REVIEW ON BONE DISEASE (OSTEOPOROSIS) IN DIABETES MELLITUS.

Osteoporosis is the most common bone disease known, affecting an estimated 200 million people worldwide. Approximately 30% of all postmenopausal women are affected and up to 40% developed a fragility fracture within their lifetime. Over time, a number of risk factors have been associated with osteoporosis and are useful when used in screening tools and treatment algorithms. Diabetes, although identified more than half a century ago as being associated with bone frailty, has come to the forefront only within last decade as an important osteoporosis risk factor. While both type 1 (DM1) and type 2 (DM2) diabetes increased fracture risk, the link is far more profound with DM1. DM1 accounts for approximately 5% of all cases of diabetes in the USA and is associated with a 6.4-6.9-fold increase in the relative risk of hip fracture compared to individuals without diabetes. As life expectancy continues to increase for those living with DM1, an increase in number of fractures occurring in this population is expected in the future. For understanding of bone fragility in DM1 calls for an update of diabetes guidelines, better screening tools, and more research into the use of therapeutic strategies in these patients.

A TRAINING PROGRAM FOR NURSING STAFF REGARDING BLOOD PARASITES ACQUIRED BY NEEDLE STICK INJURY IN A MILITARY HOSPITAL.

Nurses are likely to be exposed to microorganisms during their daily practice due to their close and frequent direct contact with patients. This could be one of the main causes of transmitting infection to the patients. Therefore, nurses should demonstrate the ability to effectively utilize principles of infection control, nurses should have professional and ethical responsibilities to make sure that their knowledge and skills regarding infection control are up-to-date and they practice safely and competently at all times. AIM: At assessing the effect of a training program for Military nursing staff knowledge, performance and attitude related to blood parasites acquired by needle stick injury. SETTING: The study was carried out at two military hospitals. Design An interventional study (pre-post study) was used. SUBJECT: The studied subjects were 90 nursing staff who accepted to participate in the study (10) of them pilot study were excluded from the study sample, (30) from The Military Fever Hospital and (50) from The Military General Hospital. Tools: The study tools used were composed of five tools as follows: (1) Educational needs assessment tool. (2) Knowledge questionnaire sheet (pre / post-test) (3) Observation check list (4) Attitude tool and (5) Participants 'evaluation Questionnaire sheet. RESULTS: Educational the intervention showed statistically significant improvements in nursing staff knowledge, performance and attitude. RECOMMENDATION: Continues training programs about blood parasites acquired by needle stick injury must be developed and provided on regular basis, this will enable nursing staff to improve their knowledge, performance and attitude about blood parasites acquired by needle stick injury.

MALARIA: A GENERAL MINIREVIEW WITH REFERENCE TO EGYPT.

The majority of world's population-live in areas at risk of malaria transmission. Malaria is a serious Anopheles-borne disease that pauses symptoms like the flu, as a high fever, chills, and muscle pain also, anemia, bloody stools, coma, convulsion, fever, headache, jaundice, nausea, sweating and vomiting. Symptoms tend to come and go in cycles. Apart from Anopheles vector, malaria could be transmitted nosocomial, blood transfusion or needle-stick injury Some types of malaria may cause more serious damage problems to heart, lungs, kidneys, or brain. These types can be deadly. The primary factors contributing to the resurgence of malaria are the appearance of drug-resistant strains of the parasite, the spread of insecticide-resistant strains of the mosquito and the lack of licensed malaria vaccines of proven efficacy. In rare cases, people can get malaria if they come into contact with infected blood as in blood transfusion or needle-stick injury also nosocomial and congenital malaria was reported. This is a mini-review of malaria with information on the lethal to humans, Plasmodium falciparum, together with other recent developments in the field.

EGYPTIAN EOSINOPHILIC AND INFECTIOUS MENINGOENCEPHA- LITIS AND THEIR IMPACT ON PSYCHOLOGICAL ASPECTS.

