Biochemical and histological study on the effect of levetiracetam on the liver and kidney of pregnant albino rats.

BACKGROUND: Levetiracetam is a broad-spectrum antiseizure agent and one of the most commonly prescribed drugs for epilepsy. The aim of this work was to assess the effect of levetiracetam at its therapeutic range on the liver and kidney of pregnant albino rats. MATERIALS AND METHODS: Forty pregnant rats were divided equally into two groups (I-II), Rats in the group I were gavaged 1.5 mL/day distilled water in two divided doses throughout pregnancy. Rats in the group II were gavaged 1.5 mL/day distilled water (containing 36 mg levetiracetam) in two divided doses throughout pregnancy. At the end of the experiment, blood samples were taken and the sera were separated and used for biochemical analysis. The kidneys and livers of both groups were excised and used for light and electron microscopic examination. RESULTS: Treatment with levetiracetam induced undesirable histopathological changes in the liver and kidney of pregnant albino rats. These changes were in the form of distortion of the hepatic architecture, dilatation of the central and the portal veins, widening of the Bowman's spaces, thickening and disruption of the glomerular basement membrane, fusion and effacement of secondary foot processes, cytoplasmic vacuolation, and swollen mitochondria with loss of their cristae. Such changes were confirmed by alteration of certain biochemical parameters related to the liver and kidney functions. CONCLUSIONS: Levetiracetam induced deleterious effects on the liver and kidney of pregnant albino rats. Further investigations are recommended to clarify the mechanism of levetiracetam toxicity.

Comprehensive evaluation of grafting the preservable narrow plates with consideration of native plate width at primary hypospadias surgery.

INTRODUCTION: Dorsal inlay graft urethroplasty using inner-face preputial graft was described as an adjunct method to the classic tubularized incised plate (TIP) urethroplasty, aiming at reducing the risk of neourethral stenosis. OBJECTIVES: To evaluate the impact of dorsal inlay grafting of preservable narrow plates, in relation to native plate width. METHODS: Consecutive children with penile hypospadias with narrow plate (width < 8 mm) were evaluated prospectively between Jan 2014 and Jun 2018. Included cases were stratified into two groups: group A (plate width: 4 to <8 mm) and group B (plate width: < 4 mm). All cases were approached by TIP urethroplasty, with dorsal inlay grafting (inner-face prepuce). Cases with significant chordee (non-preservable plates), circumcised cases, and redo cases were excluded. RESULTS: A total of 104 hypospadias cases with narrow plates were included in this study. Among group A (n = 81), the need for postrepair urethral dilations was reported in two cases (2.5%) vs seven cases (30%) in group B (n = 23) (P-value < 0.001). Another two cases (2.5%) in group A developed urethrocutaneous fistulae vs three cases (13%) in group B (P-value = 0.0624). Surgical repair of the reported five cases with fistulae, revealed an ample neourethral wall; disclosing well-taken grafts in both groups. DISCUSSION: Few published studies evaluated grafting the incised plate in penile hypospadias. To the authors knowledge, this is the first study that selectively evaluated the impact of grafting narrow plates in relation to its native pre-incision width. CONCLUSIONS: According to the presented authors' experience, 4 mm width is the border line of clinical relevance that defines poor urethral plate. Grafting that plate failed to compensate for its native poor characteristics; however, it offered a valuable neourethral wall that proved indispensable when redo surgery deemed necessary, without adding grafting-related problems. Nevertheless, further extended comparative studies came across as a necessity to verify the long-term outcomes of grafting the incised poor plates.

Outcomes of silastic trapezium replacements.

Trapezio-metacarpal joint arthritis is common, affecting 7% of men and 15% of women. Numerous surgical techniques are described for this condition but it is not clear which is best. Eighty-six silicone trapezium replacements were assessed at an average of 46 months (six to 156 months) postoperatively for patient satisfaction, pain, key and power grip strength, range of motion, complications and disability with DASH score. Patient satisfaction was 92%. There was excellent pain reduction from 4.2 to 0.6 on a scale of 0 to 5. Strength was 72% and 84% of age-sex-matched normal data for key and power grips, respectively. The complication rate was low, with two cases of persistent pain. One resolved spontaneously, the other resolved following revision of the silicone implant. The average DASH score was 30. Silicone trapezium replacement is an effective operation that offers the patient good pain relief, strength and good function with few complications.

