Study of interleukin-1 beta expression in acne vulgaris and acne scars.

BACKGROUND: Acne vulgaris is a multifactorial disease that mostly heals by scarring. Interleukin-1 beta (IL-1ß) is a proinflammatory cytokine, suggested to play a key role in acne pathogenesis. OBJECTIVE: To study the immunohistochemical (IHC) expression of IL1ß in acne vulgaris and acne scars to evaluate its possible role in their pathogenesis and to study the relation between the expression of IL1ß and the clinicopathological parameters. PATIENTS AND METHODS: This study was conducted on sixty subjects (twenty patients with acne vulgaris and twenty patients with acne scars), and twenty healthy volunteers as controls. Skin biopsies were taken from patients and controls for routine histopathological examination with hematoxylin and eosin stain and IHC staining of IL-1ß. RESULTS: There was a statistically significant increase in expression of IL-1ß in acne vulgaris compared with post-acne scars and controls, (p < 0.001) for both. IL-1ß expression was significantly positively correlated with both clinical severity of acne vulgaris (p = 0.022) and severity of histopathological inflammation (p = 0.011). CONCLUSION: Interleukin-1ß expression was associated with acne vulgaris and post-acne scars with significant positive correlation to clinical and histopathological severity of acne vulgaris. Thus, IL-1ß could be a key player cytokine in acne pathogenesis, its severity and development of post-acne scars.

Prevalence of work-related musculoskeletal disorders among Egyptian printing workers evidenced by using serum biomarkers of inflammation, oxidative stress, muscle injury, and collagen type I turnover.

OBJECTIVE: Printing workers experience a high rate of musculoskeletal disorders (MSDs). This study aims to determine the prevalence of MSDs, estimate serum biomarkers denoting musculoskeletal tissue changes, and determine some individual risk factors for MSDs among Egyptian printing workers. METHODS: Eighty-five male printing workers and 90 male administrative employees (control group) were recruited from a printing press in Giza. A validated version of the standardized Nordic questionnaire was used. Serum biomarkers of inflammation (interleukin (IL)-1α, IL-1ß, IL-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP)), cell stress or injury (malondialdehyde (MDA) and creatine kinase skeletal muscle (CK-MM)), and collagen metabolism (collagen-I carboxy-terminal propeptide (PICP) and type-I collagen cross-linked C-telopeptide (CTx)) were measured for all participants. RESULTS: This study showed a significant (p < 0.001) prevalence of the musculoskeletal symptoms (76.5%) and significant (p < 0.001) elevation in the levels of all measured biomarkers among the printing workers (means ± SD: IL-1α = 1.55 ± 0.9, IL-1ß = 1.53 ± 0.87, IL-6 = 1.55 ± 0.85, TNF-α = 4.9 ± 2.25, CRP = 6.78 ± 3.07, MDA = 3.41 ± 1.29, CK-MM = 132.47 ± 69.01, PICP = 103.48 ± 36.44, and CTx = 0.47 ± 0.16) when compared with their controls (prevalence: 34.4%; means ± SD: IL-1α = 0.88 ± 0.61, IL-1ß = 0.96 ± 0.72, IL-6 = 1.03 ± 0.75, TNF-α = 2.56 ± 1.99, CRP = 2.36 ± 1.1, MDA = 0.85 ± 0.21, CK-MM = 53.48 ± 33.05, PICP = 56.49 ± 9.05, and CTx = 0.31 ± 0.06). Also, significant (p < 0.001) positive strong associations were observed between age, body mass index (BMI), and the duration of employment with all measured biomarkers, where all correlation coefficients were >0.7. CONCLUSION: Printing workers suffer a high prevalence of work-related MSDs that might be related to some individual factors (age, BMI, and duration of employment). Consequently, preventive ergonomic interventions should be applied. Further studies should be done to elucidate the link between tissue changes and detected biomarkers to follow the initiation and progression of MSDs and study the effectiveness of curative interventions.

Prediction of lung cancer risk using circulating pro-surfactant protein B and high-sensitivity C-reactive protein among Egyptian workers in the rubber industry.

