Cell mediated immune (CMI) responsiveness to soluble egg antigen (SEA) and its relation to the occurrence of schistosomal hepatosplenic disease in patients with schistosomiasis mansoni

The delayed intradermal test and migration inhibition tests were used to assess the delayed hypersensitivity in patients with BHF and simple intestinal bilharziasis using SEA. All bilharzial patients gave a positive intradermal test. The specificity of the intradermal test using SEA is demonstrated clearly by the negative response in all control groups.     

Postplacental Insertion of Levonorgestrel Intrauterine System Versus Copper Intrauterine Device: A Prospective Study

PurposeTo compare between postplacental insertion of levonorgestrel intrauterine system versus copper intrauterine device regarding expulsion rates, patient satisfaction, complications, and continuation rates.MethodsThis prospective observational study was conducted on 1100 participants divided in to two groups: group (1) CU-IUD group and group (2) LNG-IUS group where women were assigned for postplacental insertion of either CU-IUD or LNG-IUS, respectively. Follow-up at 6 weeks, 3 and 6 months postpartum and data were collected and analyzed to evaluate outcomes.ResultsNo statistical difference between both groups regarding patients’ characteristics, the overall expulsion rate was higher in LNS-IUS group than CU-IUD group; 77 patients (14%) and 50 patients (9%), respectively, (P value < 0.05), odds ratio: 1.63 at CI: (1.12–2.37). No significant difference between the two groups regarding pain intensity, perforation, abnormal uterine bleeding, and clinical endometritis (P > 0.05). Overall satisfaction rate at six months was 478(87%) in the CU-IUD group and 472(85.8%) in the LNS-IUS group (P value > 0.05), odds ratio: 1.1 at CI: (0.78–1.55). Continuation rate at s6 months was comparable between the two groups 485 (88.2%) and 480 (87.3%) in CU-IUD group and LNS-IUS group respectively, (P value < 0.05), odds ratio: 1.09 at CI: (0.76–1.56).ConclusionThe rate of expulsion of LNG-IUS is higher than copper IUD when inserted postplacental, yet the continuation and acceptability rates were comparable between the two groups.     

Statistical analysis of referrals by general practitioner at Health Insurance Organization clinics in Alexandria

Referral of patients generates significant economic costs for both physician fees and diagnostic tests. Variation in referral rates between general practices and between individual GPs has long been the focus of attention for policy makers. The present study aimed to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. The study was conducted at 18 Health Insurance Organization (HIO) comprehensive clinics in Alexandria, distributed in the 6 districts of Alexandria HIO. Retrospective analysis of records and cross sectional interview to 180 GPs were carried out. Male GPs comprised 82.2% of the sample. On the average, GPs received 6.6 +/- 4.5 patients per working hour. Over the year 2002, 8.4% of consultations were referred to specialists, 5.4% referred to laboratory and only 0.09% were referred to hospital. The highest percent of referrals from GP to specialist were directed to internal medicine followed by orthopedics, general surgery, E.N.T, dermatology, neuropsychiatry, chest then urology clinics. Referral rate from GPs to specialists was found to have a 6.6-fold variation among clinics, and a 54.8-fold variation among individual GPs. Moreover, there was no homogeneity in variations in referral rates of clinics within 3 of the 6 districts. Using multiple regression analysis, the only significant factor was the indirect relation with workload. Comparison of referral rates of GPs with the limits set by HIO (8-17%) revealed that, 48.9% of GPs were within limits, 37.2% were lower and 13.9% were higher than limits. GPs who had diploma or master were average referrers in 51.5%, low referrers in 30.3% and high referrers in 18.2%, compared to 45.6%, 50.6% and only 3.8%, respectively for those with bachelor degree; the difference was statistically significant.     

Rhinomanometry evaluation of the effects of pre- and post-operative SMR on exercise

Nasal airway resistance due to uncomplicated DNS was examined in 43 patients, and the results compared with those obtained following corrective surgery. The patients were examined independently by the two authors using a strict examination protocol. Rhinomanometry was carried out pre- and post-operatively at rest and after exercise assessing the worst and the better breathing nostrils separately. The results show that both resting and post-exercise nasal resistance was reduced following septal surgery.     

Dermoid cyst in the mouth: value of ultrasound

Teratomas including dermoid cysts occur in approximately 1:4000 births with the incidence in the head and neck varying according to different authors between 1.6 and 6.9 per cent. The case presented is of a 28-year-old Caucasian male in whom a dermoid cyst occurred in the floor of the mouth where ultrasound was found useful in the pre-operative assessment. The role of ultrasound in the pre-operative management of lesions in the head and neck is discussed.     

Necrolytic acral erythema: a variant of necrolytic migratory erythema or a distinct entity?

BACKGROUND: Hepatitis C is a major health problem in Egypt. Necrolytic acral erythema (NAE) is a recently described necrolytic erythema that has a distinctive acral distribution and a uniform association with hepatitis C. Some authors believe that NAE is a distinct entity and others consider it as a variant of necrolytic migratory erythema (NME). METHODS: Five patients with clinical features consistent with NAE were included in this study. The patients were subjected to skin biopsy examination, CT scan of the pancreas and a liver biopsy. Liver function tests, serum glucagon, glucose, amino acids and zinc were measured. All patients were tested for hepatitis C by enzyme-linked immunosorbent assay (ELISA) and by polymerase chain reaction (PCR). RESULTS: Three patients presented with early (acute) lesions and two patients with chronic lesions. The distribution of the lesions was almost exclusively on the dorsae of the feet. Histopathological findings were similar to those of other necrolytic erythemas. Hepatitis C virus was uniformly detected in all patients. Serum glucagon was high in two patients, serum glucose was high in four patients, serum amino acids were low in three cases and serum zinc and albumin were low in two cases. Little or no improvement was reported after oral amino acid supplementation, while the response to oral zinc sulfate was moderate to good. CONCLUSION: Necrolytic acral erythema is closely associated with hepatitis C infection. Many findings indicate that NAE seems to be a variant of NME rather than a distinct entity. Hence, an alternative proposed term could be acral NME.     

Deletion Variants of Middle East Respiratory Syndrome Coronavirus from Humans,Jordan, 2015

We characterized Middle East respiratory syndrome coronaviruses from a hospital outbreak in Jordan in 2015. The viruses from Jordan were highly similar to isolates from Riyadh, Saudi Arabia, except for deletions in open reading frames 4a and 3. Transmissibility and pathogenicity of this strain remains to be determined.     

Febrile ulceronecrotic Mucha–Habermann disease: proposed diagnostic criteria and therapeutic evaluation

Febrile ulceronecrotic Mucha–Habermann disease (FUMHD) is a rare severe variant of pityriasis lichenoides et varioliformis acuta characterized clinically by aggressive ulceronecrotic skin lesions associated with high fever and histologically by features typical of pityriasis lichenoides et varioliformis acuta. Despite the continuous addition of new case reports, no definite diagnostic criteria have been established, and an optimum treatment is still waiting. Herein, we review the different aspects of this rare entity, including pathogenesis, clinical and histopathological features, differential diagnosis, course, prognosis, and outcome. Different diagnostic and therapeutic challenges associated with FUMHD are also evaluated and discussed. We propose two sets of diagnostic criteria to define the disease more precisely and to avoid missing cases. The first comprises constant clinical and histopathological features that are always present in every case, the combination of which is necessary for diagnosis. The second set includes variable features that may be present in some cases and to which any emerging finding could be added. Although different therapeutic options have been used, there is no optimum therapy for FUMHD, and the disease still represents a therapeutic challenge.