Meningoencephalitis is an acute inflammation of the brain and spinal cord & their covering protective membranes. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. The commonest symptoms of meningitis are headache and neck stiffness associated with fever, confusion or altered consciousness, vomiting, and an inability to tolerate light (photophobia) or loud noises (phonophobia). Children often exhibit only nonspecific symptoms, such as irritability and drowsiness. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash. A broad variety of allergic, infectious, neoplastic, and idiopathic diseases are associated with increased blood and/or tissue eosinophilia and range in severity from self-limited conditions to life-threatening disorders. Although accepted upper limits of normal blood eosinophil numbers vary somewhat, a value above 600 eosinophils /microL of blood is abnormal in the vast majority of cases. Generally speaking, there are several possible causes of eosinophils in the CSF; undoubtedly parasitic infection is one of the main causes.

INTERVENTION PROGRAM FOR NURSING STAFF REGARDING APPROACH TO A PATIENT WITH SPIDER PHOBIA AND/OR BITE.

Spider bites are uncommon medical events, since there are limited number of spiders world-wide with fangs strong enough to pierce human skin, and most spiders bite humans only as a final defense when being crushed between skin and another object. Thus, most lesions attributed to spider bites are caused by some other etiology. The spiders that can cause medically significant bites include widow and false widow spiders (worldwide), recluse spiders (mostly North and South America), Australian funnel web spiders (eastern coastal Australia) and Phoneutria spiders (Brazil). Acute spider bites most commonly result in a solitary papule, pustule, or wheal. Systemic symptoms can accompany envenomation of widow; funnel web, and Phoneutria spiders, and less often, those of recluse spiders.

THE EFFICACY OF THREE MEDICINAL PLANTS; GARLIC, GINGER AND MIRAZID AND A CHEMICAL DRUG METRONIDAZOLE AGAINST CRYPTOSPORIDIUM PARVUM: II-HISTOLOGICAL CHANGES.

Cryptosporidiosis parvum is a zoonotic protozoan parasite infects intestinal epithelial cells of man and animals causing a major health problem. This study was oriented to evaluate the protective and curative capacity of garlic, ginger and mirazid in comparison with metronidazole drug (commercially known) against Cryptosporidium in experimental mice. Male Swiss Albino mice experimentally infected with C. parvum were treated with medicinal plants extracts (Ginger, Mirazid, and Garlic) as compared to chemical drug Metronidazole. Importantly, C. parvum-infected mice treated with ginger, Mirazid, garlic and metronidazole showed a complete elimination in shedding oocysts by 9th day PI. The reduction and elimination of shedding oocysts in response to the treatments might be attributable to a direct effect on parasite growth in intestines, sexual phases production and/or the formation of oocysts. The results were evaluated histopathological examination of ideum section of control mice (uninfected, untreated) displayed normal architecture of the villi. Examiination of infected mice ileum section (infected, untreated) displayed histopathological alterations from uninfected groups. Examination of ileum section prepared from mice treated with garlic, ginger, mirazid, and metronidazole displayed histopathological alterations from that of the control groups, and showed marked histologic correction in the pattern with the four regimes used in comparison to control mice. Garlic successfully eradicated oocysts of infected mice from stool and intestine. Supplementation of ginger to infected mice markedly corrected elevation in the inflammatory risk factors and implied its potential antioxidant, anti-inflammatory and immunomodulatory capabilities. Infected mice treated with ginger, mirazid, garlic and metronidazole showed significant symptomatic improvements during treatment.

MAGGOT DEBRIDEMENT THERAPY (MDT): IT IS SAFE AND ECONOMIC FOR TREATING A DIABETIC FOOT ULCER.

Diabetic foot ulcer (DFU) is the major global and devastating complication of diabetes mellitus that affects at least 20% of diabetic patients during their lifetime. This article presents an overview of the research evidence on maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future. It is a time to apply this sample and safe worldwide approved method for diabetic foot ulcer to save money and avoid surgical intervention.

TICK-BORNE INFECTIOUS DISEASES WITH REFERENCE TO EGYPT.