Prostate cancer screening in a Saudi population: an explanatory trial study.

The aim of this study is to explore the actual situation of prostate cancer in a cohort of healthy population in Saudi Arabia and to show the feasibility of screening for this disease using the internationally agreed criteria. This study was conducted in the city of Riyadh, in the outpatient clinics of four different health facilities. All men presented to the outpatient clinics during the period of study, from January 2008 to December 2008, were invited to participate in the study, in which they were subjected to PSA blood testing and digital rectal examination (DRE). When either test was abnormal, transrectal ultrasound and multiple prostatic biopsies were performed for confirmation of the results. A total of 2100 healthy males who met the inclusion criteria of the study were evaluated. The highest percentage of men with PSA>/=4 ng ml(-1) was in the age group 61-70, 51-60 years (42.7 and 31.8%, respectively). The number of subjects with an elevated PSA only was 172 (8.1%). Those having both elevated PSA and an abnormal DRE were 51 (2.4%). The total number referred to biopsy was 223. Fifty two subjects had a positive diagnosis of prostatic adenocarcinoma, which compromised 2.5% of the cohort studied. The cancer in 27 (52%) persons was organ confined, whereas in 14 (26.9%), it was metastatic. The prevalence rate of prostate cancer detected by screening was higher than expected and the disease was advanced. Larger community-based larger studies are highly warranted specially among high-risk groups.

Device-related nosocomial infection in intensive care units of Alexandria University Students Hospital.

We studied the magnitude and determinants of device-related nosocomial infections in intensive care units (ICU) and identified the predominant microorganisms involved. Sputum, urine, blood cultures and chest X-ray were taken from each patient on admission and on appearance of any sign/symptom of infection. Out of 400 patients admitted to 3 units during the study, 45 (11.3%) developed nosocomial infections. The most important determinants of infection were previous admission to an ICU, whether in the same or another hospital, and duration of stay. Overall, 38 patients developed 43 device-related nosocomial infections (1.13 episodes per patient). The main infectied association with invasive procedures were ventilator-associated pneumonia followed by catheter-related urinary tract infection and bloodstream infections.

Device-related nosocomial infection in intensive care units of Alexandria University Students Hospital

We studied the magnitude and determinants of device-related nosocomial infections in intensive care units [ICU] and identified the predominant microorganisms involved. Sputum, urine, blood cultures and chest X-ray were taken from each patient on admission and on appearance of any sign/symptom of infection. Out of 400 patients admitted to 3 units during the study, 45 [11.3%] developed nosocomial infections. The most important determinants of infection were previous admission to an ICU, whether in the same or another hospital, and duration of stay. Overall, 38 patients developed 43 device-related nosocomial infections [1.13 episodes per patient]. The main infectied association with invasive procedures were ventilator-associated pneumonia followed by catheter-related urinary tract infection and bloodstream infections

Epidemiologic evaluation of the immunity against hepatitis B in Alexandria, Egypt.

BACKGROUND: Hepatitis B (HB) vaccine represents one of the major achievements in the 20th century. The most important epidemiologic factor affecting the chronic carrier rate is age of infection. The earlier in life an infection occurs, the higher the probability that this infection will result in chronic carriage. METHODS: A seroepidemiologic study was conducted to examine the impact of HB vaccination on the carrier state among a vaccinated group of children (1000) compared to a non-vaccinated group (500) aged 6 years in Alexandria, Egypt. RESULTS: The rate of HbsAg positivity among the vaccinated group was found to be 0.8% compared to 2.2% among the non-vaccinated group. The study showed that the efficacy of HB vaccine in preventing the carriage of HbsAg, 5 years after full course vaccination, was estimated to be around 67%. However, long-term monitoring should continue to confirm the efficacy of the vaccine in preventing chronic carrier state. On the other hand, studying the exposure to some risk factors associated with hepatitis B virus (HBV) infection revealed more or less a similar pattern of exposure among both vaccinated and unvaccinated children. CONCLUSION: It can be concluded that the significantly lower rate of HbsAg positivity among the vaccinated compared to the rate among the non-vaccinated is attributed to the preventive effect of the vaccine.

Clinico-epidemiological study of human fascioliasis in an endemic focus in Dakahlia Governorate, Egypt.

