Tuberculous peritonitis in Egypt: the value of laparoscopy in diagnosis.

Abdominal laparoscopy was performed on 200 patients with undiagnosed ascites. It was unsuccessful in one patient with tuberculous peritonitis because of extensive adhesions. A presumptive diagnosis of tuberculous peritonitis based on clinical findings and peritoneal tubercles or adhesions visualized during laparoscopy was made in 90 of these patients. The diagnosis was confirmed in 88 by histopathology, bacteriology, or therapeutic response. Two of the 109 remaining patients who had other presumptive diagnoses made during laparoscopy were eventually confirmed to be cases of tuberculous peritonitis. Of 91 patients with tuberculous peritonitis included in this series, 79% were females, with the majority (79%) of them being of child-bearing age. Half had been ill for longer than one month. The most frequent complaints were abdominal pain, fever, anorexia, night sweats, abdominal swelling, and weight loss. Ascites, fever, wasting, pallor, and abdominal tenderness were common findings. Ultrasonography demonstrated ascites in all patients who underwent this procedure; 21% also had adhesions. Pleural effusion was present in 15% and pulmonary tuberculosis was detected in only two patients. Biopsy samples taken during laparoscopy showed that 60% had noncaseous granulomas and 33% had caseous granulomas. Mycobacterium tuberculosis was detected in 77%, with guinea pig inoculation having the highest sensitivity, followed by culture, and lastly by acid-fast smear. Mycobacterium tuberculosis was isolated more easily from biopsy samples than from ascitic fluid. Nine of 20 M. tuberculosis isolates that were identified as to species were M. bovis. Tuberculous peritonitis, a frequent cause of febrile ascites in Egyptian women, was easily diagnosed by histopathologic and bacteriologic studies of biopsy samples taken at laparoscopy. All patients responded rapidly to antituberculosis therapy.     

Effect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty

BackgroundWe hypothesized that NMDA antagonist, amantadine, may be beneficial in reducing the intraoperative anesthetic and analgesic requirements. The aim of this study to evaluate the effect of preoperative oral amantadine on induction doses of propofol, intraoperative anesthetic and analgesic requirements.MethodsIn a prospective, randomized, double-blinded controlled study 60 female patients ASA I or II aged 18–60 years old, planned for abdominoplasty surgery divided into two groups (30 patients each). Group A: received oral amantadine 200 mg on the evening before surgery and 200 mg 60 min prior to surgery. Group P (control group): the patients received placebo capsules. Propofol and isoflurane were titrated guided by BIS during induction and maintenance of anesthesia where the total dose of propofol and the time elapsed between injection of propofol to achieve BIS value 60 were recorded. Also, the inspired isoflurane concentrations required to maintain BIS between 40 and 60 and the total dose of fentanyl needed to maintain adequate analgesia were recorded.ResultsThe induction dose of propofol and the time from propofol injection till BIS value reached 60, the total intraoperative fentanyl requirements and the inspired isoflurane concentration required to maintain BIS reading between 40 and 60 were statistically significant lower in amantadine group compared to placebo treated group. The two groups were similar regarding the occurrence of side effects.ConclusionPreoperative oral amantadine reduced the induction time, induction dose of propofol, intraoperative anesthetic and analgesic requirements compared to placebo without serious side effects in female patients during abdominoplasty.     

Immunogenicity,safety and tolerability of anti-pneumococcal vaccination in systemic lupus erythematosus patients: An evidence-informed and PRISMA compliant systematic review and meta-analysis

The immunological perturbations associated with systemic lupus erythematosus (SLE) put many patients at a higher risk of infections, including pneumococcal pneumonia. However, the uptake and utility of anti-pneumococcal vaccines in SLE patient is both controversial and not completely agreed upon. Indeed, several epidemiological studies of anti-pneumococcal vaccine safety and efficacy in SLE have reported short-term immunogenicity with elevated anti-pneumococcal antibody titres but inconsistent long-term findings, with some studies finding poor responses, mainly for long-term immune protection. Moreover, the safety and efficacy of the pneumococcal vaccine in SLE patients remains controversial due to the different types of anti-pneumococcal vaccines, and the heterogeneity of SLE patients. Several reviews addressing anti-pneumococcal vaccination in SLE patients exist, however, to the best of our knowledge, the present is the first systematic review and meta-analysis. To better understand the efficacy and safety of pneumococcal vaccination in SLE, a comprehensive literature search was performed identifying 18 studies, which have been included in the present systematic review and meta-analysis. All studies were designed as longitudinal investigations, 2, in particular, were of high quality, being randomized, double-blind trials (RCTs). Four studies had control groups. Total sample size included 601 participants. Vaccine immunogenicity in terms of subjects with protective antibody titers ranged from 36% to 97.6%. According to our systematic review and metanalysis, high erythrocyte sedimentation rate (ESR), older age, earlier SLE onset, high disease activity, and immunosuppressive therapy were predictors of poor immunogenicity, although belimumab was found to have no significant impact. With regard to safety, no serious adverse events were found, with up to one third of cases reporting mild/low-grade complaints.In conclusion, due to the high risk of pneumococcal infection in SLE patients and given the safety and, at least partial, effectiveness, according to our systematic review and meta-analysis, in such patients, preventive strategies mainly by immunization, are required in all age groups and, in those needing immunosuppressive therapy, immunization should be given prior the initiation of the treatment.PROSPERO registration code CRD42018103605.     

