Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Superproof about Sexual Reproduction and Life Cycle in the Parasitic Generation of Strongyloides stercoralis in Human Host16962010.21608/aeji.2016.9620ENFeleke ErisoDepartment of Biology, Dilla University, Dilla, EthiopiaJournal Article20180724<strong>Background and study aim: </strong><em>Strongyloides stercoralis </em>was believed to have two kinds of life cycles. One of them was an internal parthenogenetic life cycle that constituted the parasitic generation. Some authors also stated that this parasitic generation of the internal life cycle used to reproduce only by protandrogony (i.e., hermaphroditism). The second type of life cycle was the external sexual cycle, interacting among free-living worms that represented the free-living generation in soil. The key objectives of this study were to: verify the type of reproduction in the parasitic generation of <em>S. stercoralis</em>, and demonstrate the complete integrated life cycles of both parasitic and free-living generations of <em>S. stercoralis</em>.<br /> <strong>Patients and Methods:</strong> The major sites of stool sample collection were selected to be the elementary schools (from students) at Dilla District, because <em>S. stercoralis </em>was ascertained to be endemic in this region. The parasitic worms of <em>Strongyloides stercoralis </em>obtained from fresh stools were used to set growth culture of free-living generation of this very species and to find the free-living male and female in copulation from the growth culture. A set of parasitic male & female in copulation isolated from a fresh stool sample of a patient under medical care in a hospital was also included. <br /> <strong>Results: </strong>The male and female worms of <em>S. stercoralis </em>had been isolated from both parasitic and free-living generations while they were in the actual copulation.<br /> <strong>Conclusion: </strong>The method of reproduction in the parasitic generation of <em>S. stercoralis </em>in human host was practically proved to be certainly sexual. This verified conclusion was the first practical achievement in the entire globe by solving the persistent problems (i.e., erroneous concepts of parthenogenesis and protandrogony as the types of reproduction in the parasitic generation of <em>S. stercoralis</em>) that had been misleading and puzzling the minds of the concerned scientists of the world until the establishment of this very achievement. Additionally, this achievement had enabled the investigator to construct the complete integrated life cycles of both parasitic and free-living generations of <em>S. stercoralis</em>.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301The Fibrosis-Cirrhosis Index (FCI) for Staging of Liver Fibrosis in Chronic Hepatitis C715962510.21608/aeji.2016.9625ENYehia YounisHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine,
Benha University,Benha ,EgyptHosam BaiomyHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine,
Benha University,Benha ,Egypt.Ibrahim El-ShawafPathology Department, Faculty of Medicine, Mansoura University,Mansoura,EgyptEbada SaidHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine,
Benha University,Benha ,Egypt.Amr EisaHepatology, Gastroenterology and Infectious Diseases Department, Mansoura Health Insurance
Hospital, Manosura,,Egypt.Journal Article20180724<strong>Background and study aim : </strong>Chronic hepatitis C (CHC) is a major global health problem with its consequences of liver fibrosis and cirrhosis. Liver fibrosis is the main predictor of the progression of chronic hepatitis C, and its assessment can help determine therapy. Several indices are available to predict cirrhosis. The fibrosis – cirrhosis index (FCI) was proposed to be efficient for none invasive staging of liver fibrosis besides being simple and inexpensive. This study is designed to assess the accuracy of the fibrosis-cirrhosis index (FCI) for non-invasive staging of liver fibrosis in patients with chronic hepatitis C compared to the liver biopsy findings.<br /> <strong>Patients and methods: </strong>This study was conducted on 150 chronic hepatitis C patients who attended the Hepatology, Gastroenterology and Infectious Diseases Department at Benha University Hospital and El Mansoura Health-Insurance Hospital. Another group of 30 healthy subjects (with negative hepatitis viral markers) represented the control group.