Writing for publication: Argument and evidence.

The rules for writing a research report are well defined but novice writers need more clarification on writing scholarly scientific papers for publication. The purpose of this paper is to enable novice writers to confidently apply the skills of scientific writing to the development of a scholarly paper for publication. We highlight the importance of having a clearly defined question or clarity in focus before moving on to consider the components of a scholarly paper including, the question, thesis, introduction, body, discussion, conclusion and finally, an abstract.

Factors Affecting Patient Perceptions and Satisfaction with Telemedicine in Outpatient Clinics.

Despite the increasing use of telemedicine, patients' views on telemedicine remain unclear. This study aimed to understand factors affecting patient perceptions and satisfaction with telemedicine services. 235 patients were surveyed on accessibility to telemedicine clinics, medical specialities and satisfaction with the services. 58.3% confirmed having a stable internet connection, 24.3% used telemedicine services in internal medicine clinics, and only 5.1% accessed the telemedicine services in psychiatry clinics. 68.5% used the telephone to access telemedicine service, while only 6.4% used the hotline. Over half of patients confirmed their ability to hear clearly and speak easily with their healthcare providers during their consultations. 55.7% confirmed they were satisfied with their telemedicine experience, while 23.4% were neutral and 8.9% were unsatisfied. There was a significant difference in the rates of satisfaction between female and male respondents (p-value<0.001). Those with stable internet connection had significantly higher satisfaction rates with telemedicine services (p-value<0.001). The rates of satisfaction with telemedicine services were significantly higher in Cardiology and Orthopaedic clinics. Larger multi-center studies examining other factors affecting patients' satisfaction are recommended.

Evaluation of reference values of standard semen parameters in fertile Egyptian men.

The reference values of human semen, published in the WHO's latest edition in 2010, were lower than those previously reported. The objective of this study was to evaluate reference values of standard semen parameters in fertile Egyptian men. This cross-sectional study included 240 fertile men. Men were considered fertile when their wives had recent spontaneous pregnancies with time to pregnancy (TTP) ≤12 months. The mean age of fertile men was 33.8 ± 0.5 years (range 20-55 years). The 5th percentiles (95% confidence interval) of macroscopic semen parameters were 1.5 ml for volume and 7.2 for pH. The 5th percentiles of microscopic parameters were 15 million/ml for sperm concentration, 30 million per ejaculate for total sperm count, 50% for total motility, 40% for progressive motility, 62% for vitality, 4% for normal sperm forms and 0.1 million/ml for seminal leucocyte counts. In conclusion, fertile Egyptian men had higher reference values of sperm total motility, progressive motility and vitality, and lower reference values for total sperm counts as compared to those determined by the latest edition of the WHO laboratory manual in 2010. Other semen parameters were identical to those defined by the WHO 2010 manual.

Lesional skin vascular endothelial growth factor levels correlate with clinical severity in patients with cement allergic contact dermatitis.

Allergic contact dermatitis to cement is a delayed-type hypersensitivity reaction in which cytokines interferon-gamma (IEN-y) and vascular endothelial growth factor(VEGF) may be involved in persisting erythema and oedema. VEGF and IFN-gamma levels in serum and skin lesions were measured in 32 Egyptian building workers with chronic allergic contact dermatitis due to occupational exposure to cement and 20 healthy controls. Dermatitis patients had significantly higher levels of serum and lesional skin VEGF and IFN-gamma than controls. A significant positive correlation was found between tissue VEGF and the eczema area and severity index (EASI) score in dermatitis patients (r = 0.86). VEGF and IFN-gamma may play a role in the pathogenesis of cement allergic contact dermatitis.

Cigarette smoking, hypertension and diabetes mellitus as risk factors for erectile dysfunction in upper Egypt.