Glycopolymer Polyelectrolyte Multilayers Composed of Heparin and Maltose‐Modified Poly(ethylene imine) as a Strong/Weak Polyelectrolyte System for Future Drug Delivery Coatings: Influence of pH and Sugar Architecture on Growth of Multilayers and Multilayer Swelling and Stability

Establishing highly sophisticated polymer films for delivery systems in a biological environment and bioanalytical tasks, the formation, thickness, swelling behavior, and (physiological) stability of highly biocompatible polyelectrolyte multilayers (PEMs) are described. These PEMs are composed of the very weak polycation maltose‐modified hyperbranched poly(ethylene imine) (PEI‐Mal) and the strong polyanion heparin sodium salt (HE^?Na⁺) deposited on Si wafer substrates . Two different glyco architectures for PEI‐Mal are used, characterized by two different degrees of maltose decoration on a PEI scaffold. Using two pH‐dependent deposition approaches for optimizing the (physiological) PEM stability and swelling, PEMs are characterized by (in situ) ellipsometry, atomic force microscopy (AFM), and (in situ) attenuated total reflection‐Fourier‐transform infrared (ATR‐FTIR). Thus, PEMs reveal significantly different thicknesses, growth mechanisms (linear versus exponential), and swelling behavior in dependence of both the polycation architectures and the deposition protocol. These PEMs will allow the study of their complexation and release properties as preswollen PEMs against anionic drug molecules, especially under physiological conditions in the future.

     

Inherited Immunoregulatory Dysfunction in Extrinsic Bronchial Asthma

We studied 119 members of 22 asthmatic multiplex families. Included were: 44 parents (seven were asthmatics), 48 asthmatics (23 were undergoing an attack at the time of sampling), and 27 normal siblings. The following investigations were carried out on all subjects: 1) detection of total T lymphocytes, helper cells, and suppressor cells, using monoclonal antibodies (OKT3, OKT4, and OKT8), 2) study of nonspecific T-lymphocyte blast transformation induced by PHA, and 3) HLA-A, B, and DR antigen determination using the microcytotoxicity technique.

The results were compared with normal ranges and data for a normal group and statistically and genetically analyzed. They indicate that: 1) the number of T cells was low in asymptomatic asthmatics and normal in asthmatics in attack; 2) there were fewer helper and normal suppressor cells (that is, a low H:S ratio) in asymptomatic asthmatics, and a normal amount of helper and suppressor cells (a normal H:S ratio) in those experiencing an attack; 3) there was a percentage of lymphocyte transformation in both groups of asthmatics; 4) whereas the T-helper cells increased, there was no change in the number of suppressor cells during an attack, which points to deficient function of suppressor cells; 5) the disorder is inherited and the gene controlling this dysfunction is HLA-linked and probably dominant.     

Studies on pathogenicity of turkey ureaplasma

Turkeys and chickens were experimentally infected with a ureaplasma strain T-1001 isolated from turkey semen. Following infection, sero-fibrinous airsacculitis and serological responses developed in turkeys and chickens of different ages.     

Prevalence of erectile dysfunction and its correlates in Egypt: a community-based study

We evaluated the prevalence of erectile dysfunction (ED) in a cross-sectional community-based random sample of Egyptian men. ED was correlated with the socioeconomic status, risk factors and quality of life. Married men in Ismailia province were interviewed at home. Data were processed for 805 men with mean age of 43.58 y (s.d. 11.03). There is a fair correlation between ED and increasing age (< or = 0.001). Males with complete ED comprised 13.2% of the sample, 26% of men in their 50s, 49% of men in their 60s and 52% of those 70 y or older. The state of better erection correlated fairly with sexual desire and sexual satisfaction (< or = 0.01). ED was associated with living in rural areas and lower socioeconomic level (< or = 0.01), with smoking, diabetes, heart disease, hypertension, liver disease, arthritis, peptic ulcer and renal disease (< or = 0.05). ED was negatively associated with good quality of life (< or = 0.001). These results indicate that ED is a common problem among married Egyptian men.