OBJECTIVE: For several decades, there has been increasing evidence for excess incidence of lung cancer among workers in the rubber industry. The purpose of this study was to assess the risk of lung cancer occurrence among Egyptian workers involved in the rubber industry using two circulating protein biomarkers. METHODS: This study was performed in a rubber manufacturing factory in Shubra El-Kheima region in Greater Cairo, Egypt. Environmental assessment for the suspended particulate matter of size 10 µm (PM10) concentrations was done. Levels of plasma pro-surfactant protein B (pro-SFTPB) and serum high-sensitivity C-reactive protein (HsCRP) were measured among the studied population (n = 155) who were divided into two groups. The first group included 75 workers exposed to rubber manufacturing process while the control group involved 80 administrative subjects. RESULTS: The levels of PM10 neither exceeded the Egyptian nor the international permissible limits where the highest levels were observed in the mixing department. However, through medical history and clinical examination, it was observed that some general and respiratory manifestations were more prevalent among the exposed group when compared with their controls. Laboratory investigations revealed that the mean values of pro-SFTPB and HsCRP levels among exposed workers were significantly higher than those of the control group. These increased circulating proteins levels were strongly and positively correlated with each other and with the duration of employment of exposed workers. CONCLUSION: The study results support the conclusion that prolonged occupational exposure to rubber manufacturing process is associated with an elevated risk of lung cancer.

Demonstration of Subclinical Early Nephrotoxicity Induced by Occupational Exposure to Silica among Workers in Pottery Industry.

BACKGROUND: For many years, several studies drew attention to the possible nephrotoxic effects of silica and distinct renal dysfunction involving glomerular and renal tubules in workers exposed to silica. OBJECTIVE: To determine the early signs of subclinical nephrotoxic effects among some Egyptian workers exposed to silica in the pottery industry. METHODS: This study was carried out in El-Fawakhir handicraft pottery area, in Greater Cairo, Egypt. The studied population included 29 non-smoking male workers occupationally exposed to silica in addition to 35 non-smoking administrative male subjects who represented the comparison group in the study. Measured urinary parameters were concentrations of total protein (TP), microalbumin (Malb), activities of alkaline phosphatase (ALP), γ-glutamyl transferase (γ-GT), lactate dehydrogenase (LDH), kidney injury molecule-1 (KIM-1), and silicon (Si). RESULTS: Silica-exposed workers showed significantly (p<0.05) increased levels of urinary TP, Malb, ALP, γ-GT, LDH, and KIM-1 compared with the comparison group. Among the silicaexposed group, increased urinary Si levels were positively and significantly correlated (Spearman's ρ>0.60, p<0.001 for all variables) with the elevated urinary proteins (including KIM-1) and enzymes levels. All measured urinary parameters were positively and significantly correlated (ρ>0.75, p<0.001 for all variables) with the duration of work among exposed subjects. No significant correlation was observed between the measured variables and the age of workers. CONCLUSION: There is associated subclinical glomerular and tubular affection among silica exposed workers, which is related to the duration and intensity of exposure.

Evaluation Of The Efficacy Of Fluorescent Staining And Chicago Sky Blue Staining As Methods For Diagnosis Of Dermatophytosis In Hair And Nails.

PURPOSE: Dermatophytes are fungi that cause infections affecting hair, nail, and skin; in nails they cause onychomycosis, while in hair they lead to tinea capitis. Detection of dermatophytes using traditional methods, including potassium hydroxide (KOH) and culture on agar-based media leads to high rates of false-negative results. Here, we investigated more accurate diagnostic techniques, including Chicago sky blue staining and Calcofluor white fluorescent staining and compared them with traditional KOH and culture methods for the diagnosis of fungi causing onychomycosis and tinea capitis. PATIENTS AND METHODS: This study was conducted using samples from 50 patients with dermatophytosis of the hair or nail. Samples were subjected to all the following laboratory investigations: KOH wet mount, culture on Sabouraud's dextrose agar, Chicago sky blue staining, and Calcofluor white staining. The results of the new diagnostic techniques were compared with those of the traditional methods. RESULTS: Calcofluor white stain and Chicago sky blue stain for dermatophytosis of hair and nail are more specific and sensitive as compared to traditional diagnostic methods. KOH wet mount is simple, rapid, and inexpensive test but lacks color contrast and gave more false positive (artifacts) and false-negative results as compared to these new stain methods. CONCLUSION: Chicago sky blue and Calcofluor white staining are excellent methods for diagnosis of fungal infections, including those that cannot be confirmed using conventional methods.