Ticks are hematophagous ectoparasites of man, domestic and street animals, and birds of health and economic hazard worldwide. They transmit many micro-organisms and protozoan infectious diseases and their toxins cause different signs and symptoms that may be fatal according to the infesting tick saliva protein. In Egypt where there are many rural and urban areas, so many genera and species of ticks are encountered. The Egyptian veterinary and agricultural authorities deal with ticks from econom- ic point of view. But from medical point of view, ticks have specific role in transmission of zo- onotic infectious diseases as well as their saliva causes tick paralysis. When dealing with chil- dren from tick infested areas, tick paralysis should be considered in differential diagnosis of the clinically confused diseases as poliomyelitis, myasthenia gravis; Guillain-Barre; paralytic rabies botulism; transverse myelitis and /or the diphtheritic polyneuropathy. Tick-borne relapsing fever is a zoonosis and is endemic in many countries. The two main Borrelia spp. involved in. North America are B. hermsii (in the mountainous West) and B. turicatae (in the southwest). Crimean Congo hemorrhagic fever (CCHF), babesiosis and infantile tick paralysis were identified as emerging diseases disaster. Also, Lyme disease is the commonest worldwide and encountered in Egypt since a long tilne. And now what about other tick-borne diseases, taking into consideration the tick populations is endemic riot only in Egypt but worldwide vectors.

ASEPTIC MENINGITIS IN ADULTS CAUSING BY VIRUS, BACTERIA, DRUG WITH SPECIAL REFERENCES TO ZOONOTIC PARASITES.

Diagnosis of a patient with aseptic meningitis may be so-difficult because of the large vanety of potential etiologic agents as viruses, fungi, parasites and some drugs and the overlap between self-limited viral illnesses and potentially fatal bact~nial infections.

PROTOZOA CAUSING FOOD POISONING.

Food poisoning also called foodbome illness, or illness caused by eating contaminated food is a term used to cover an unpleasant range of illnesses. Food poisoning symptoms vary with the source of contamination. Most types of food poisoning cause one or more of the following signs and symptoms: nausea, vomiting, watery diarrhea, abdominal pain and cramps and fever Signs and symptoms may start within hours after eating the contaminated food, or they may begin days or even weeks later. Sickness caused by food poisoning generally lasts from a few hours to several days.

ZOONOTIC CUTANEOUS LESHMAIASIS THREE YEARS FEVER HOSPITAL RECORDS: WITH GENERAL DISCUSSION.

Leishmaniasis is widely present in more than 88 countries worldwide, resulting in up to 80,000 deaths annually. Leishmaniasis occurs as visceral, cutaneous, or mucocutaneous variants. Mucosal involvement can occur secondarily to the cutaneous or visceral varieties.

AN OVERVIEW OF OSTEOMYELITIS WITH REFERENCE TO TREATMENT IN PARTICULAR MAGGOT DEBRIDEMENT THERAPY (MDT).

Osteomyelitis occurs either as a result of hematogenous seeding, contiguous spread of infection to bone from adjacent soft tissues and joints, or direct inoculation of infection into the bone as a result of trauma or surgery. Hematogenous'osteomyelitis is usually monomicrobial, while osteomyelitis due to contiguous spread or direct inoculation is, usually polymicrobial. Staphylococcus aureus, coagulase-negative staphylococci and aerobic grani-negative bacilli are the most common organisms; other pathogens including streptococci, enterococci, anaerobes, fungi and mycobacteria have also been implicated. Acute osteomyelitis typically presents with gradual onset of pain over several days. Local findings (tenderness, warmth, erythema and swelling) and systemic symptoms (fever, rigors) may. also be present. Chronic osteomyelitis tends to occur in the setting of previous osteomyelitis and presents with recurrent pain, erythema or swelling, sometimes in association with a draining sinus tract. Treatment of osteomyelitis often requires both surgical debridement of necrotic material and antimicrobial therapy for eradication of infection. The optimal duration of antibiotic therapy is not certain; but continuing parenteral antimicrobial therapy at least six weeks from the last debridement.. Maggot therapy is an effective and environmentally friendly treatment of complicated necrotic wounds that are resistant to conventional reatment and should also be considered in earlier. stages of treatment. The history of maggot therapy, and the mechanisms by which it works, is discussed..

A TRAINING PROGRAM FOR NURSING STAFF ON HEALTH HAZARDS OF CHEMICAL INSECTICIDES EXPOSURE IN A PRACTICAL FIELD.

