Development and evaluation of a novel score for prediction of large oesophageal varices in patients with hepatitis c virus-induced liver cirrhosis.

OBJECTIVE: Variceal bleeding is one of the most common life-threatening complications of liver cirrhosis. This study aimed to develop and evaluate a predictive score, named Platelet count, Alpha fetoprotein (AFP) and Prothrombin-INR (PAP) for the prediction of large oesophageal varices and to compare PAP score with eight common liver fibrosis scores (AAR, APRI, GUCI, BRC score, Fibro-Alfa, FIB4, Lok and Fibro-Q) in patients with hepatitis C virus (HCV) induced liver cirrhosis. METHODS: A total of 277 patients with HCV-induced liver cirrhosis were evaluated by upper gastrointestinal endoscopy for presence of varices. Liver biochemical profile, complete blood count, prothrombin time and AFP were estimated. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score (PAP score) comprising platelet count, AFP and prothrombin-INR. RESULTS: PAP score predicts large oesophageal varices in patients with HCV-induced liver cirrhosis with AUC of 0.85. The optimum cut-off for predicting large oesophageal varices using ROC curve analysis was 0.27. At this point the PAP score had 77% sensitivity, 86% specificity, 94% negative predictive value and 84% efficiency. The diagnostic performances (AUC) of eight common liver fibrosis scores were 0.58 for the AAR score, 0.63 for APRI, 0.66 for GUCI, 0.68 for BRC, 0.72 for Fibro-Alfa, 0.70 for FIB4, 0.72 for Lok and 0.77 for Fibro-Q. CONCLUSION: PAP scores a non-invasive, inexpensive and simple score that could predict the presence of large oesophageal varices reducing the need of endoscopy. The PAP score has a superior AUC score than other scores, suggesting improved clinical value.

Association of human leucocyte antigen Class I (HLA-A and HLA-B) with chronic hepatitis C virus infection in Egyptian patients.

Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% with an average of approximately 13.8% in the general population. It has been reported that human leucocyte antigen (HLA) alleles are associated with the outcome of HCV infection, but this associations showed ethnic and geographical differences. The objective of this study is to investigate the association between the frequencies of HLA Class I and chronic HCV infection in Egyptian patients and to find out whether there is a relation between certain HLA Class I antigens and HCV viral load, degree of fibrosis, activity and alanine aminotransferase (ALT) level. A case control study was conducted on 100 patients with chronic HCV infection and 150 healthy controls. HLA-A and HLA-B typing by complement-dependent micro-lympho-cytotoxicity assay was performed for both groups. HLA-A11 antigen was significantly increased in patients with chronic HCV infection versus controls (OR 3.98; 95% CI = 1.85-8.89; P = 0.001; and Pc = 0.021). HLA-B12, HLA-B13, HLA-B17 and HLA-B40 were higher in patients, and HLA-A32 and HLA-B14 were higher in controls, although the significance was lost after correction for multiple testing. HLA-A9 was significantly associated with low viral load (P = 0.008, Pc = 0.048). The results of this work implicate that HLA-A11 antigen may influence chronic HCV infection and may play a role in viral persistence. Different HLA Class I antigens are not associated with degree of liver fibrosis, grades of activity or level of ALT. However, HLA-A9 is associated with low HCV viral load in chronic HCV Egyptian patients.

Gynecological efficacy and chemical investigation of Vitex agnus-castus L. fruits growing in Egypt.

Flavonoid glycosides, orientin and apigenin 3, 8-di-C-glycosides in addition to, iridoid compound, aucubin were isolated from the ethanolic extract of Vitex agnus-castus fruits. Their structures were identified on the basis of the spectroscopic data. The estrogenic activity of the ethanolic extract in two dose levels 0.6 and 1.2 g kg(-1) per body weight (b.w.) was studied by the vaginal smear, and uterine weight methods for normal and ovariectomized female rats. The extract induced significant increase in the uterine weight of ovariectomized rats at two dose levels comparable to that of control group. The percentages of the total average number of scores were increased significantly too. Significant increases in plasma progesterone and total estrogens levels were shown at the two dose levels when compared to that of control group. On the other side, the extract induced significant reduction in luteinizing and plasma prolactin hormones.

One-pot synthesize of dendritic hyperbranched PAMAM and assessment as a broad spectrum antimicrobial agent and anti-biofilm.

