The ethnopharmacological study of plant drugs used traditionally in Djibouti for malaria treatment.

ETHNOPHARMACOLOGICAL RELEVANCE: Djibouti was a country where malaria has been endemic for centuries. The local population use the plants as repellents or first aid for uncomplicated malaria. AIM OF THE STUDY: The aim was, for the first time, to collect and identify plants used by the local population to treat malaria and select the most interesting plants (those that are more commontly used, more available, and have fewer studies). These plants were evaluated for their antiplasmodial activity as well as their cytotoxicity on human cell lines for the most active ones. MATERIALS AND METHODS: A semi-structured questionnaire was developed for this study to collect information about the use and identity of botanical drugs used to treat malaria. The use-reports (percentage) of each plant were recorded to determine their use importance. Also, the availability status of the plants was assessed; and those in critical condition were discarded excluded from further study. Fifteen plants, out of the 41 listed, were extracted with hydro alcohol, ethyl acetate, and dichloromethane for biological testing. Chloroquine-resistant strain FcB-1 of P. falciparum and a human diploid embryonic lung cell line were used for the antiplasmodial test, and to assess the cytotoxicity for human cells respectively. Preliminary analysis of extract constituents was carried out using thin layer chromatography (TLC). RESULTS: This study identifies 41 plant taxa belonging to 32 families and records their use against malaria. Balanites rodunfolia, belonging to the Zygophyllaceae family, was the most commonly used plant, representing 44 % of use-reports. It was followed by Cadaba rodunfolia (15 %) from the Capparaceae family, and then the three species of Aloe: Aloe djiboutiensis (8.2 %), Aloe ericahenriettae (3.4 %), and Aloe rigens (3.4 %) from the Asphodelaceae family. The leaves are the most commonly used part of the plants to treat malaria, accounting for 76 % of usage. The preparation methods were decoction (52 %), maceration (29 %), and boiling (19 %). The administration routes were by oral (80 %), inhalation 19 %), and bathing (1 %). The best antiplasmodial activities were observed in the dichloromethane extracts of Cymbopogon commutatus and the ethyl acetate extracts of Aloe rigens and Terminalia brownii, with IC50 values of 9.8, 5, and 7.5 µg/mL, respectively. Their toxicity/activity levels were very favorable with selectivity indices of 5.6, 8.1, and 11.8 for C. commutatus, A. rigens, and T. Brownii, respectively. CONCLUSION: Forty-one species of botanical drugs were listed as being used to treat malaria in Djibouti. All fifteen selected species showed antiplasmodial activity (IC50 < 50 µg/mL). This work will help guide the valorization of botanical drugs used to treat malaria in Djibouti.

Biomonitoring of manganese metal pollution in water and its impacts on biological activities of Biomphalaria alexandrina snail and larvicidal potencies.

Metal pollution has many dangerous environmental and human health consequences due to the bioaccumulation in the tissues. The present study aims to measure the bioaccumulation factor of the manganese (Mn) heavy metal in Biomphalaria alexandrina snails' tissues and water samples. The current results showed the concentration of Mn heavy metal in water (87.5 mg/l) and its bioaccumulation factor in Helisoma duryi tissue was higher than that in tissues of Physa acuta and B. alexandrina snails. Results showed that 87.5 mg/l Mn concentration had miracidicidal and cercaricidal activities. Also, this concentration decreased the mean total number of the hemocytes after exposure for 24 h or 48 h, while increasing both the mean mortality and phagocytic indices of the hemocytes of exposed snails. It caused alterations in the cytomorphology of the hemocytes of exposed snails after 24 or 48 h, where the granulocytes had irregular cell membranes and formed pseudopodia. Besides, levels of testosterone (T) and estradiol (E) were increased after exposure to 87.5 mg/l Mn metal compared to the control group. Also, it increased MDA (malonaldehyde) and TAC (total antioxidant capacity) contents, while decreasing SOD (superoxide dismutase). Besides, it caused significant histopathological damages in both hermaphrodite and digestive glands, represented in the degeneration of the gonadal, digestive, secretory cells, and the connective tissues. Therefore, B. alexandrina might be used as a sensitive bioindicator of pollution with Mn heavy metal to avoid ethics rules; besides, they are readily available and large in number.