<br /> <strong>Results:</strong> FCI was a relatively sensitive, specific and accurate marker of fibrosis. At a cutoff value of < 0.12, FCI had a NPV of 81.7% for the exclusion of significant fibrosis, while at cutoff value > 0.19 it had a PPV of 82.5% for the diagnosis of advanced fibrosis.<br /> <strong>Conclusion:</strong> FCI is a simple index that integrates ALP, bilirubin, albumin and platelet count for staging fibrosis from absent up to cirrhosis.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Impact of Training Education Program on Improving of Nurses Performance Regarding Infection Control in Endoscopy Unit1628962610.21608/aeji.2016.9626ENAsmaa Abd-ElhamidMedical Surgical Nursing Department, Faculty of Nursing, Fayoum University,Egypt.Mohamed El-khashabTropical medicine Department, Faculty of medicine, Zagazig University,Egypt.Nadia TahaMedical Surgical Nursing Department, Faculty of Nursing, Zagazig University,Egypt.Maha SalehMedical Surgical Nursing Department, Faculty of Nursing, Zagazig University,Egypt.Journal Article20180724<strong>Background and study aim:</strong>Endoscopes are complex and reusable devices. Understanding infection control in the context of endoscopy is important in reducing the transmission of infection. This study aims to evaluate the effect of an educational program on improving nurse's knowledge and practice regarding infection control in endoscopy unit at Zagzig University Hospital.<br /> <strong>Subjects and methods:</strong> A quasi experimental research design was used. The study was conducted in the Endoscopy Unit at Zagazig University Hospitals. The study samples were all available endoscopy nursing staff . First tool was Questionnaire sheet, to assess nurses' knowledge. The second tool was observational checklist to assess nurses' practice.<br /> <strong>Results:</strong>this study revealed that two third of nurses were in the age group of more than 40 years with mean age 42.2 ± 8.4 years and the majority of the sample had more than 10 years experience. There was improvement in total level of nurses'knowledge and practice regarding infection control with highly statistically significant difference between pre- post and pre-follow up program phase as regarding to infection control.<br /> <strong>Conclusion:</strong>The implementation of health educational program had improved nurse's knowledge and practice regarding endoscopy infection.<br /> <strong>Recommendations: </strong>Continuous educational and infection control training programs are recommended in endoscopy units. So incorporation of such interventions apply in all endoscope unite all over Egypt.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Evaluation of Granulocyte Elastase Enzyme in Diagnosis of Spontaneous Bacterial Peritonitis2940962710.21608/aeji.2016.9627ENMohamed Abed El-AzizMetwallyHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University, Benha, EgyptMohammad El-SayedEl-ShewiHepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Benha University, Benha, EgyptJehan HassanSabryClinical and Chemical Pathology Department, Faculty of Medicine, Benha University, Benha, EgyptMahmoud MohammadAbed El MagidHepatology, Gastroenterology and Infectious Diseases Department, Shebein El-Kom Fever Hospital, Shebein El-Kom, EgyptJournal Article20180724<strong>Background and study aim:</strong> The most common infections in decompensated liver cirrhotic ascites patients are cases of spontaneous bacterial peritonitis (SBP), which account for 40%–70% of cases. SBP is a bacterial infection that occurs in absence of an evident intra-abdominal or surgically treatable source of infection.<br /> <strong>Patients and methods:</strong> This study was conducted on 80 patients with liver cirrhosis and ascites; 40 patients of them without SBP (group A) and 40 patients of them with SBP (group B) who were admitted to the Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital in the period between April 2014 and October 2014. Full history taking, clinical examination and laboratory investigation were done. Ascitic fluid analysis was done including detection of granulocyte elastase level.<br /> <strong>Results:</strong> Granulocyte elastase was markedly elevated in group B; mean ascitic fluid GE ELISA (4.1±2.8) comparing with group A (0.8±0.7) and it revealed a high statistically significant association between SBP and GE (P value <0.05). SBP was more common in child C. Fever, hypotension and abdominal pain were more common in SBP group.