Erectile dysfunction impairs the quality of life of millions of men worldwide. This study aims to determine the relationship between selected clinical risk factors and erectile dysfunction in men residing in upper Egypt. Patients were surveyed with the 5-item International Index of Erectile Function (IIEF-5) and assessed for the presence of hypertension, diabetes and smoking. Of 658 men with erectile dysfunction, 17.3% had hypertension, 21.4% had diabetes and 40.1% were smokers, whereas among 821 age-matched controls without erectile dysfunction, the corresponding figures were 2.8%, 3.7% and 28.7%. Multivariate analysis showed that hypertension (OR = 5.4), diabetes mellitus (OR = 5.4) and smoking (OR = 3.1) were significant risk factors for erectile dysfunction.

Lesional skin vascular endothelial growth factor levels correlate with clinical severity in patients with cement allergic contact dermatitis

Allergic contact dermatitis to cement is a delayed-type hypersensitivity reaction in which cytokines interferon-gamma [IFN-gamma] and vascular endothelial growth factor [VEGF] may be involved in persisting erythema and oedema. VEGF and IFN-gamma levels in serum and skin lesions were measured in 32 Egyptian building workers with chronic allergic contact dermatitis due to occupational exposure to cement and 20 healthy controls. Dermatitis patients had significantly higher levels of serum and lesional skin VEGF and IFN-gamma than controls. A significant positive correlation was found between tissue VEGF and the eczema area and severity index [EASI] score in dermatitis patients [r = 0.86]. VEGF and IFN-gamma may play a role in the pathogenesis of cement allergic contact dermatitis

Cigarette smoking, hypertension and diabetes mellitus as risk factors for erectile dysfunction in upper Egypt

Erectile dysfunction impairs the quality of life of millions of men worldwide. This study aimed to determine the relationship between selected clinical risk factors and erectile dysfunction in men residing in upper Egypt. Patients were surveyed with the 5-item International Index of Erectile Function [IIEF-5] and assessed for the presence of hypertension, diabetes and smoking. Of 658 men with erectile dysfunction, 17.3% had hypertension, 21.4% had diabetes and 40.1% were smokers, whereas among 821 age-matched controls without erectile dysfunction, the corresponding figures were 2.8%, 3.7% and 28.7%. Multivariate analysis showed that hypertension [OR = 5.4], diabetes mellitus [OR = 5.4] and smoking [OR = 3.1] were significant risk factors for erectile dysfunction

Cytokines in leprosy, I. Serum cytokine profile in leprosy.

BACKGROUND: Leprosy is a chronic infectious disease characterized by a broad spectrum of clinical forms depending on the patient's immune response, in particular cell-mediated immune response. METHODS: Cytokines can play a role in the cell-mediated immune response. Serum levels of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta) were measured by enzyme-linked immunosorbent assay (ELISA) in 55 untreated leprosy patients and 35 reactional leprosy patients, in addition to 20 age- and sex-matched healthy controls. RESULTS: Leprosy patients showed significantly higher serum levels of the studied cytokines (except IL-2) compared with healthy controls. When the two poles were compared, tuberculoid leprosy (TT) patients showed significantly higher levels of IFN-gamma and TNF-alpha with significant negative correlations with the bacterial index (BI), whereas lepromatous leprosy (LL) patients showed significantly higher serum levels of IL-2R, IL-10, and IL-1beta with significant positive correlations with the BI. Both type I and type II reactional patients showed significantly higher serum IFN-gamma, IL-2R, and IL-1beta, in addition to IL-10 in type II reactional patients, compared with nonreactional leprosy patients. When compared with each other, type I reactional patients showed increased levels of IFN-gamma, whereas type II reactional patients showed increased levels of IL-10. CONCLUSIONS: In leprosy patients, both IFN-gamma and TNF-alpha are immunoprotective, whereas IL-2R, IL-10, and IL-1beta are immunosuppressive. Our results indicate that type I reaction, with increased levels of IFN-gamma, is a cell-mediated immune response, whereas type II reaction, with increased levels of IL-10, is essentially an immune complex disease.

Cytokines in leprosy, II. Effect of treatment on serum cytokines in leprosy.