Differentiation between Bulinus truncatus and Bulinus hexaploidus by morphological characters, chromosomal study and compatibility with Schistosoma haematobium.

Schistosomiasis is a snail-born, neglected tropical disease (NTD) caused by blood flukes (trematode worms) of the genusSchistosoma. It is the second most socioeconomically devastating parasitic disease after malaria. Urogenital schistosomiasis is caused by Schistosoma haematobium which is transmitted by snail intermediate host of the genus Bulinus. This genus is a model system for the study of polyploidy in animals. This study aims to investigate ploidy levels existing among the Bulinus species and their compatibility with S. haematobium. The specimens were collected from two governorates in Egypt. Chromosomal preparation was made from gonad tissue (ovotestis). This study found two ploidy levels (tetraploid, n = 36 and hexaploid, n = 54) of B. truncatus/tropicus complex in Egypt. Tetraploid B. truncatus was found in El-Beheira governorate while-unexpectedly and for the first time in Egypt, the hexaploid population was found in Giza governorate. This identification focused on shell morphology, chromosomal count, and spermatozoa of each species. Afterward, all species were exposed to S. haematobium miracidia where B. hexaploidus snails were the only refractory species. The histopathological study showed early destruction and abnormal development of S. haematobium in B. hexaploidus tissues. In addition, the hematological investigation showed increasing in the total hemocyte count, the formation of vacuoles, several pseudopodia, and more dense granules in the hemocytes of infected B. hexaploidus snails. In conclusion, there were two types of snails one was refractory and the other was susceptible.

Use of an adapted participatory learning and action cycle to increase knowledge and uptake of child vaccination in internally displaced persons camps (IVACS): A cluster-randomised controlled trial.

BACKGROUND: Vaccination is a key public health intervention that can reduce excess mortality in humanitarian contexts. Vaccine hesitancy is thought to be a significant problem requiring demand side interventions. Participatory Learning and Action (PLA) approaches have proven effective in reducing perinatal mortality in low income settings and we aimed to apply an adapted approach in Somalia. METHODS: A randomised cluster trial was implemented in camps for internally displaced people near Mogadishu, from June to October 2021. An adapted PLA approach (hPLA) was used in partnership with indigenous 'Abaay-Abaay' women's social groups. Trained facilitators ran 6 meeting cycles that addressed topics of child health and vaccination, analysed challenges, and planned and implemented potential solutions. Solutions included a stakeholder exchange meeting involving Abaay-Abaay group members and services providers from humanitarian organisations. Data was collected at baseline and after completion of the 3 month intervention cycle. RESULTS: Overall, 64.6% of mothers were group members at baseline and this increased in both arms during the intervention (p = 0.016). Maternal preference for getting young children vaccinated was >95% at baseline and did not change. The hPLA intervention improved the adjusted maternal/caregiver knowledge score by 7.9 points (maximum possible score 21) compared to the control (95% CI 6.93, 8.85; p < 0.0001). Coverage of both measles vaccination (MCV1) (aOR 2.43 95% CI 1.96, 3.01; p < 0.001) and completion of the pentavalent vaccination series (aOR 2.45 95% CI 1.27, 4.74; p = 0.008) also improved. However, adherence to timely vaccination did not (aOR 1.12 95% CI 0.39, 3.26; p = 0.828). Possession of a home-based, child health record card increased in the intervention arm from 18 to 35% (aOR 2.86 95% CI 1.35, 6.06; p = 0.006). CONCLUSION: A hPLA approach, run in partnership with indigenous social groups, can achieve important changes in public health knowledge and practice in a humanitarian context. Further work to scale up the approach and address other vaccines and population groups is warranted.

Prevalence, Virulence Genes, Phylogenetic Analysis, and Antimicrobial Resistance Profile of Helicobacter Species in Chicken Meat and Their Associated Environment at Retail Shops in Egypt.