<br /> <strong>Conclusion:</strong> Granulocyte elastase is increased in cases of SBP, cutoff value of ascitic fluid (GE) for diagnosis of SBP at 0.88 ng/mL had 100% sensitivity, 75% specificity, 80% positive predictive value, 100% negative predictive value and 87.5% accuracy.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Effect of Punica and Silymarin on Hepatotoxicity Induced by Pesticides4147962810.21608/aeji.2016.9628ENRasha Abdel-GhanyDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, EgyptShimaa AnisDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, EgyptAhmed BiheryDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, EgyptWaleed BarakatDepartment of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Egypt
Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabuk University, Kingdom of
Saudi ArabiaJournal Article20180725<strong>Background and Study Aim:</strong> Human beings are exposed to pesticides through consumption of contaminated food or exposure in the occupational environment. These compounds induce hepatotoxicity through generation of reactive oxygen species. There is much evidence indicating that natural substances from medicinal plants possess powerful antioxidant activities. The aim of the present study was to investigate the potential curative effects of punica and silymarin in rats exposed to fenitrothion.<br /> <strong>Materials and methods:</strong> Animals were randomly allocated into one of the following groups (n= 10): (C) control group treated with oral distilled water, 3 ml/kg/day for 42 days, (F4) oral fenitrothion, 10 mg/kg/day for 28 days, (F6) oral fenitrothion, 10 mg/kg/day for 42 days, (Pun) fenitrothion, 10 mg/kg/day for 42 days and oral punica juice 3ml/kg/day for 14 days starting from day 29 of fenitrorthion administration and (Sil) fenitrothion, 10 mg/kg/day for 42 days and oral silymarin, 100 mg/kg/day for 14 days starting from day 29 of fenitrothion administration. Activities of hepatic enzymes including alanine amino-transferase (ALT), aspartate amino-transferase (AST), alkaline phosphatase (ALP) were evaluated. Serum albumin and total bilirubin concentrations were measured. Catalase (CAT) activity, reduced glutathione (GSH) and malondialdhyde (MDA) content in liver were determined. Total phenolic and flavonoids content were assessed in plant samples.<br /> <strong>Results:</strong> Exposure to fenitrothion caused a significant increase in AST, ALT and ALP activities, total bilirubin concentration and a significant decrease in serum albumin. The hepatic antioxidant capacity was significantly lowered in fenitrothion- treated rats as compared to the control group (p<0.05). Treatment with punica or silymarin significantly ameliorated these changes.<br /> <strong>Conclusion:</strong> This study indicated the promising therapeutic potential of punica and silymarin against hepatotoxicity induced by pesticides. These effects could be attributed to their antioxidant properties.Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Different Factors Correlated to Early Rebleeding in Cirrhotic Patients Treated by Variceal Band ligation versus Endoscopic Sclerotherapy4858962910.21608/aeji.2016.9629ENKamal AmerTropical Medicine Department, Faculty of Medicine, Zagazig University, EgyptAmal JoudaTropical Medicine Department, Faculty of Medicine, Zagazig University, EgyptSameh MAbdel MonemTropical Medicine Department, Faculty of Medicine, Zagazig University, EgyptJournal Article20180725<strong>Background and study aim :</strong> Endoscopic treatment has become the principal first-line intervention in patients with bleeding oesophegeal varices, both during the acute event and for long-term therapy to prevent recurrent bleeding. Several clinical considerations affect the prognosis in individual patients including the severity portal hypertension, the location of the bleeding varices, residual hepatic function, the presence of associated systemic disease, and others. Early rebleeding has been shown to be a strong predictor of mortality and recurrent variceal bleeding substantially increases the risk of complications which further contribute to mortality<strong>.</strong> This study aimed to evaluate early rebleeding after different methods of endoscopic intervention and investigate the different parameters of the patient that can be correlated to it.