Human fascioliasis is increasing in the Nile Delta particularly in Dakahlia Governorate, where it reached 7.47%. In this study, the tetrad of fascioliasis was established as high eosinophilia (100%), fever (85.6%), painful hepatomegaly (81.93%) and anaemia (100%). The laboratory results showed ESR accelerated in 87%, ALT elevated in 21.5%, AST elevated in 21.9%, S. bilirubin elevated in 16.5%, gamma GT elevated in 80.6%, and SAP elevated in 76.4%. Abdominal ultrasonography showed variable findings, as hepatomegaly, splenomegaly, periportal fibrosis, thickened wall of gall bladder, dilated common bile duct, dilated biliary radicals (partial), dilated common bile duct and biliary radicals (total), Fasciola worms in gall bladder, Fasciola worms in common bile duct, stones in gall bladder, stones in bile duct, cystic lesions in the liver, local lesions in the liver and ascitis. The highest was hepatomegaly in 81.93% of fascioliasis patients and the lowest was biliary dilated radicles (partial) in 0.26%.

Predictive models for mortality and length of hospital stay in an Egyptian burns centre.

Our aim was to obtain a statistical profile of survivors and deaths among burn victims and to develop predictive models for mortality and length of hospital stay. All patients admitted to the Burns Unit of Alexandria Main University Hospital over a 1-year period were included. Of 533 cases, mean length of hospital stay was 15.5 +/- 21.6 days and the mortality rate was 33%. Total surface area burnt, inhalation burns, age, sex, depth and degree of burn wounds were the significant independent predictors of mortality in multiple logistic regression analysis. The significant independent predictors of the length of hospital stay were clothing ignition, total surface area burnt, sex, degree and depth of burn and inhalation burns.

Fast-Dot ELISA using urine, a rapid and dependable field assay for diagnosis of schistosomiasis.

The fast dot-enzyme linked immunosorbent assay (FD-ELISA) was used as a field applicable tool for rapid diagnosis of schistosomiasis. Seven hundreds faecal specimens were parasitologically examined for detection of S. mansoni eggs and other parasitic infection. Egg count was done for 100 infected patients. Rectal biopsies (394) were taken from individuals with no S. mansoni egg in their stool where it was used as a golden standard for diagnosis of schistosomiasis. Cross-reactivity with other parasites was studied. Serum samples were tested by ELISA technique for detection of human IgG anti-schistosomal antibodies. Seven hundreds urine samples (433 S. mansoni infected patients and 267 healthy individuals) were tested by FD-ELISA for detection of a schistosomal antigen excreted in urine using BRLF4 mouse monoclonal antibody. FD-ELISA results were compared with ELISA detecting antischistosomal IgG and stool analysis where, it showed highest efficiency (91%), compared with 81% and 60% for ELISA and stool analysis respectively. The sensitivity of FD-ELISA was high ranging from 90-94% in the four different clinical stages of schistosomiasis (Simple intestinal. Hepatosplenomegaly, Shrunken liver & Splenomegaly, and Shrunken liver-splenomegaly & ascites). FD-ELISA was highly sensitive, detecting infection cases with 20 eggs/gm faeces and its specificity was 89%. The antigen was characterized as a protein with a molecular weight of 74 KDa using western blot technique.

Allopurinol in the treatment of zoonotic cutaneous leishmaniasis.

Twenty male patients with zoonotic cutaneous leishmaniasis were included in this study. Each patient received 1200 mg of allopurinol/day in divided doses for a duration of one month. 80% of patients had an excellent response (cure), however, sometimes leaving mild pigmented or faintly coloured skin i.e. a more or less acceptable scar, but with no recurrence for one year follow-up. The drug was well tolerated. However, it showed headache in 20%, myalgia in 10% and transient increase of liver enzymes in 20%. All these side effects disappeared at the end of treatment. The parasites have particular enzymatic reactions that have relevance for chemotherapy. Certain purine analogous are metabolised by the parasites to nucleotides and aminated to the analogous of adinine nucleotides. These halt protein synthesis and cause break down of RNA. Allopurinol is recommended in treatment of cutaneous leishmaniasis, as it is effective, cheap, orally administered, available and with less side effects.

The efficacy of ivermectin in treating rabbits experimentally infected with Eimeria as indicated parasitologically and histologically.