Helicobacter pylori (H. pylori) and Helicobacter pullorum (H. pullorum) are frequently reported pathogens in humans and poultry, respectively. Nevertheless, the source of H. pylori is still unclear. This study aimed to detect Helicobacter spp. in chicken carcasses and to assess the antibiogram and the virulence genes of Helicobacter isolates. Three hundred chicken meat samples (100 each of chicken breast, liver, and gizzard), besides 60 swab samples from chicken processing surfaces, were collected from retail shops in Qalyubia Governorate, Egypt, and examined for the prevalence of H. pylori and H. pullorum. The 16S rRNA of three H. pylori and two H. pullorum isolates were sequenced to determine the genetic relationship between these two Helicobacter spp. Of the 300 chicken samples tested, 16 (5.33%) and 14 (4.67%) were positive for H. pylori and H. pullorum, respectively. Multiplex PCR revealed that the virulence genes vacuolating cytotoxin A (vacA)s1, cytotoxin-associated gene A (cagA), and restriction endonuclease-replacing gene A (hrgA) were detected in 66.7%, 77.8%, and 100% of H. pylori strains tested, respectively. H. pylori showed the highest resistance for clarithromycin, while H. pullorum exhibited the highest resistance towards erythromycin and ciprofloxacin. The study concluded that the chicken meat and giblets are potential sources of the virulent and antimicrobial-resistant strains of H. pylori of human origin.

In-Vitro Anticancer and Antioxidant Activities of Eremina desertorum (Forsskal, 1775) Snail Mucin.

OBJECTIVES: The aim of the present research is to elucidate the anti-oxidant and anti-tumor activities of the mucin extracted from Ereminia desertorum snails´ mucus against two types of tumor cell lines; human colon adenocarcinoma (CACO-2) cells and human hepatoma (HepG-2) cells. METHODS: Both cell lines were treated with Ereminia desertorum snails´ mucin and the oxidative markers were measured in culture media and cells by biochemical and gene expression analysis using RT-PCR. The tumor suppressor gene expression was also evaluated using RT-PCR. RESULTS: The culture media of HepG-2 or CACO-2 cells treated with the extract have high significant increased levels of catalase, SOD, GSH and total antioxidants. Apart from SOD in CACO-2 cells that didn't differ from untreated cells. Also, Gene expression levels (2^-ddct) of the antioxidant markers in HepG-2 cells; GSTA-1, catalase, SOD, and GPx increased in mucin- treated cells. Also, these antioxidant genetic markers were up-regulated in CACO-2 cells by treatment with mucin extract. Gene expression levels (2^-ddct) of tumor suppression genes (p53, Rb, APC, and PTEN) in both HepG-2 and CaCO-2 cells were increased in mucin extract-treated cells. CONCLUSION: The present study highlighted the anti-oxidant and the anti-cancer activities of the mucin extracted from E. desertorum snails´ mucus that could attract attention to such natural product as a possible source of therapeutic compounds against liver and colon cancers.

Effectiveness of the Premature Infant Oral Motor Intervention on Feeding Performance, Duration of Hospital Stay, and Weight of Preterm Neonates in Neonatal Intensive Care Unit: Results From a Randomized Controlled Trial.

BACKGROUND: Most preterm neonates are unable to achieve independent oral feeding and are fed using tubes. Premature infant oral motor intervention (PIOMI) is effective in initiating early oral feeding and reducing hospital stays. OBJECTIVE: This study aimed to evaluate the effectiveness of PIOMI on feeding performance, duration of hospital stay, and weight of preterm neonates in the neonatal intensive care unit (NICU). METHODS: This was a parallel randomized controlled trial conducted in Egypt. Sixty preterm neonates born between 30 and 34 weeks of gestation were randomly selected (30 in the study group and 30 in the control group). The study was conducted at the NICU in Sohag, Egypt, over 3 months from October to December 2019. Two tools were used: demographic data of preterm neonates according to gestational age, sex, weight, and diagnosis, and PIOMI. RESULTS: Among the preterm neonates in the study group, full oral feeding was achieved significantly earlier (P = .03), milk leakage decreased significantly (P = .001), weight was significantly higher (P = .018), and the duration of hospital stay was significantly lower (P = .014) than that in the control group. CONCLUSION: Premature infant oral motor intervention was effective in improving preterm neonates' feeding performance, reducing the duration of hospital stay, and increasing their weight. This study recommended that a training program for nurses in the NICU about PIOMI for preterm neonates be conducted, along with training of the parents to use PIOMI and the implementation of policies in the NICU to conduct PIOMI as a part of daily routine preterm neonatal care.