<br /> <strong>Patients and methods: </strong>Hundred and four cirrhotic patients with first attack of variceal bleeding were included in this study. They were randomly allocated to two groups, group I: 52 patients who were managed by endoscopic variceal sclerotherapy and group II: 52 patients who were managed by endoscopic variceal band ligation to control their attack. The patients were followed up for six weeks and all their clinical, laboratory, endoscopic parameters were monitored. The rate of mortality and early rebleeding was measured and correlated to these different patients' parameters<br /> <strong>Results: </strong>There was no significant difference between the two groups as regards rate of early rebleeding (15.4% in group I vs 9.6% in group II P= 0.374). The rate of early rebleeding was significantly correlated to Child's score (r=+0.136 P=0.014), PT (r=+0.35 P<0.001), INR(r=+0.419 P<0.001), grade of OV (r=+0.233 P=0.001), risky signs (r=+0.179 P=0.001), units of blood received (r=+0.387 P<0.001), amount of ethanolamine oleate (r=+0.329 P=0.017) and number of rubber bands used (r= +0.245 P=0.039). Mortality rates showed also no significant difference during the six weeks of follow up ,(19.2% in group I vs 21% in group II P= 0.647), as well as mortality rates in rebleeding cases (37.5% in group I vs 40% in group II P=0.925).<br /> <strong>Conclusion: </strong>The factors that are strongly correlated to rate of early rebleeding after endoscopic management of OV are severely decompensated liver disease, larger OV size and presence of risky signs, use of more blood units during resuscitation, use of large amount of ethanolamine oleate during sclerotherapy and use of more rubber band during banding. Sclerotherapy and band ligation are comparable to each other in most outcomes especially early rebleeding and mortality.<br /> Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Image Case: Gastric Corpus Angiodysplasias in 61 years old Egyptian Man Presented by Dysphagia5959963010.21608/aeji.2016.9630ENMohamad RefaeyDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, EgyptTarik ZaherDepartment of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt0000-0002-3846-0032Journal Article20180725<span>Upper gastrointestinal endoscopy of 61 years old Egyptian man presented by dysphagia revealed : normal esophageal mucosa without masses, ulcers nor stricture; just sliding hiatus hernia. On examination of the stomach there were extensive angiodysplasias of the corpus of the stomach as shown in figures (1) and (2).</span>Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Value of Serum Neopterin Level in Evaluating Ulcerative Colitis Disease Activity6067966010.21608/aeji.2016.9660ENHoda Abd-ElazizEl-HadyDepartments of Internal Medicine, Faculty of Medicine, Zagazig University,EgyptSahar AEl-NemrDepartment of tropical Medicine, Faculty of Medicine, Zagazig University,Egypt.Hanan SamirAhmedDepartment of Clinical Pathology, Faculty of Medicine, Zagazig University,Egypt.Journal Article20180725<strong>Background and study aim:</strong> Ulcerative colitis (UC) is a major type of inflammatory bowel disease (IBD). It is characterized by chronic inflammation of the large bowel occurring in genetically susceptible individuals exposed to environmental factors and typically, has a relapsing–remitting pattern. Neopterin serves as a marker of cellular immune system activation. This study aims to evaluate serum neopterin concentration as being a new biomarker for U.C. disease activity evaluation and to correlate it with some of the other markers of disease activity.<br /> <strong>Patients and methods:</strong> This study included 80 subjects, twenty apparently healthy volunteers as a control group (Group I) that included (13 male and 7 female, mean age ± SD 36.0 ± 12.6 y) and sixty patients with UC disease as a patient group (Group II) that included (46 male and14 female, Mean age ± SD 35.5 ± 9.6 y) Group II was subdevided into 20 patients recently diagnosed as active U.C. disease, 20 patients clinically in relapse and 20 patients clinically in remission. Colonoscope and calculation of Simple Ulcerative Colitis Clinical Activity Index Score (SCCAIS) was done for patients with U.C. Laboratory investigations as complete blood count (CBC), erythrocytic sedimentation rate (ESR), Complete liver and kidney function tests, Prothrombin time (PT), partial thromboplastin (PTT), International Normalizing Ratio (INR) and determination of serum neopterin level were done for all subjects.