BACKGROUND: Multidrug therapy (MDT) causes a decrease in the bacterial burden in leprosy patients. Does the decrease in the antigenic stimulation of the immune system have an effect on cytokine production? METHODS: The effect of treatment on serum cytokines was evaluated in 36 leprosy patients and 35 reactional leprosy patients and compared with that in 20 age- and sex-matched healthy individuals. The enzyme-linked immunosorbent assay (ELISA) technique was used to measure serum levels of interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), and interleukin-1beta (IL-1beta) before and after treatment. These cytokines represent T-helper 1 (TH1), T-helper 2 (TH2), and macrophage cytokines, respectively. RESULTS: The studied serum cytokines were significantly reduced after 1 year of treatment in leprosy patients. The degrees of reduction were significantly positively correlated with a reduction in the bacterial index (BI) and morphologic index (MI). After 1 year of MDT (but not 6 months), paucibacillary (PB) patients showed a significant reduction in all the studied serum cytokines to levels comparable with those of healthy controls. Multibacillary (MB) patients also showed a significant reduction in all the studied serum cytokines, but the levels were still significantly higher than those of healthy controls. Leprosy patients with high levels of serum IL-1beta were more susceptible to the development of reactions after the initiation of treatment. Corticosteroid therapy of reactional patients resulted in a significant reduction in the studied serum cytokines to levels similar or lower than those of nonreactional leprosy patients. The dose of steroids showed a significant positive correlation with the amount of decrease in IL-1beta. CONCLUSIONS: MDT caused a reduction in serum cytokines correlated with a reduction in the bacterial burden. It is advisable to continue MDT for PB patients for 1 year. Serum IL-1beta levels may have a prognostic value for the susceptibility of leprosy patients to the development of reactions.

Microbial transformation of lucanthone by growing cultures, washed mycelia and non-germinating spores of fungi from the Aspergillus group.

Whole broth cultures, washed mycelia and non-germinating spores of 13 aspergilli scored from among 91 moulds isolated from soil and air transformed lucanthone (I) into three to five products with increased polarity. Biotransformations brought about by actively growing cultures were also performed by washed mycelia and non-germinating spores of the same strains. Lucanthone (I) was oxidized by growing cultures, washed mycelia and spore suspensions of an Aspergillus species (no. 2) into: hycanthone (II) as the main product, its aldehyde analogue (III) and its carboxylic acid derivative (IV). The pathway of lucanthone (I) oxidation by this strain involved hydroxylation of the 4-methyl group (to give hycanthone, II) followed by dehydrogenation of the resulting primary alcohol (to give the aldehyde, III). The aldehyde III was finally slowly oxidized to the corresponding carboxylic acid analogue IV. Evidence is presented to show that mycelial and spore enzymes effecting these oxidative reactions are intracellular and non-inducible in nature. Spore-mediated transformations were found not to require a source of energy and could be conducted in distilled water over a wide range of incubation temperature (from 4 to 37 degrees C). Use of the spores in successive transformations did not affect lucanthone (I) hydroxylation into hycanthone (II) or the dehydrogenation of the latter into the aldehyde analogue (III) but the ability of the spores to oxidize the aldehyde (III) to the carboxylic acid (IV) was lost.

Formation and properties of L-glutaminase and L-asparaginase activities in Pichia polymorpha.

An ascogenous yeast with high potentialities for L-glutaminase and L-asparaginase formation was isolated from Egyptian soils by the application of the culture enrichment method. The organism, identified as Pichia polymorpha, was obtained through the enrichment of soil samples with a simple medium containing 0.5% L-glutaminase as a major carbon and nitrogen source at low pH values. The amidase activities were produced constitutively on a variety of media irrespective of the presence of their substrates in the growth medium. Assays of enzyme activity have revealed that optimum pH values for L-glutamine and L-asparagine hydrolysis are 6.0 and 6.7, respectively. The L-asparaginase activity of the cells was heat-stable for at least 10 minutes at 60 degrees C. The enzyme exhibited apparent Km of 1.37 x 10(-2) M and 1.95 x 10(-2) M for L-asparagine and L-glutamine, respectively. No metal requirement were detected for the amidase activities of the organism under study.