Hepatoprotective Effects of Chitosan and Chitosan Nanoparticles against Biochemical, Genetic, and Histological Disorders Induced by the Toxicity of Emamectin Benzoate.

BACKGROUND: Emamectin benzoate (EMB) is a biopesticide which used in agriculture as an insecticide. It is easier to reach ecologically and affects human health. This study aims to evaluate the protective effect of chitosan and chitosan nanoparticles against EMB-induced hepatotoxicity. METHODS: Male mice were distributed into four groups: G1: the negative control, G2: EMB group (5 mg/kg diet), G3: EMB with Chitosan, (600 mg/kg diet), and G4: EMB with Chitosan nanoparticles (600 mg/kg diet). The experiment continues for 8 weeks, and the animals were sacrificed, and their organs were removed and immediately weighed after sacrifice. The liver was quickly removed and processed for histopathological and genetic studies. RESULTS: Emamectin benzoate (EMB) treatment induced oxidative stress by increased levels of Malondialdehyde (MDA), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with inhibition of acetylcholinesterase (AChE), Superoxide dismutase (SOD) and Catalase (CAT) levels. EMB produced several histopathological changes in the liver. Relative expressions of studied genes elevated in the liver with increase in DNA damage. Co-treatment with chitosan and chitosan nanoparticles reduced EMB related liver toxicity that belong to biochemical, histopathological, gene expression, and DNA damage by increasing antioxidant capacity. CONCLUSION: This study offers insight into the potential for Chitosan and chitosan nanoparticles as a novel natural material against the oxidative stress induced by EMB.

The epidemiological characterization and geographic distribution of hepatitis D virus infection in Libya.

INTRODUCTION: North Africa is known to be endemic for hepatitis D virus. However, data one the prevalence of this virus in Libya are scanty. This study aimed to determine the prevalence of hepatitis D virus infection in Libya and analyze the demographic factors associated with the infection, and also to assess the variations across the regions and districts. METHODS: A total of 1873 samples collected from all over the country were tested for antibodies against hepatitis B surface antigen and the results were correlated with demographic and geographic variables. RESULTS: The overall prevalence of hepatitis D virus infection was 1.7%. The prevalence rate was significantly high among those aged over 40 years (P < 0.001) and it was associated with intravenous drug use and coinfection with human immunodeficiency virus and/or hepatitis C virus infection (P < 0.001). The prevalence rates varied with geographic location and differed markedly within the regions the country. The highest rate reported was in the central region of Libya, followed by the western and eastern regions. CONCLUSION: Hepatitis D virus infection rate in Libya is considered to be low but is of some concern in some districts. This has been propagated by population displacement and African immigrants, indicating that a continuous epidemiological surveillance program should be implemented.

Toxicological impact of oxyfluorfen 24% herbicide on the reproductive system, antioxidant enzymes, and endocrine disruption of Biomphalaria alexandrina (Ehrenberg, 1831) snails.

Oxyfluorfen (Goal 24%EC) herbicide is widely used in agriculture for weed control. Biomphalaria alexandrina snails can be used as bioindicator of the chemical pollution in the aquatic environment. The objective of this study was to evaluate the molluscicidal activity of this herbicide on Biomphalaria alexandrina snails and how it affected its biological system. The present study revealed a molluscicidal effect of oxyfluorfen 24%EC on these snails at LC50 5.9 mg/l. After exposure of snails to the sub-lethal concentrations (LC0, LC10, or LC25) of this herbicide, the survival rates, reproductive rate (R0), and fecundity (Mx) of adult B. alexandrina snails were significantly decreased in comparison with the control group. Also, levels of testosterone and estradiol were decreased significantly. It caused alterations in the antioxidant system, where exposure to sub-lethal concentration of this herbicide caused significant increases in levels of lipid peroxide malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD), while it significantly decreased glutathione transferase (GST). Histopathological changes in the digestive gland included severe damage in the digestive cells, where, they lost their tips and some were degenerated, while the secretory cells increased in number. Regarding the hermaphrodite gland, there were losses of the connective tissues, irregular sperms, and the eggs degenerated. These findings concluded that B. alexandrina snails can be used as a bioindicator for pollution with pesticide in the aquatic environment.