<br /> <strong>Results:</strong> Serum neopterin level for the U.C. patients was (Mean ± SD= 18.6 ± 5.79, range= 6 – 40) which is highly significant than the control subjects with ( Mean ± SD = 5.9 ± 2.4, Range = 2.7 – 9.8). Serum neopterin concentration was positively correlated with SCCAIS ( r = 0.77 and P-value <0.001) that indicates a high significant relation between serum neopterin level and clinical active U.C. than in those whose disease was in clinical remission. Serum neopterin concentration was positivelycorrelated with ESR, TLC, platelet count and PT (r= 0.71, P-value <0.001), (r= 0.41, P-value <0.001), (r= 0.34, P-value <0.01) (r= 0.28, P-value <0.05) respectively, whereas negatively correlated with Hb. (r= -0.56, P-value = <0.001) and albumin (r= -0.35, P-value <0.01). There was statistically a high significant relation between serum neopterin level and endoscopic disease distribution (P-value <0.001) as serum neopterin level increases with the increasing of the U.C. disease extent.<br /> <strong>Conclusions and Recommendations:</strong> Serum neopterin concentration can be used as a new biomarker for U.C. activity that could reliably distinguish between clinically active and inactive U.C., as well as, it can be a helpful tool in predicting the stage of the disease activity. Moreover, the degree of elevation in serum neopterin concentration may be in part related to location and extent of disease.<br /> <strong> </strong>Zagazig University, Faculty of Medicine, Endemic and Tropical Medicine DepartmentAfro-Egyptian Journal of Infectious and Endemic Diseases2090-76136120160301Value of Protein C and D-Dimer in Predicting Non Hepatocellular Carcinoma Portal Vein Thrombosis in Patients with Liver Cirrhosis6874966910.21608/aeji.2016.9669ENSahar AEl-NemrDepartments of Tropical Medicine, Faculty of Medicine, Zagazig University,EgyptSherief MGalalDepartments of Tropical Medicine, Faculty of Medicine, Zagazig University,Egypt.Hoda Abd-El-AzizEl-HadyDepartment of Internal Medicine, Faculty of Medicine, Zagazig University,Egypt.Naglaa AliKhalifaDepartment of Clinical Pathology, Faculty of Medicine, Zagazig University,Egypt.Journal Article20180725<strong>Background and study aim:</strong> Patients with liver cirrhosis may develop serious changes of coagulation process. Protein C (PC) is synthesized in the liver and considered as the key component of an important natural anticoagulant pathway. D-dimer is a fibrin degradation product that represents an accurate marker of fibrinolytic activity. Advances in imaging techniques have resulted in 5–27% increase in patients with liver cirrhosis being diagnosed with portal vein thrombosis (PVT). The aim of this study was to estimate the value of plasma levels of protein C and D-dimer as predictors for diagnosis of PVT in patients with liver cirrhosis.<br /> <strong>Patients and methods:</strong> This study included one hundred cirrhotic patients who under-went abdominal ultrasound and dynamic contrast enhanced computed tomography (CT) scans. Therefore, they were classified into two groups as following: Group 1: Included twenty six patients (22 males and 4 females, mean age 53.60±7.8 years) with PVT and Group 2: Included seventy four patients (65 males and 9 females, mean age 54.96±6.5 years) without PVT as a control group. Full history taking, complete physical examinations and laboratory investigations including liver function tests, complete blood count, prothrombin time (PT), activated partial thromboplastin time (aPTT), International Normalizing Ratio (INR) and determination the levels of plasma protein C and D-dimer were done for all cirrhotic patients.<br /> <strong>Results:</strong> The levels of D-dimer were significantly higher in cirrhotic patients with PVT than in those patients without PVT, while the level of protein C were significantly lower in cirrhotic patients with PVT than the control group. Also, D-dimer was significantly increased from Child-Pugh class A to C, while PC was significantly progressively decreased. D-dimer cut-off values above 530 ng/L provided high sensitivity and negative predictive value (92.3% and 95.7%, respectively). Also, PC cut-off values below 71.6 % had a high sensitivity and negative predictive value (96.2 and 96.9%, respectively).<br /> <strong>Conclusion:</strong> PVT formation in liver cirrhosis is closely associated with decreased plasma levels of PC, and increased D-dimer. So, they are considered risk factors in PVT formation in patients with liver cirrhosis. So, estimation of plasma levels of protein C and D-dimer are important for early detection of PVT in patients with liver cirrhosis.