Hyperbranched poly(amidoamine) (h-PAMAM) compound was synthesized from diethylene triamine and different moles percent of methyl acrylate using simple one-pot and commercial synthesis method. The synthesized h-PAMAM was provided with ester and amine terminations. Chemical structure of the synthesized h-PAMAM, with different terminations, was confirmed by Fourier Transform Infrared (FTIR) spectroscopy. In addition, the size and the distribution of the synthesized h-PAMAM were evaluated using Dynamic Light Scattering (DLS) analysis. The molecular weights of the synthesized modified hyperbranched polymer, with different terminations, were measured using Gel-permeation chromatograph. The ill-structure of the h-PAMAM with different molar feed methyl acrylate:diethylene triamine (MA:DETA) ratios was designed as h-PAMAM-amine, h-PAMAM-ester and h-PAMAM-amine plus (sharing similar chemical and physical properties with well-defined poly(amidoamine) (PAMAM) dendrimers in generation 2, 2.5 or 3, respectively). Moreover, the synthesized compound expressed broad spectrum antimicrobial and anti-biofilms activity.

Angiosarcoma arising in an arteriovenous fistula site in a renal transplant patient: a case report and literature review.

Angiosarcoma in the setting of immunosuppressed renal transplant recipients is exceedingly rare. In this report, we describe the occurrence of angiosarcoma arising at an arteriovenous fistula site of a 39-year-old renal transplant recipient that clinically mimicked a thrombosed aneurysm. These tumors are histologically high-grade and clinically aggressive malignancies. They have a predilection for arteriovenous fistula sites. The literature on this uncommon entity is reviewed and possible histogenesis is discussed.

Effect of khat on the metabolism of erythrocytes.

The plant khat "Catha Edulis Forsk" is widely distributed among most East African countries, Yemen and many other areas of the world. Administration of khat extract by the intragastric route in rabbits affected the metabolism of erythrocytes. There is a significant decrease in pyruvate kinase and the level of reduced glutathione (P less than 0.001), and a highly significant increase in both glucose-6-phosphate dehydrogenase and glutathione reductase activities (P less than 0.001) in khat-fed rabbits as compared to controls. On the other hand the activity of uridyl transferase as well as the concentration of 2,3-diphosphoglycerate were not significantly changed in experimental khat-fed rabbits (P greater than 0.5).

Changing presentation of myocardial infarction with increasing old age.

The symptoms associated with acute myocardial infarction in a series of 777 elderly hospitalized patients are reviewed. Their ages ranged from 65 to 100, with a mean of 76.0 years. The spectrum of presentation changed significantly with increasing age. Chest pain or discomfort were less frequently reported, although present in the majority of patients up to 85 years. Syncope, stroke, and acute confusion became more common and were often the sole presenting symptom. Shortness of breath, although the most frequently reported symptom in the absence of chest pain, was equally common at all ages. Thus, in patients aged 85 years or over, "atypical" presentation of myocardial infarction became the rule, and in the very old the clinician must be prepared to screen for the diagnosis in most acutely ill patients.

Evaluation of some tissue and serum biomarkers in prostatic carcinoma among Egyptian males.

OBJECTIVES: The purpose of this study is to evaluate the role of soluble E-cadherin as a serum marker and bcl-2 and DNA content as tissue markers in characterization and management of prostatic adenocarcinoma (PC) among Egyptian males. DESIGN AND METHODS: The study group included 71 patients with prostatic adenocarcinoma, 30 patients with benign prostatic hyperplasia (BPH), and 20 normal male subjects. Serum soluble E-cadherin (sE-cadherin) and PSA were quantified by ELISA and MEIA (microparticle enzyme immunoassay) techniques, respectively. Tissue samples were investigated for bcl-2 chromosomal translocation t(14;18) by polymerase chain reaction (PCR) together with detection of bcl-2 protein expression by immunohistochemistry. The results were correlated with DNA content (as defined by flow cytometric analysis) and also with traditional clinicopathologic parameters. RESULTS: Our data revealed that, serum PSA was superior to sE-cadherin as a marker for PC with a sensitivity of 83% compared to 59% in case of E-cadherin at the same specificity (96.6%). Combination of both markers raised the sensitivity to 90%. E-cadherin correlated with Gleason score. Ploidy status, synthetic phase fraction (SPF), and proliferation index (PI) correlated significantly with tumor Gleason score. PI was also correlated to clinical stage. bcl-2 protein was overexpressed in 14% of PC and it showed a trend for correlation with tumor Gleason score (p = 0.06). We failed to detect chromosomal t(14;18) in the bcl-2 gene in all the studied tumors. CONCLUSIONS: E-Cadherin is a clinically useful biomarker in PC specially in combination with PSA. DNA content changes and bcl-2 oncogene may account for tumorogenesis and may assist in prognostication of PC.