Diagnostic value of serum heat shock protein 70 in hepatocellular carcinoma patients

Background and study aim: Hepato-cellular carcinoma (HCC) is the commonest essential hepatic threat among adult. Nowadays, the HCC determination without obsessive relationship is done by imaging methods. To elucidate the role of heat shock protein 70(HSP70) in the diagnosis of HCC. Subjects and Methods: This case control study was achieved in Internal Medicine and Clinical Pathology Departments, Zagazig University, Egypt. It involved 99 participants divided into three groups; control group, cirrhotic patients and cirrhotic patients with HCC. Participants underwent complete history taking, comprehensive clinical examination, laboratory investigations including viral markers and alpha-fetoprotein. HSP 70 level was calculated via the enzyme-linked immunosorbent assay (ELISA) technique. Radiological investigations including abdominal ultrasonography and triphasic CT scan were done. Results: There was a non-significant difference between the studied groups concerning demographic characteristics. There was a significant difference between them regarding hemoglobin, platelet count, liver and kidney function tests and coagulation profile(p<0.05). Also, there was a significant difference between them as regards HSP 70, and AFP with the maximum values in HCC group. HSP 70 at cutoff ≥120 ng/ml can diagnose HCC at sensitivity 85%, specificity 50%, and accuracy 84% (p<0.05). AFP at cutoff ≥20 ng/ml can recognize HCC with sensitivity 87.5%, specificity 75.8% and accuracy 89%. Combined HSP 70 and AFP increase the sensitivity of diagnosis at 91.5% and accuracy to 93%. Conclusion: HSP 70 as a serum biomarker can be used with AFP to increase the accuracy of HCC diagnosis

Validated spectrophotometric and spectrofluorimetric methods for determination of dapoxetine hydrochloride and dosulepin hydrochloride in their dosage forms using mercurochrome.

Validated, simple, rapid and sensitive spectrophotometric and spectrofluorimetric methods were developed for the determination of dapoxetine HCl and dosulepin HCl. The spectrophotometric method (I) was based on a binary complex formation between each drug and mercurochrome (MER) in acetate buffer (pH 3.5) with maximum absorbance at 557 nm. Calibration graphs were linear over the range 2.0-20.0 and 2.0-24.0 µg/ml, detection limits were 0.23 and 0.41 µg/ml and quantitation limits were 0.71 and 1.26 µg/ml for dapoxetine HCl and dosulepin HCl, respectively. Spectrofluorimetric method (II) was based on the measurement of the quantitative quenching effect of each drug on the native fluorescence of MER at the same pH. Fluorescence quenching of MER was measured at 538 nm after excitation at 470 nm. Calibration graphs were linear over the range 0.5-10.0 and 0.4-10.0 µg/ml, detection limits were 0.17 and 0.12 µg/ml and quantitation limits were 0.5 and 0.36 µg/ml for dapoxetine HCl and dosulepin HCl, respectively. Statistical comparison of results with those obtained by reported methods provided good agreement and revealed that there were no significant differences in accuracy and precision between methods. The proposed methods were applied successfully to analyse commercial tablets and capsules containing the studied drugs.

Toxicological assessment of lambda-cyhalothrin and acetamiprid insecticides formulated mixture on hatchability rate, histological aspects, and protein electrophoretic pattern of Biomphalaria alexandrina (Ehrenberg, 1831) snails.

