Overview of injection practices in two governorates in Egypt

OBJECTIVE: To describe the extent and characteristics of injection use and injection providers in Egypt, given that unsafe injections are associated with blood-borne pathogen transmission. METHODS: Household surveys of a population-based sample of residents in the Nile Delta and in Upper Egypt; focus group discussions and in-depth interviews with community target groups, formal and informal medical providers. RESULTS: Of 4197 persons interviewed, 26.2% reported receiving an injection in the past 3 months. Of these, 77% reported it was for therapeutic indications. The age-sex specific prevalence of injections was highest among children 0-2 years of age and among older adults. Women were more likely to report having an injection than men, particularly at the age above 20 years. Overall, respondents reported receiving on average 4.2 injections per year, indicating that up to 281 million injections are provided per year in Egypt. Injection administrators were public and private sector physicians, pharmacists, barbers, doctor assistants, housekeepers, relatives and friends. Injection prescribers were mostly private and public sector physicians. Of the 1101 respondents who received an injection in the past 3 months, 92 (8.4%) reported that the provider did not use a syringe taken from a closed sealed packet. CONCLUSION: The frequency of therapeutic injection use is high in Egypt and may contribute to blood-borne pathogen transmission. The Ministry of Health and Population (MOHP) is developing interventions targeted towards promotion of injection safety and reduction of injection overuse on community basis as part of a comprehensive strategy to prevent blood-borne pathogen transmission in Egypt.     

African trypanosomes activate human fetal brain cells to proliferation and IFN-gamma production

We addressed the host-parasite interplay and the immunopathogenetic events occurring in the central nervous system (CNS) during human African trypanosomiasis. Human first trimester forebrain cells were stimulated with a trypanosome lymphocyte-triggering factor (TLTF) and studied for their immune response as exemplified by cell proliferation and IFN-gamma production. TLTF induced proliferation of human first trimester forebrain cells and IFN-gamma production at the mRNA and protein levels. Astrocytes are the major producers of IFN-gamma in response toTLTE These data illustrated for the first time a direct effect of a parasite factor on human brain cells. TargetingTLTF during the course of the disease may be considered in preventing the deadly neurological complications of human African trypanosomiasis. NeuroReport     

Clinical trials in metastatic prostate cancer – Has there been real progress in the past decade?

Hormone refractory prostate cancer remains a challenge. While only palliative treatment strategies were available for the past several decades, many promising agents have been investigated over the past decade. Of those the taxanes appeared with significant anti-tumor activity and recently, two large randomized controlled trials demonstrated for the first time, a survival and palliative benefit with docetaxel based chemotherapy. In the current era, recurrent disease after local treatment for localized disease is diagnosed long before evidence of systemic disease. With earlier institution of hormonal treatments, patients are becoming "hormone refractory" earlier in the course of their disease with considerable long life expectancy. Hence, there is a greater need than ever for more treatment options for this expanding group of patients. A number of new systemic therapies have recently emerged, based on a deeper understanding of prostate cancer biology. Novel chemotherapeutics such as the epothilones, molecularly targeted therapies against angiogenesis, the proteosome and endothelin receptor antagonists, as well as biological agents such as anti-sense oligonucleotides are being tested as part of the armamentarium. Key to progress in the therapy of this fatal disease is the commitment and timely enrolment of prostate cancer patients in clinical trials.     

A prospective analysis of the time to normalization of serum androgens following 6 months of androgen deprivation therapy in patients on a randomized phase III clinical trial using limited hormonal therapy

PURPOSE: Patients with prostate cancer are treated with neoadjuvant, adjuvant and intermittent therapy with gonadotropin-releasing hormone agonists (GnRH-A). While these are largely successful in decreasing testosterone (T) and dihydroxytestosterone (DHT) to castrate levels, discontinuation of such therapy often results in continued suppression of androgens for variable periods of time. We present the largest published series of patients evaluating the timing of T and DHT increase after cessation of GnRH therapy. MATERIALS AND METHODS: Serial T and DHT measurements were prospectively obtained every 3 months while on GnRH-A then monthly upon discontinuation of GnRH-A. Analysis of time from the second 3-month GnRH-A administration to T and DHT increase was undertaken. RESULTS: A total of 80 evaluable patients had a median time to T 50 ng/dl or greater of 12.9 weeks and a median time to T normalization (212 ng/dl or greater) of 16.6 weeks. Low baseline T was associated with a prolonged time to T 212 ng/dl or greater (p = 0.0086) and a similar trend was seen in patients older than 66 years (p = 0.08). There were 62 evaluable patients with a median of 14.9 weeks to DHT 150 pg/ml or greater. There was no association with Gleason score at diagnosis, on study prostate specific antigen, type of prior definitive therapy, or any prior hormonal therapy and time to increase in circulating androgens. CONCLUSIONS: After 6 months of GnRH-A therapy in these patients, DHT and T levels did not return to normal for a median of 14.9 and 16.6 weeks, respectively.     