Reconstructive surgery of hydrosalpinx with and without the carbon dioxide laser.

Pregnancy rates and surgery-conception intervals were determined in 91 women operated on for bilateral terminal tubal occlusion with different techniques. The intrauterine pregnancy rate following salpingostomy utilizing the CO2 laser was 21.7% (n = 23) and following salpingostomy with the microdiathermy needle was 22.7% (n = 22) at 1 year's follow-up. The pregnancy rate following conventional surgery was 17.4% (n = 46) at 5 years' follow-up. The surgery-conception interval was shorter in the laser group than in the other two groups. This preliminary report suggests that there is no difference between the pregnancy rate following salpingostomy with CO2 laser or microdiathermy needle; however, the surgery-conception interval is shorter. This might reflect the rapid healing of the tube after laser surgery.

Effects of certain antibilharzial and contraceptive drugs on liver functions in rats.

Effects of single and combined administration of contraceptive drug (microvlar-30) and anti-urinary bilharzial drug (metriphonate) as well as anti-intestinal bilharzial drug (oxamniquine) on the liver functions of female albino rats were studied. Metriphonate increased serum globulin content and caused no change in the hepatic cells. Oxamniquine significantly increased the activities of serum transaminases and alkaline phosphatase and caused necrosis in some liver cells. Microvlar-30 exhibited no change on the serum enzymes, while marked increase was found in serum triglyceride and protein levels. The combined administration of metriphonate or oxamniquine with microvlar-30 prevented the increase in the levels of serum triglycerides and proteins. Histopathological examination confirmed the results obtained by chemical analysis.

Pararectal paraganglioma.

Paragangliomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the phaeochromocytoma. The majority of extra-adrenal tumours develop within the abdomen and are associated with the coeliac, superior and inferior mesenteric ganglia, which run parallel to the aorta. The organ of Zuckerkandl origin is most common. Pararectal paragangliomas are extremely rare. This case report presents ultrasound, magnetic resonance and histological features of such a case.

Delay in discharge of patients from an acute geriatric unit.

The delay in discharge of patients from an acute geriatric unit was reviewed. More than three-quarters of the patients were subject to delayed discharge and the cumulative delay accounted for 24% of the total occupancy of beds by the 100 patients studied. Some delays may be avoided by changes in management procedure at ward level.

Influence of gamma-irradiation and microwaves on the antioxidant property of some essential oils.

The antioxidant property of anise, caraway, cumin and fennel essential oils extracted from untreated, gamma-irradiated and microwaved fruits against sunflower oil oxidative rancidity was evaluated. The fruits were exposed to gamma-irradiation at 10 KGy and to microwaves at low oven power setting for 1 min. The essential oils were added individually (200 ppm) to sunflower oil and the rate of oil oxidation was followed by determining the peroxide value during storage at room temperature. The irradiated and microwaved essential oils exhibited an antioxidant activity and was superior to that of sunflower oil catalysed by a mixture of BHT + BHA (200 ppm) in most cases. The present data show that gamma-irradiation and microwave treatments did not affect the antioxidant property of the essential oils under study. In addition the essential oils extracted from the gamma-irradiated fruits were more effective as an antioxidant in sunflower oil than those produced from microwaved fruits.

Growth and Aflatoxin Production by Aspergillus parasiticus in a Medium Containing Plant Hormones, Herbicides or Insecticides.

The effect of some widely used plant hormones (indol-3-acetic acid and gibberellic acid), herbicides (gramoxone, stomp and treflan) and insecticides (malathion, actellic and guthion) on Aspergillus parasiticus growth and aflatoxin production in a synthetic medium was studied. Addition of indol acetic acid to the medium increased aflatoxin production more than gibberellic acid. Treflan at 5, 10 and 20 ppm levels caused a highly significant stimulatory effect on A. parasiticus growth and aflatoxin production. In contrast, stomp at 10 and 20 ppm produced the reverse effect. Guthion, an insecticide, caused a marked decrease in fungal growth and aflatoxin production. The inhibitory effect of insecticides under study on both fungal growth and aflatoxin production in effectiveness followed the sequence: guthion>actellic>malathion. At the recommended application rate (10 ppm), with the exception of indol acetic acid and treflan, all compounds suppressed mold growth and aflatoxin production.

