Asleep-Awake-Asleep general anesthesia for open cervical rhizotomy: case report and description of the technique.

The authors describe the technique of Asleep-Awake-Asleep anesthesia for open dorsal rhizotomy in a 78-year-old female patient, admitted to the hospital with intractable pain in the distribution of C2 dermatome following a road traffic accident. The patient was anesthetised and the rhizotomy performed using the intradural approach. Anesthesia was conducted by Total Intravenous Anesthesia using a Target Controlled Infusion system. The patient was awakened twice intraoperatively to verify success of the rhizotomy. Complete pain relief was obtained and maintained at 1 year follow-up.

Henna (Lawsonia inermis Linn.) inducing haemolysis among G6PD-deficient newborns. A new clinical observation.

Over a 10-year period, 15 glucose-6-phosphate dehydrogenase (G6PD)-deficient male newborns were admitted to Al-Jahra Hospital with acute haemolysis a few days after applying henna dye over the body, which is a unique Bedouin tribal practice to celebrate the arrival of the first-born boy. Laboratory investigations revealed significant anaemia, reticulocytosis and indirect hyperbilirubinaemia among the index newborns as compared with controls (p < 0.001). The mean (SD) haemoglobin concentration in index patients was 113.4 (13.4) g/l vs 171.2 (11.2) g/l in controls, reticulocytic count 13.8% (4.2%) vs 1.4% (0.74%), and indirect bilirubin 382.8 (58.7) mumol/l vs 63.7 (61.4) mumol/l. G6PD-deficient newborns with haemolysis linked to henna application had delayed age at presentation and a higher reticulocytic count and hyperbilirubinaemia compared with non-henna-induced haemolysis (p < 0.05). Percutaneous henna absorption is well recognized and clinical findings support the harmful effect of henna on G6PD-deficient red blood cells. A local health education programme has been established to prevent the use of henna dye in infancy.

Tumour necrosis factor-alpha (cachectin) in human visceral leishmaniasis.

Generally speaking, the cell mediated immunity plays a pivotal role in the host resistance against the protozoal parasite of the genus Leishmania. The polypeptide hormone cachectin (Tumour Necrosis Factor-alpha) which is produced mainly by macrophages, is a primary mediator in the pathogenesis of infection, injury and inflammation. Depending on its concentration, duration of cell exposure and presence of other mediators in the cellular environment, the net biological effect of this peptide regulatory factor may ultimately be benefit or injury to the host. This work aimed to study the tumour necrosis factor-alpha as measured by Quantikine human immunoassay Kits using ELISA technique in Egyptian visceral leishmaniasis patients (VL). The severity of VL. was measured by IHAT Cellognost Kits. The results showed a certain type of correlation between elevated serum TNF-alpha and human visceral leishmaniasis. It was concluded that TNF-a is an important factor in the pathogenesis of visceral leishmaniasis and may be a marker or an indicator of the VL. activity.

Tumour necrosis factor (TNF-alpha) in zoonotic cutaneous leishmaniasis.

Generally speaking, the cell mediated immunity plays a pivotal role in the host resistance against the protozoal parasite Leishmania species. On the other hand, TNF-a (Cachectin) is a protein produced mainly by macrophages, with wide range of biological activities and may be important in inflammatory processes. Also, it plays the important role in some infectious diseases. In the present study, TNF-alpha was measured in the sera of 30 parasitologically proved zoonotic cutaneous leishmaniasis (ZCL). Serum TNF-alpha was elevated in 4/30 (13.3%) of the patients. However, it was not elevated in 26/30 of the patients as well as in 15 normal control. It was concluded that the TNF-alpha did not correlate with the number, site and/or duration of the lesion (s), but with high serum level of indirect haemagglutination tests associated with the severity of ZCL.

Some clinical features of pediculosis among school children.

Pediculosis is one of the most conspicuous and important type of contagious disease among school children. Lice infestation is always accompanied with different clinical manifestations. Thirty lousy school children were clinically examined. The common manifestation was pruritus with or without lymphadenopathy. The least common manifestation was erythema. Other manifestations as excoriation, bite reaction, impetigo contagiosa, crusts behind ears. Conjunctivitis and psoriasis were also seen. It was concluded that school children are the group at high risk for lice infestation.

Parasitic infection among children living in two orphanages in Cairo.