UNLABELLED: An insecticide is an agent used against insects, ticks, mites and other animals affecting human welfare. Exposure to Insecticides is one of the most important occupational risks among staff worker in Military camp, veterinary medicine, industry and household as well as schools and hospitals. This study Aimed to improve nursing staff knowledge regarding adverse health effects of chemical insecticides exposure in a military field. SETTING: The study was conducted in one of the Main Military Hospital. RESEARCH DESIGN: was used a quasi-experimental research design to conduct this study. SUBJECT: all nursing staff who work in a Military Hospital (n=55) who accept to participate in the research study. RESULTS: A significant improvement in the Nurses' Total knowledge score was found in post-test as compared to that in pre-test. All nurses obtained a satisfactory level of knowledge after the 1st & 2nd post-tests; all of them evaluate the program in relation to trainees' exnectations as "excellent".

ALLERGIC REACTIONS CAUSED BY VENOM OF HYMENOPTEROUS STINGING INSECTS AND THE ROLE OF HEALTH CARE WORKERS.

The Hymenoptera are the third largest order of insects, comprising the sawflies, wasps, bees and ants. Worldwide, over 150,000 species are recognized, with many more remaining to be described. The name refers to the wings of the insects, but the original derivation is ambiguous. The Ancient Greek υµÎ·ν (hymen) for membrane provides a pLusible etymology for the term because these insects have membranous wings. However, a key characteristic of this order is that the hind wings are connected to the fore wings by a series of hooks called hamuli. Thus, another plausible etymology involves, Hymen, the Ancient Greek god of marriage, as these insects have "married wings" in flight. Stinging insects and the medical risk associated with their venoms are complex topics, and presentation of information pertaining to them requires the use of technical terms. The most common reactions to these stings are transient pain and redness at the site lasting a few hours (local reaction), and exaggerated swelling lasting a few days (large local reaction). The most dangerous immediate reaction is anaphylaxis, which is potentially fatal.

Beyond immunization: travelers' infectious diseases. 1--Diarrhea.

Travelers' diarrhea is the most common illness in persons traveling from resource-rich to resource-poor regions of the world. The fear of developing diarrhea while traveling is common among travelers to any part of the developing world. This concern is realistic; 40 to 60% of travelers to these countries may develop diarrhea. Diarrheal diseases represent one of the five leading causes of death worldwide. Morbidity and mortality are significant even in the United States where diarrhea is more often than not a "nuisance disease" in the normally healthy individual.

Lassa fever or lassa hemorrhagic fever risk to humans from rodent-borne zoonoses.

Viral hemorrhagic fevers (VHFs) typically manifest as rapidly progressing acute febrile syndromes with profound hemorrhagic manifestations and very high fatality rates. Lassa fever, an acute hemorrhagic fever characterized by fever, muscle aches, sore throat, nausea, vomiting, diarrhea and chest and abdominal pain. Rodents are important reservoirs of rodent-borne zoonosis worldwide. Transmission rodents to humans occur by aerosol spread, either from the genus Mastomys rodents' excreta (multimammate rat) or through the close contact with infected patients (nosocomial infection). Other rodents of the genera Rattus, Mus, Lemniscomys, and Praomys are incriminated rodents hosts. Now one may ask do the rodents' ectoparasites play a role in Lassa virus zoonotic transmission. This paper summarized the update knowledge on LHV; hopping it might be useful to the clinicians, nursing staff, laboratories' personals as well as those concerned zoonoses from rodents and rodent control.

SAND-FLY PHLEBOTOMUS PAPATASI (PHLEBOTOMINAE): A GENERAL REVIEW WITH SPECIAL REFERENCE TO ZOONOTIC CUTANEOUS LEISHMANIASIS IN EGYPT.