Ivermectin (Ivomec) was used as coccidiocidal drug against Eimeria in experimentally infected rabbits as indicated parasitologically & histologically. Twenty Bosskat rabbits, were divided in to 5 groups, 3 groups were inoculated with 1000 sporulated oocysts and the other 2 groups were kept as negative controls with and without Ivermectin administration. Ivermectin (1:10) was injected subcutaneously in a dose of 0.5 ml in animals of groups 1,2 & 3. The treatment of group (1) was on the 4th day A.I. and on the 4th day and 7th day A.I.in group (2). The treated animals with one or two doses showed mild coccidiosis with very few number of oocysts deposition & rapid intestinal regeneration with degenerated Eimeria developmental stages, especially the asexual ones.

Studies on Paederus alfierii Koch (Coleoptera:Staphylinidae) with special reference to the medical importance.

In Egypt, the rove beetle; Paederus alfierii Koch, is an active predator of several insects pests attacking a wide variety of cultivated plants as maize, cotton, clover ... etc. On the other hand, members of genus Paederus contain pederin (potent toxin) which in contact with human skin causes a necrotizing lesion (dermatitis linearis) and with the eye causes conjunctivitis. After the sudden flood of the year 1994, this beetle attacked a factory and about forty factors suffered a form of contact dermatitis and conjunctivitis. The majority of such factors needed hospitalization. To fill the gap in the knowledge of medical importance on such a predator, the present investigation was aimed. The aqueous extract from twenty wild collected adults (0.0101 gm) was tested on different groups of albino mice. No cutaneous reaction was seen macroscopically. On the other hand, another group of mice (3/4) showed mild conjunctival congestion faded on the next day. However, these experimental findings do not indicate the innocence of this rove-beetle from being harmful to man. The discussion was given on the light of work done abroad.

Effect of the behavioural stress on susceptibility of Syrian hamsters to Schistosoma mansoni infection: effect on number and fertility of worm burden.

Effect of pairing on susceptibility of male Syrian hamsters to Schistosoma mansoni infection in comparison to their isolated counter-parts have been studied. Pairing resulted in significant differences between paired and isolated hamsters in measurements of eggs, miracidia, number of adult worms recovered and mean testicular number of males. Paired hamsters seemed to be immunologically suppressed and such a suppression resulted in increasing the fertility and number of worms recovered. The width of the male schistosomes recovered from the paired hamsters was two folds and the length was four folds greater than those recovered from isolated ones. The mean testicular number was 8.17 +/- 0.53 in males recovered from paired hamsters and 6.16 +/- 0.71 in those recovered from isolated ones. Of interest was, the demonstration of a male with two groups of testes recovered from a paired hamster. It was concluded that the stressed host reflex effects on the number and fertility of the schistosome worms burden, and hence the severity of the disease and its complications.

Serum levels of tumour necrosis factor alpha (TNF-alpha) versus immunoglobulins (IgG., IgM., and IgE.) in Egyptian scabietic children.

The tumour necrosis factor-alpha (TNF-alpha or Cachectin) is a protein produced mainly by macrophages, with a wide range of biological activities and in inflammatory process. On the other hand, scabies is a skin disease caused by Sarcoptes scabiei which is typified by severe itching (particularly at night), red papules and often secondary infection. The female mite tunnels in the skin to lay her eggs and the newly hatched mites pass easily from person to person by contact. Commonly the infested areas are the groin, penis, nipples and the skin between the fingers. In this paper, the serum levels of TNF-alpha versus IgG., IgM., and IgE. were estimated in parasitologically proven scabietic male children (8-13 years) with no secondary infection or other parasitic infection. The results showed high significant elevation of serum TNF-alpha in 94.1% (P = 7.763E-04) and IgE in 100% (P = 1.530E-07) in the scabietic patients than in the control group, and non significant increase in IgG in 47% (P = 0.0605) and in IgM in 5.9% (P = 0.9404). It was concluded that TNF-alpha plays a role in the pathogenesis of human scabies. Extensive study is ongoing to clarify the outcome of TNF-alpha in human scabies.

Radio-immuno assay estimation of plasma endothelin levels in patients with bilharzial and post viral liver cirrhosis: a possible new additive factor in aggravation of portal hypertension.