Several formulated mixtures of pesticides are widely used in modern agriculture. Nevertheless, the agriculture runoff causes a serious damage to the aquatic ecosystem. Therefore, the present study aims to use B. alexandrina snails as bioindicators for 30 g/l lambda-cyhalothrin and 17 g/l acetamiprid as a formulated mixture insecticide. Results showed that it has a molluscicidal activity against snails at LC50 7.9 mg/l. The hatchability percent of both treated 1-day-aged and/or 3-day-aged groups were less than that of the control group. The sublethal concentrations of the tested insecticide caused a remarkable abnormal necrosis in male and female gametogenic cells, besides a severe damage in both secretory and digestive cells. The results of SDS-PAGE protein profiles of treated snails showed that the least number of protein bands was noticed in snail groups that subjected to LC10 (6.6 mg/l) and LC25 (7.2 mg/l) concentrations when compared to control protein fractions.

Detection of rotavirus before and after monovalent rotavirus vaccine introduction and vaccine effectiveness among children in mainland Tanzania.

BACKGROUND: Monovalent rotavirus vaccine (RV1) was introduced in Tanzania in January 2013 under the Reach Every Child initiative, to be given at ages 6 and 10 weeks. We used the sentinel hospital rotavirus surveillance system to examine the rotavirus detection rate before and after vaccine introduction and estimate vaccine effectiveness. METHODS: Before vaccine introduction, rotavirus surveillance was established at two mainland hospitals; children admitted for acute diarrhea were eligible for enrollment and stools were tested for rotavirus antigen. We compared the rotavirus positivity rate in the pre-vaccine period (Tanga Hospital, 2009 and 2011; Bugando Medical Centre, 2012) to that from post-introduction years, 2014-2015. In 2013, surveillance was established at 9 additional hospitals. We examined rotavirus positivity among infants at these sites for 2014-2015. We obtained vaccine records and calculated vaccine effectiveness at 3 sites using case-test-negative control design. RESULTS: At Tanga Hospital, the rotavirus positivity rate among infants was 41% (102/251) pre-vaccine and 14% (28/197) in post-vaccine years (rate ratio: 0.35 [95% CI 0.22-0.54]). At Bugando, the positivity rate was 58% (83/143) pre-vaccine, and 18% (49/277) post-introduction (rate ratio 0.30 [95% CI 0.210.44]). Results were similar among children <5 years. At the new sites, the median site rotavirus positivity rate among infants was 26% in 2014 (range 19-44%) and 18% in 2015 (range 16-33%). The effectiveness of ≥1 RV1 dose against rotavirus hospitalization among children 5-23 months was 53% (95% CI: -14, 81), and 66% (95% CI: 9-87) against hospitalization with intravenous rehydration. Following introduction, peak rotavirus activity occurred later in the year and appeared more concentrated in time. CONCLUSION: Rotavirus surveillance data from Tanzania indicate that the rotavirus positivity rate among children hospitalized with diarrhea that were enrolled was substantially reduced after vaccine introduction. Low positivity rates among infants were detected at hospitals across the country. Overall, the data support that rotavirus vaccine has been successfully introduced and is effective in Tanzanian children.

Serum cystatin C as an earlier predictor of acute kidney injury than serum creatinine in preterm neonates with respiratory distress syndrome.

In this study, we aimed to evaluate serum cystatin C (sCysC) as an early predictor of acute kidney injury (AKI) in preterm neonates with respiratory distress syndrome (RDS). Sixty preterm neonates diagnosed with RDS and 40 healthy controls (28-36 weeks) admitted to the neonatal Intensive Care Unit were investigated. AKI was defined on the 3rd day of life (DOL-3) as an increase in serum creatinine (sCr) of >0.3 mg/dL from baseline (the lowest previous sCr). sCysC levels were measured on DOL-1, -3 and -7. Of the 60 neonates with RDS, 24 (40%) developed AKI. Five patients (79.17%) were classified as AKI Network (AKIN-1) and 19 patients (20.83%), as AKIN-2. At DOL-3, the mean sCysC values were significantly higher among neonates with RDS and AKI (1.68 ± 0.37) compared with controls (0.79 ± 0.83) and those with RDS and no AKI (0.85 ± 0.20) (P <0.001). sCysC levels significantly increased among neonates with AKI from DOL-3 to DOL-7 (P = 0.002). The sCr values showed no significant difference between those with RDS with AKI, RDS, and no AKI or control groups at DOL-1 and -3. Only as late as DOL-7, the mean values of sCr were higher among neonates with AKI compared with no AKI and controls (P <0.001). The receiver operating characteristic curves area under the curve was 0.97 for predicting the development of AKI within 72 h (P = 0.001). With the best cutoff value of ≥1.28 mg/L, the sensitivity and specificity of sCysC for detecting AKI within 72 h were 100 and 83.3%, respectively. In conclusion, sCysC is an early marker for AKI in neonates with RDS.