Distribution of steroid 1-dehydrogenation and side-chain degradation enzymes in the spores of Fusarium solani: causes of metabolic lag and carbohydrate independence.

The spores of a strain of Fusarium solani 1-dehydrogenate ring A and cleave the 17beta-acetyl side chain of 17alpha-hydroxypregn-4-ene-3,20-dione (17alpha-hydroxyprogesterone) to give 17alpha-hydroxypregna-1,4-diene-3,20-dione (the 1-dehydro analogue) and little androsta-1,4-diene-3,4-diene-3,17-dione (androstadienedione). A 4-h lag period is observed in the course of metabolism, and there are no requirements for external additives. Exoenzymes or surface enzymes bound to the cell outside the plasma membrane, either in the periplasmic space or bound to the cell wall, cannot be detected. The spore activity is not destroyed by treatment with aqueous HCl (pH 1.50), indicating that the 1-dehydrogenation and side-chain degradation enzymes are located away from the surface of the spores. Phenethyl alcohol destroys the spore permeability barriers, and it is also likely that it exposes its enzymes to acid inactivation. The action of phenethyl alcohol is reversible at low concentrations and irreversible at high concentrations. This investigation shows that: (i) the spore 1-dehydrogenating and side-chain-degrading enzymes appear to be bound to, or imbedded in, the plasma membrane; (ii) the lag period observed in the course of metabolism of the steroid by the spores might be required for enzyme activation or diffusion of the substrate through the cell wall; and (iii) the internal metabolities of the spores, that might be required for the conversion process, appear to be present in a nondiffusible form or bound to intrasporal macromolecules.

Reduction of the 20-carbonyl group of C-21 steroids by spores of Fusarium solani and other microorganisms. I. Side-chain degradation, epoxide cleavage, and substrate specificity.

The spores of Fusarium solani reduced the C(2)-carbonyl group, 1-dehydrogenated ring "A" and cleaved the side chain of 16alpha, 17alpha-oxidopregn-4-ene-3, 20-dione (16alpha, 17alpha-oxidoprogesterone)(I) to give the following products: 20alpha-hydroxy-16alpha, 17alpha-oxidopregn-4-en-3-one(II); 20alpha-hydroxy-16alpha, 17alpha-oxidopregna-1, 4-dien-3-one(III); 16alpha-hydroxy-17a-oxa-androsta-1, 4-diene-3, 17-dione (16alpha-hydroxy-1-dehydrotestololactone)(IV); and 16alpha, 17beta-dihydroxy-androsta-1, 4-dien-3-one (16alpha-hydroxy-1-dehydrotestosterone)(V). When II was used as a substrate, it was metabolized into III, IV, and V at a slower rate than I. Furthermore, 16alpha-hydroxy-androst-4-ene-3, 17-dione (16alpha-hydroxyandrostenedione)(X) was transformed into IV and V. Pregn-4-ene-3, 20-dione (progesterone)(XII) was transformed into androsta-1, 4-diene-3, 17-dione (androstadienedione)(VIII) and 17a-oxa-androsta-1, 4-diene-3, 17-dione (1-dehydrotestololactone)(IX), while 17alpha-hydroxy-pregn-4-ene-3, 20-dione (17alpha-hydroxyprogesterone)(VI) was converted into its 1-dehydro analogue (VII) without accumulation of any 20-dihydro compounds. Substrate specificity in the 20-reductase system of F. solani, Cylindrocarpon radicicola, Septomyxa affinis, Bacillus lentus, and three strains of B. sphaericus are demonstrated. The 20-reductase is active only on steroids having the 16alpha, 17alpha-oxido, and Delta(4)-3-keto functions. Evidence of competition between side-chain degrading enzymes and the 20-reductase for the steroid molecule and evidence of side-chain degradation followed by epoxide cleavage (and not the reverse) are presented. A mechanism for the epoxide opening by nongerminating spores of F. solani is postulated.