Radio immunoassay estimation of plasma endothelin level was carried out in 90 patients with bilharzial and post viral chronic liver diseases with portal hypertension associated with bleeding and non bleeding oesophageal varices as well as 10 normal control subjects. It was found that plasma endothelin level was significantly elevated in such patients when compared to normal controls. Moreover, there was a positive correlation between the elevated levels of plasma endothelin and portal vein diameter as well as bleeding oesophageal varices. It may be concluded that plasma endothelin, which is a very potent vasoconstrictor for both systemic and portal circulation, plays an important role in aggravation of portal hypertension in liver cirrhosis.

Demodex (follicular mite) infesting a boy and his pet dog.

Intense iritation and dermatitis, somewhat resembling that produced by scabies can result from various mites living as temporary ectoparasites on the skin of man. Demodex folliculorum is a worm-like mite that infests hair follicles above the level of sebaceous glands in various mammals. In this paper, Demodex folliculorum was recovered from a boy and his pet dog. Both the boy and the dog were successfully treated with permethrin.

Four species of house dust mites recovered from houses of patients with allergic respiratory diseases.

Arthropods and their products are wide spread and considered one of the common allergens affecting man. Allergy to arthropod antigens is the major cause of respiratory allergy as rhinitis and bronchial asthma. The range of reaction depends on several factors which include the type and source of the material, the rate of intensity, the duration of exposure, the human immune response and history of prior exposure. Successful management of allergic disease depends on proper identification of the causative allergen and reduce exposure to this allergen. Generally speaking, the house dust is not a simple substance but an accumulation of living and non living parts as mites, pollens, molds, dander and decaying insects. In the present study, four species of mites were isolated from the dust collected from the houses of patients with allergic respiratory diseases. The species were Dermatophagoides pteronyssinus, D. farinae, Ornithonyssus bacoti and Haemogamassus pontiger. The two species of Dermatophagoides. were the predominant mites which are known to produce the most potent allergies. Studying the serum immunoglobulins level showed that the IgE had a highly significant concentration among respiratory allergic patients (28) with (5) or without (23) atopic dermatitis. It was concluded that house dust mites, that cause inhalant allergens, are one of the main aetiological factors of allergic respiratory diseases, with or without atopic dermatitis.

Congenital toxoplasmosis among premature infants with different clinical pictures in Saudi Arabia.

No doubt, toxoplasmosis is a prevalent infection in all the Arab countries. However, the incidence differs from one country to another and even within the same country. Congenital toxoplasmosis is the most important form of the infection. In the present study, some 78 premature infants with different clinical pictures were examined for Toxoplasma IgG (by IHAT and ELISA) and Toxoplasma IgM (by ELISA). The results showed Toxoplasma IgG ranging between 32.1% (IHAT) and 46.2% (ELISA) while IgM (ELISA) was 23.1%. The highest positivity rate was among those suffering jaundice and the lowest was among those suffering fever of unknown origin. Protection of women particularly pregnant ones, from Toxoplasma infection is a must.

PIP: Laboratory personnel at Taif Children's Hospital in Saudi Arabia used indirect hemagglutination tests (IHAT) to analyze blood samples from 78 Saudi Arabian premature infants suffering from neonatal jaundice (21 infants), lymphadenopathy (18), fever (20), chorioretinitis (15), hepatomegaly (3), or pneumonia (1). Laboratory personnel in Egypt used ELISA assays to examine the second set of blood samples. The researchers wanted to measure antibodies to Toxoplasma gondii in the infants exhibiting symptoms of congenital toxoplasmosis. 32.1% of the infants tested positive for Toxoplasma antibodies based on the IHAT. The most common symptoms among these positive congenital toxoplasmosis cases were jaundice (57.1%) and lymphadenopathy (38.9%). The ELISA test for IgG found Toxoplasma antibodies in 46.2% of the premature infants. The ELISA test for IgM found Toxoplasma antibodies in 23.1%. The leading symptoms for IgG included jaundice (66.7%), chorioretinitis (53.3%), and lymphadenopathy (50%). The leading symptoms for IgM were jaundice (42.9%) and lymphadenopathy (22.2%). None of the premature infants with hepatomegaly or pneumonia tested positive for Toxoplasma antibodies. Pregnant women can avoid toxoplasmosis by cooking the meat they eat, and not eating it raw or frozen; not touching cats; and washing hands after handling raw meat, cats, or contaminated soil. Women should be routinely tested for Toxoplasma antibodies before pregnancy.