Children living in institutions as orphanages are more exposed to intestinal parasitism, since crowding and behavioral pattern contribute greatly to the spread of parasitic infection. The present study was conducted on 100 children living in Ain-Shams and El-Mowassa orphanages, Cairo. Twenty children living under appropriate health conditions were studied as controls. Ages of both groups ranged from 6-12 years. The results of this study revealed that 69/100 (69%) orphanage children were positive for parasitic infection, while 8/20 (40%) control subjects were positive for parasitic infection; the difference was statistically significant. Enterobius vermicularis was the commonest parasite among both groups. Other parasitic infections detected were; Giardia lamblia, Entamoeba histolytica, Hymenolepis nana and Entamoeba coli with a prevalence of 10%, 9%, 2% and 9% respectively in the study group compared to 15%, 10%, 0% and 5% in the control group; the differences were statistically not significant. Cryptosporidium oocysts were not detected in both groups.

Investigation on the presence of Leishmania natural infection and antibodies among rodents in Riyadh, Saudi Arabia.

Leishmaniases whether cutaneous and/or visceral are one of the public health problems in nearly all countries of the Eastern Mediterranean Region. The prevalence and the incidence are increasing. Control of the animal reservoir hosts in zoonotic forms is one of the best means of measures against leishmaniasis. This paper aimed to screen rodents for their role as reservoir for leishmaniasis. Natural Leishmania infection was detected in one Meriones crassus out of 3 which had cutaneous lesions. The lesion present on Gerbillus cheesmani was negative for amastigotes. Anti-leishmanial antibodies as detected by indirect haemagglutination tests (I.H.A.T.) showed reaction among the seven species of the trapped rodents. However, by interpretation of the diagnostic value of I.H.A. only three M. crassus (3/512) and one Gerbillus cheesmani (1/256) gave seropositive reactions. The whole results were discussed.

Toxoplasma gondii in Saudi blood donors a serological study using three tests.

A total of one hundred and fifty Saudi blood donors were examined for Toxoplasma gondii antibodies (IgG-IgM) by three serological techniques, 50 normal cross matched controls were subjected to the same examination. The number of positive donors for IgG by Indirect Haemagglutination test (IHA) was 36 (24%), by Enzyme Linked Immunosorbent Assay (ELISA) was 70 (46.7%), and by Immunofluorescent test (IFAT) 74 (49.3%). As to IgM the ELISA and IFAT showed 3 positive cases among the blood donors (2%). Rheumatoid factor and antinuclear antibodies were done for positive cases, and showed no significant cross reaction, IgG antibodies were significantly high in donors than in controls. The three tests were more or less dependable. However regarding simplicity, specificity, accuracy and time consumption factor IFAT was recommended for Toxoplasma IgG for all blood donors to avoid the risk of in infection.

Epidemiological studies on human scabies in Cairo.

Nowadays, human scabies is more or less a public health problem in Egypt, particularly among school children. The results of this epidemiological studies among one hundred scabietic patients showed that (a) Scabies is widespread among children and youth particularly students (b) The sex and the site distribution are attributed to the risk factor of exposure to infestation (c) Scabies is a disease determined by Sociodemographic and Hygienic customs of the population with high familial incidence among the patients. The whole results were discussed on the light of the work done in Egypt and similar countries.

Parasitic infections among patients of Al Nour Specialized Hospital.

Parasitic infections are still the main public health problem in the developing countries. Saudi Arabia is a developing country beside, it is the main center for all muslims for "Haj and Omra". Most of the work done in the field of parasitic infections dealt with Saudis or Yemenis. In this paper, most of the patients are muslims coming for Haj and or Omra. The highest rate if infection was 11.63% for Giardia and the lowest was 0.007% for Fasciola. Urine examination showed S. haematobium (2.99%), T. vaginalis (3.82%) and Enterobius eggs (0.04%). Malaria infection was also encountered. P. vivax showed 2.5% and P. falciparum showed 6.5% among a total of 5233 suspected cases. Still the direct examination of urine and stool being the most reliable method for diagnosis of helminthic infections. The whole results were discussed.

Parasitological and clinical studies on human scabies in Cairo.

This study is a parasitological and clinical study on human scabies. This study was carried out on 100 patients attending the Dermatology Outpatient Clinic at Ain Shams University Hospitals, including 54 males and 46 females. All patients were subjected to detailed history taking, complete dermatological examination including Skin Scraping Test and Burrow Ink Test. Younger patients attended the dermatology clinic earlier than older patients, who usually delayed their visits until complications occurred. Scratching, erythematous papules and secondary infected lesions were the commonest lesions. The hands, wrist and external genitalia were the most frequently affected sites while the feet, ankles, knees and back were the least affected. Burrows could only be detected in 40% of patients. The most frequent sites were the web spaces, external genitalia, and finger sides. Burrow Ink Test was positive among 85% of patients with burrows while mites could be identified by Skin Scraping Test in 55% of patients. The most frequent clinical manifestations in the parasitologically positive patients were itching, burrows, and papules, and the most frequent sites were the web spaces, and the finger sides. Multiple sites affection was the characteristic feature among the preschool age children who represented 14% of cases.