Antimicrobial Activity of Some Egyptian Spice Essential Oils.

Six spice essential oils (sage, rosemary, caraway, cumin, clove, and thyme) and their basic ingredients were tested for their inhibitory effect against 3 strains of Gram-negative bacteria, 4 strains of Gram-positive bacteria, one acid fast bacterium, and one yeast. Preliminary screening of antimicrobial activity of the essential oils was done using the filter paper disc agar diffusion method. The minimum inhibitory concentration for each essential oil against various micro-organisms was also measured. Very low concentrations (0.25 - 12 mg/ml) of the various essential oils were sufficient to prevent microbial growth. The data show that Gram-positive bacteria were more sensitive to the antimicrobial compounds in spices than Gram-negative. The inhibition zones of different microbial growth produced by various essential oils were similar to those produced by their basic compounds. Thyme and cumin oils possessed very strong antimicrobial activity compared with the other essential oils. There was a relationship between the chemical structures of the most abundant compounds in the essential oils under investigation and the antimicrobial activity.

Comparative Study on the Deterioration of Oils by Microwave and Conventional Heating.

Refined cottonseed oil and hydrogenated palm oil were heated by two methods, conventionally by gas-cooker (deep fat frying) and by microwave energy. Quality assurance methods such as refractive index, color, diene content, acid value, peroxide value, thiobarbituric acid value, iodine value, petroleum ether insoluble oxidized fatty acid content, and degree of polymerization were determined. Exposing the oil samples to various heating times and microwave oven power levels caused some hydrolysis to free fatty acids and accelerated the formation of hydroperoxides and secondary oxidation products. The value from each test increased with both the power settings of the microwave oven and the time of heating. In general, the development of rancidity for refined cottonseed oil heated by microwaves was twice as fast as that produced by conventional heating. Also, the chemical values indicating deterioration for refined cottonseed oil were much higher for refined cottonseed oil than for hydrogenated palm oil in all cases. Gas-liquid chromatographic analysis of fatty acids obtained from the heated oils indicates the occurrence of oxidative degradation and production of short-chain acids.

Safety evaluation of olive phenolic compounds as natural antioxidants.

Free and total polyphenolic compounds were extracted from the fruits and leaves of the Picual cultivar. The safety limits of these compounds were recognized by measuring the activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and the levels of high-density lipoprotein (HDL) cholesterol and total lipids of rat serum. The free and total phenolic compounds (400, 800, and 1600 ppm) and butylated hydroxy toluene (BHT) (200 ppm) were daily ingested for 7 weeks. The administration of olive total and free phenolic compounds at 400 and 800 ppm did not cause any significant changes on ALT and AST activities and serum total lipids. These compounds at 1600 ppm caused significant increase in ALT and AST activities and the content of total lipids. Both olive phenolic compounds were superior to that of BHT in increasing HDL-cholesterol level. Nutritional experiments demonstrated that BHT at 200 ppm caused an enlargement in the kidney and liver of the rat compared with the administration of total and free olive phenolic compounds at 1200 and 1600 ppm. Microscopical examination of kidney and liver tissues of rats administered free and total phenolic compounds at 1200 ppm had the same histological character as that of control rats, while the administration of BHT (200 ppm) and phenolic compounds (1600 ppm) induced severe damage to the tissues of the rat kidney and liver.

Plasma electrolytes in elderly patients taking fixed combination diuretics.

Plasma potassium and sodium concentrations were measured in a group of elderly patients taking maintenance thiazide diuretic therapy alone, with a potassium supplement or in combination with a potassium sparing diuretic. Fixed dose combinations of a thiazide and potassium sparing diuretic did not significantly reduce the prevalence of hypokalaemia and the combination of amiloride-hydrochlorothiazide was associated with a disproportionate number of cases of hyponatraemia. The desirability of the current widespread use of fixed dose combination diuretics over less expensive single agents is questioned.