Leishmania are digenetic protozoa which inhabit two hosts, the sandfly where they grow as promastigotes in the gut, and the mammalian macrophage where they grow as amastigotes. Sandfly (or sand fly) is a colloquial name for any species or genus of flying, biting, blood-sucking Dipteran encountered in sandy areas. In the United States, sandfly may refer to certain horse flies that are also known as "greenheads" (family Tabanidae), or to members of the family Ceratopogonidae, also known in Florida and elsewhere as a sand gnat, sandflea, no-see-um (no-see-em, noseeum), granny nipper, chitra, punkie, or punky. Outside the United States, sandfly may refer to members of the subfamily Phlebotominae within the Psychodidae. Biting midges (Ceratopogonidae) are sometimes called sand flies or no-see-ums (no-see-em, noseeum). New Zealand sandflies are in the Austrosimulium genus, a type of black fly. Of 500 known phlebotomine species, only some 30 of them have been positively identified as vectors of the disease. Cutaneous leishmaniasis (ZCL) is a protozoan disease well documented not only in Egypt, but in nearly all the East Mediterranean Countries. It is prevalent in the Egyptian Sinai Peninsula with at least three identified foci.

THE EFFICACY OF THREE MEDICINAL PLANTS: GARLIC, GINGER AND MIRAZID AND A CHEMICAL DRUG METRONIDAZOLE AGAINST CRYPTOSPORIDIUM PARVUM. I-IMMUNOLOGICAL RESPONSE.

Cryptosporidisis parvum is a zoonotic protozoan parasite infects intestinal epithelial cells causing a major health problem for man and animals. Experimentally the immunologic mediated elimination of C. parvum requires CD4+ T cells and IFN-gamma. But, the innate immune responses also have a significant protective role in both man and animals. the mucosal immune response to C. parvum in C57BL/6 neonatal and GKO mice shows a concomitant Thl and Th2 cytokine mRNA expression, with a crucial role for IFN-gamma in the resolution of the infection. NK cells and IFN-gamma have been shown to be important components in immunity in T and B cell-deficient mice, but IFN-gamma-dependent resistance is demonstrated in alymphocytic mice. Epithelial cells may play a vital role in immunity as once infected these cells have increased expression of inflammatory chemokines and cytokines and demonstrate anti-infection killing mechanisms. C. parvum immunological response was used to evaluate the efficacy of anti-cryptosporidisis agents of Garlic, Ginger, Mirazid and Metronidazole in experimentally infected mice.

THE ARTHROPOD-BORNE ONCHOCERCIASIS: IS IT DESERVED TO BE NEGLECTED?.

Onchocerciasis a filarial parasitic nematode, also known as river blindness and Robles disease, is a neglected tropical disease infecting more than 18 million people mainly in sub-Saharan of Africa, the Middle East, South and Central America and many other countries. Disease infectivity initiates from Onchocerca volvulus (Filarioidea: Onchocercidae) transmitted by the blackfly, Simulium sp. which introduces the infective stage larva with its saliva into the skin. Within human body, adult females (macrofilaria) produce thousands of larvae (microfilariae) which migrate in skin and eye. Infection results in severe visual impairment or blindness for about 2 million, as being the world's second-leading cause of blindness after trachoma, as well as skin onchocercomata.

Phenolic content of some selected Lamiaceous Egyptian medicinal plants: antioxidant potential and ecological friend mosquito-larvicldal.

Phenol compounds are naturally occurring biologically active compounds existing in all plants had received major medical concern so development in research focused on their extraction, identification and quantification have occurred over the last 25 years; they constitute an important source of antioxidants and were used to help human body to reduce oxidative damage. Mosquitos-borne diseases constitute one of the major health problems worldwide. Control strategies involving pinpointing natural ecological friend, cheap and safe mosquitocides, mainly larvicides to stop their life cycle. Quantitative estimation of total phenol, flavonoids, phenylethanoid and iridoid contents of sixteen selected Lamiaceous Egyptian plants for screening of their antioxidant and mosquito larvicidal effects was carried out. The results showed that the most suitable medicinal plants used as antioxidants were Lavendula dentata L., Thymus capitatus L. and Thymus bovei Benth., which contain adequate mixture of total phenol, flavonoid and phenylethanoid contents, with distinct larvicidal effect in a descending order was T. capitatus L., T. bovei Benth. and L. dentata L. by their adequate mixture of total phenol, flavonoid, iridoid and phenylethanoid glycoside content.