Comparison of the outcome of intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia in the first cycle: a report of case series and meta-analysis

To investigate the outcome of intracytoplasmic sperm injection with fresh and cryopreserved-thawed testicular spermatozoa in the first cycle in patients with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), a total of 90 cases, 48 OA and 42 NOA were studied. All patients underwent sperm retrieval by testicular sperm extraction (TESE) while their wives received conventional ovarian hyperstimulation. The hormone levels, testicular histology, the rates of sperm retrieval, fertilization, implantation and pregnancy were analysed and evaluated. This study and other four similar studies were subjected to meta-analysis. Sperm retrieval was successful in 100% OA and 61% NOA. Fresh spermatozoa were used in 87.5% and 92.4% of OA and NOA cases respectively; while cryopreserved-thawed spermatozoa were used in 12.5% and 7.6% of OA and NOA, respectively. The fertilization, implantation and clinical pregnancy rates were 65.5%, 15% and 25% respectively in OA group, and 54.2%, 5% and 23.1% respectively in NOA group. Sperm status (fresh or thawed), male partner's age, female age and male serum follicle-stimulating hormone had no significant effect upon fertilization rate, implantation rate, or pregnancy rate per embryo transfer. The results of meta-analysis indicate that there is no statistically significant difference in clinical pregnancy rates between the two groups. There was a significantly higher fertilization rate among OA patients in all analysed studies (95% CI = 14.29-15.71, d.f. 832, T = 1.96). In conclusion, although the fertilization rate was significantly higher in the OA group in our study and from the given meta-analysis, there were some differences as regards pregnancy rates. Although the overall effect was more or less similar pregnancy rates in both subtypes of azoospermia, this may not be true if non-male infertility variables were controlled for in all studies.     

Serologial screening of human T cell lymphotropic virus I and II (HTLV I/II) in blood banks by immunoblotting and enzyme-immuno assays: to demand or to defeat?

Human T cell lymphotropic virus I and II (HTLV I/II) has been recommended to be screened for blood donors since 1988, and it become a mandatory test to get college of american Pathologists (CAP) accreditation. The present study aimed at investigating the prevalence rate of HTLV I/II among Arab blood donors, to revise whether is its screening mandatory? Thirty-thousand (30,000) Arab donors along two years attending two central hospital blood banks in Jeddah. Antibodies to HTLV I/II have been screened using enzyme immunoassay (E.I.A) and immunoblotting assay (Western blot). Results revealed zero prevalence rate. Based upon this finding, no potential risk of HTLV I/II transmission among blood donors population exist. As screening for HTLV I/II is still mandatory, it could be done on pools of sera rather than on individual serum samples, after standardization of a pooling protocol, to fulfill coast-effectiveness and reduce the coasts by 90-95%.     

Developmental changes in proximal tubule tight junction proteins

We demonstrated previously that neonatal proximal tubules have a lower passive paracellular permeability to chloride ions and higher resistance than that of adult proximal tubules. In addition, administration of thyroid hormone to neonates, before the normal maturational increase in serum thyroid hormone levels, prematurely accelerates the developmental increase in chloride permeability to adult levels. To test the hypothesis that there is a maturational change in tight junction proteins and that thyroid hormone mediates these changes, we examined the two known tight junction proteins present in proximal tubules, occludin and claudin 2. Using immunoblot and immunohistochemistry, we demonstrated that claudin 2 has a 4-fold greater abundance in neonatal proximal tubules than in adult tubules. Occludin, however, has a 4-fold greater expression in adult tubules than in neonatal tubules. Administration of thyroid hormone to neonates did not affect claudin 2 expression, occludin expression, or the transepithelial resistance in rat proximal tubule cells in vitro. In conclusion, there are postnatal maturational changes in tight junction proteins. The factors that cause these maturational changes are unknown but unlikely to be due solely to the maturational increase in thyroid hormone.     

Lichen sclerosus mistaken for child sexual abuse

A 3-year-old girl presented to the primary care clinic at King Abdulaziz Medical City (KAMC) with asymptomatic white discoloration of the vulva of 3 months’ duration. Dysuria, genital itching, and vaginal discharge followed 2 months later. The discharge was yellowish-greenish in color and occasionally associated with blood-tinged staining of the underwear. The mother had noted that the genital skin changes had worsened in the last 2 weeks and that the genital itching and dysuria had become more frequent. There was no history of trauma, behavioral problems, abnormal sexual behaviour, encopresis, or any underlying disease. On questioning the mother, the possibility of sexual abuse could not be ruled out as she reported that the father was drug and alcohol dependent and behaved inappropriately when under the influence of these factors. Because of this possibility, the girl and her parents were referred to the suspected child abuse and neglect (SCAN) team at KAMC for further evaluation. The physician, social worker, and child psychiatrist interviewed the girl, her three older brothers, and the parents separately. The girl and her siblings denied any abnormal touching by an adult. The mother reported that she and the father had been separated for 1 year; however, the couple had been reunited for the last month and were currently living together. The mother linked the appearance of the genital changes to the time the father returned; however, no definite history of sexual abuse was obtained. The father denied any sexual or other abnormal encounter with the child. On examination, the child was well developed and well nourished, cooperative, and showed no abnormal fear of genital or anal examination. Genital examination revealed sharply demarcated, hypopigmented, atrophic plaques symmetrically surrounding the labia majora ( Fig. 1 ). Three sharply demarcated, 0.5 cm, nonpalpable, reddish purpuric macules on the medial aspect of both the labia majora and the base of the clitoris were noted ( Fig. 2 ). Two sharply defined healing erosions were noted on the left side distal to the introitus. The hymenal ring could not be seen, but the hymenal orifice was not dilated. The introitus and the anus appeared normal. Because of the genital findings and the mother's concerns, the possibility of sexual abuse was contemplated. Extensive laboratory testing for sexually transmitted diseases, including syphilis, chlamydia, human immunodeficiency virus, and gonorrhea, were negative. Urine analysis and culture were negative. Routine vaginal culture grew group B β-hemolytic streptococcus, and the patient was treated with amoxicillin-clavulanate orally for 10 days. Due to a lack of evidence of sexual abuse, the SCAN team decided to follow up the child and to investigate further before reporting to the protective agency.

Figure 1 Open in figure viewer PowerPoint Photograph of the vulva showing atrophic, hypopigmented, sharply defined plaques