Isoenzyme characterization of Leishmania isolates from patients in El Nour Specialized Hospital, Saudi Arabia.

No doubt, the three forms of leishmaniasis (VL, ZCL & ACL) are well documented in Saudi Arabia. The basis of epidemiological studies must be adequate identification of the Leishmania patients. Seven leishmanial strains have been isolated from patients attending El Nour Specialized Hospital, Makka Al Mokarrama. The majority of the patients of this hospital are temporary visitors to Makka Al Mokarrama for "Haj and Omra". Isoenzyme characterization by cellulose acetate electrophores's used nine enzymes was done. The seven isolates were: two L. donovani zymodeme LON 41 (Indian patient) and LON 46 (Sudanese patient); three L. tropica zymodeme LON 71 (2 Yemeri patients) and LON 22 (Egyptian patient) and two L. major zymodeme LON 4 (2 Saudi patients).

Some aspects of Phlebotomus papatasi (Scopoli) in greater Cairo, Egypt.

Exogenous and indigenous cases of zoonotic cutaneous leishmaniasis are reported in several Egyptian Governorates particularly those in the Nile Delta, Phlebotomus paptasi (Scopoli) is the only proven insect vector. This paper was intended to study the seasonal abundance, nocturnal activity and breeding sites as well as other relevant behaviour aiming to throw some light on this insect vector. The results showed that: (a) the seasonal activity started in April and ended in November or beginning of December. (b) female outnumbered male indoors (7.4:1) and V.V. outdoors (0.14:1). (c) blood fed females were 97.7% indoors and 29.4% outdoors. (d) the nocturnal activity ranged between 6 p.m. to 6 a.m. indoors and 8 p.m. to 6 a.m. outdoors. (e) the immature stages of Phlebotomus were successfully recovered from rodent burrows and poultry sheds.

The effect of scorpion envenomation on the different organs of albino mice.

The effect of sublethal doses of scorpion venom (Buthus quinquestriatus) on the hepatic vascular bed and hepatic parenchyma were studied. The main toxic effect of the venom was primarily on the vascular bed of the liver as manifested by dilatation of branches of the hepatic artery, portal vein together with intravascular thrombi and subcapsular haemorrhages. Apart from mild hydropic degeneration some cells of the hepatic parenchyma showed focal necrosis and Kupffer cells were frequently hypertrophied and contained pigment. In the lung, dilated thrombosed vessels were observed. In the kidney, the vessels showed the same changes. The epithelial and endothelial cells of the glomeruli appeared normal except for slight swelling with intact basement membrane. The tubular cells were swollen with increased granularity and attenuation of the tubular lumen, a picture compatible with hydropic degeneration. The possible mechanisms in inducing such lesions were discussed.

Recent study of Hymenolepis nana infection in Egyptian children.

Survey on 1800 children was conducted to detect the prevalence of H. nana infection in Egyptian children, by direct smear and concentration techniques. The incidence of infection was found to be 16%. Two hundred cases of them were subjected to full clinical history, thorough physical examination and anthropometric assessment. Different clinical manifestations were found in 84% of cases. Delayed growth manifested by decrease of the body weight below the third percentile was found in 62% of cases, in addition to marked affection of the body, height, head circumference, midarm circumference and triceps skinfold thickness in 16%, 10%, 32% and 28% of cases respectively. Trials on these 200 cases were carried out to evaluate the efficacy of "Praziquantel" in comparison with "Mebendazole". Praziquantel gave significant higher cure rates, being 91.1% and 97.7% after 2 and 4 weeks respectively, compared to Mebendazole which gave cure rates of 50% and 59%. Both drugs were well tolerated and have no side effects, however Praziquantel was given as a single dose, and so have the advantage of being more effective, easily administered, safe with higher cure rate.

The relation between intestinal troubles and parasitic infection in Cairo.

Stool and urine from 320 subjects in Ain shams region, and 200 subjects in Nasr city were collected and examined for parasites. All these subjects were suffering from abdominal troubles. The results revealed a marked relation between parasitic infection and abdominal troubles, especially in Ain shams region (80%), and to a lesser extent in Nasr City (51%). The commonest parasite in Ain shams was Giardia lamblia (20.3%), and in Nasr city was E. histolytica (13%).

The relation between red cell antigens and the occurrence of filariasis and its complications.

In a trial to assess the role of red cells antigens in pathogenesis of filariasis, 520 individuals from El Korean village were examined clinically to detect clinical filariasis, blood examined by counting chamber to detect microfilaraemic cases and red cell antigens (ABO system, Rh system and MN system) using slide method. The study showed no statistical significance association between filariasis (clinical and microfilaraemic) and red cells antigens.