Early detection of lung cancer potential among Egyptian wood workers.

Wood dust is known to be a human carcinogen, with a considerable risk of lung cancer. The increased cancer risk is likely induced through its genotoxic effects resulting from oxidative DNA damage. This study aimed at assessing the genotoxicity of wood dust and demonstrating the role of sputum PCR as a screening tool for early prediction of lung cancer among wood workers. The study was carried out in the carpentry section of a modernized factory involved with the manufacture of wooden furniture in Greater Cairo, Egypt. Environmental assessment of respirable wood dust concentrations was done. Frequency of chromosomal aberrations (CA%) and sister chromatid exchanges (SCE%) in peripheral blood lymphocytes (PBL) was assessed and comet assays were performed in samples from among the study population (n = 86). Levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymes were measured. The polymerase chain reaction (PCR) was used to study hypermethylation of p16 and ̸or O6-methylguanine-DNA methyltransferase (MGMT) gene promoters in sputum DNA. The concentrations of respirable wood dust exceeded the Egyptian and international permissible limits with highest levels generated by sawing operations. Laboratory investigations revealed statistically significantly higher frequencies of CA and SCE as well as increased comet tail length associated with significant decrement in the levels of SOD and GPx among exposed group. A statistically significant elevation in the extent of hypermethylation was detected for the p16 and MGMT gene promoters in the sputum DNA of studied wood workers. The study results support the conclusion that prolonged unprotected occupational exposure to wood dust is associated with possible genotoxicity and oxidative stress that might raise the risk for carcinogenesis including lung cancer.

Spray versus intralesional cryotherapy for keloids.

BACKGROUND: Keloids may follow local skin trauma or inflammation leading to pruritus, pain, restriction of movement or cosmetic disfigurement. OBJECTIVES: To compare between the efficacy and tolerability of spray versus intralesional cryotherapy for keloids. PATIENTS AND METHODS: Fifty patients with keloids were randomized to treatment with spray cryotherapy (group I) or intralesional cryotherapy (group II). Swada and Sone scoring of scars was performed at treatment and follow-up (6 months). Histopathological examination was done before and after end of treatment sessions. RESULTS: Intralesional cryotherapy showed greater efficacy than spray cryotherapy. Fewer treatments were required with intralesional cryotherapy than with spray cryotherapy. CONCLUSION: Intralesional cryotherapy was more effective and tolerable modality for treatment of keloids than spray technique with greater internal freezing area.

Assessment of efficacy and tolerability of different concentrations of trichloroacetic acid vs. carbon dioxide laser in treatment of xanthelasma palpebrarum.

BACKGROUND: There are numerous methods currently available for the management of xanthelasma. These include surgical excision, laser ablation using a variety of lasers and chemical cauterization. However, each method of treatment is associated with particular limitations and side effects. OBJECTIVES: To assess the clinical efficacy and tolerability of different concentrations of topical trichloroacetic acid (TCA) vs. carbon dioxide laser in the treatment of patients with xanthelasma palpebrarum. METHODS: Thirty patients with xanthelasma palpebrarum were classified into four groups, treated by TCA 35%, 50%, 70%, and CO2 laser, respectively. Lipid profile was estimated for all patients. RESULTS: Both TCA peeling 70% and carbon dioxide laser ablation showed more significant clinical efficacy and tolerability with least number of sessions in the treatment of xanthelasma palpebrarum than 50% and 35% TCA peeling. Post-therapy erythema and hypopigmentation were more with TCA 70%. Post-therapy hyperpigmentation was more with TCA (50%). There was a significant improvement in patients with normal lipid profile than those with abnormal profile. CONCLUSION: Both TCA peeling 70% and carbon dioxide laser ablation are highly effective and well tolerated with least number of sessions in the treatment of xanthelasma palpebrarum.

Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt.

INTRODUCTION: Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. PATIENTS AND METHODS: Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18-80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. RESULTS: This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. CONCLUSION: Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.