A comparison of nasogastric tube insertion techniques without using other instruments in anesthetized and intubated patients.

BACKGROUND AND OBJECTIVES: Several techniques are available to facilitate nasogastric (NG) tube insertion with or without using other instruments to guide the NG tube to the stomach. This study aimed to determine the success rate and time required for inserting NG tube by 2 non-instrumental methods of NG tube insertion and compare the findings with the common method of NG tube insertion. DESIGN AND SETTINGS: A prospective randomized, controlled clinical trial carried out at Chang Gung Memorial Hospital in Taiwan. SUBJECTS AND METHODS: A total of 150 patients were randomized into 3 groups: control group, neck flexion with lateral pressure group, and lifting of the larynx group. The number of attempted insertions, success rate, duration of insertion, and various complications were recorded. RESULTS: Both neck flexion with lateral pressure and lifting of the thyroid cartilage techniques had high success rates; however, the time required to insert the NG tube was shortest in the thyroid cartilage lifting group. CONCLUSION: Neck flexion with lateral pressure and lifting of the thyroid cartilage are convenient and reliable techniques for NG tube insertion without using any other instruments. Lifting of the thyroid cartilage had the highest success rate and was less time consuming than the other NG tube insertion techniques. Familiarization with the procedure influenced the success rate and the time required for insertion.

Spectrophotometric determination of some fluoroquinolone antibacterials by binary complex formation with xanthene dyes.

Two simple, rapid and sensitive spectrophotometric methods for the determination of levofloxacin, norfloxacin and ciprofloxacin have been performed in pure form, pharmaceutical tablets and spiked human urine. Both methods are based on the formation of a binary complex between the drugs and one of the two xanthene dyes, eosin Y or merbromin in aqueous buffered medium. Under the optimum conditions, the binary complexes showed absorption maxima at 547 nm for eosin Y and 545 nm for merbromin. Using eosin Y, the calibration graph was linear over the range 2-8 microg ml(-1) for the three drugs with mean percentage recoveries 99.935 +/- 0.648, 99.973 +/- 0.678 and 100.011 +/- 0.606 for levofloxacin, norfloxacin and ciprofloxacin, respectively. While in case of merbromin, the concentration range was 2-15 microg ml(-1) with mean percentage recoveries 99.960 +/- 0.491, 100.017 +/- 0.510 and 99.980 +/- 0.506 for the three drugs, respectively. The proposed methods were successfully applied to determine these drugs in their tablet formulations and spiked human urine and the results compared favorably to that of reference methods. The suggested methods have the advantage of being applicable for the determination of the three drugs without prior extraction. They are recommended for quality control and routine analysis where time, cost effectiveness and high specificity of analytical techniques are of great importance.

Detection of serum p53 protein in patients with different gastrointestinal cancers.

Overexpression of p53 has been found in many types of human malignancy. The present study aimed to detect preoperative serum p53 among 158 patients with different gastrointestinal cancers using ELISA technique based on mouse anti-p53 DO-7 monoclonal antibody and anti-p53 rabbit polyclonal antibody. A single band of 53kDa was detected in nuclear protein tissue extracts of selected cancer patients and in 96% of the corresponding sera using Western blot assay. The ELISA technique revealed that the serum p53 was detected in 100% of patients with cholangiocarcinoma, 76% of pancreatic carcinoma, 75% of hepatocellular carcinoma, 70% of colon cancer, 60% of esophagus carcinoma, and 35% of gastric carcinoma. The serum p53 concentrations of the positive patients were highly elevated (P<0.001) compared with healthy individuals. These results suggest that immunodetection of serum p53 could be valuable for post-operative monitoring during follow up in preoperatively positive patients with gastrointestinal cancers.