Objective The aim of the study was to perform a systematic review to summarize the diagnosis and management of nephrotic syndrome in family practice. Data sources Medline, articles in Medscape, American Family Physician (AAFP), and PubMed were searched. The search was performed on 1 November 2014 and included all articles with no language restrictions. Study selection The initial search yielded 250 articles. Six articles fulfilled the inclusion criteria. The articles included nephrotic syndrome clinical presentation, investigation to confirm the diagnosis, and management in family practice. Data extraction Data from each eligible study were abstracted independently in duplicate using a data collection form to obtain information on study characteristics, interventions, and quantitative results reported for each outcome of interest. Data synthesis There was heterogeneity in the data collected. A meta-analysis could not be carried out. Significant data were collected. Thus, a structured review was performed. Conclusion Six articles were reviewed; five articles and one systematic review summarize the clinical presentation investigation and management. Patients with nephrotic syndrome present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. In adults, diabetes mellitus is the most common secondary cause, and focal segmental glomerulosclerosis and membranous nephropathy are the most common primary causes. Family physicians may encounter patients with nephrotic syndrome because of primary renal disease or a number of secondary causes, and should initiate appropriate diagnostic workup and medical management pending specialist consultation.

Objective This study aimed to detect the prevalence of class 1 integrons among clinical as well as commensal Escherichia coli isolates. To investigate the distribution of class 1 integrons among E. coli isolates from different types of infection and E. coli isolates with different antibiotic susceptibility patterns, and to evaluate the contribution of class 1 integrons toward the dissemination of multidrug resistance (MDR) E. coli, particularly extended-spectrum b-lactamase (ESbL)-producing strains. Background Class 1 integrons play a role in the emergence of multiresistant bacteria by facilitating the recruitment of gene cassettes encoding antibiotic resistance. Many of the most recently ESbL genes are frequently found within integron-like structures. Materials and methods The study was carried out by collecting specimens from 210 patients with nosocomial infection aimed to obtain 80 E. coli clinical isolates (CIs) from Menoufia University Hospitals and 20 E. coli commensals. MDR E. coli including ESbL producers were detected among the studied E. coli using standardized methods. Class 1 integrons (IntI1 gene) and ESbL (SHV, TEM, and CTX-M genes) were detected by PCR. Results Urine, being the most frequent specimen, had E. coli CIs (56.25%), followed by sputum specimens (20%). About 64% of E. coli CIs and 30% of E. coli commensals had class 1 integron. All E. coli CIs and 70% of the E. coli commensals were MDR strains. Using the phenotypic confirmatory combined disk test, 31.1% of E. coli CIs and 5% of E. coli commensals were ESbL producers. In the PCR results, total SHV genes were 70.4% of E. coli CIs and 100% of E. coli commensals. Total TEM were 37% of E. coli CIs and total CTX-M were 29.6% of E. coli CIs. About 41% of the intI1 gene-positive E. coli CIs and 16.7% of the intI1 gene-positive E. coli commensals were ESbL producers. Conclusion The study highlights the prevalence of class 1 integrons in MDR E. coli CIs in our hospitals and E. coli commensal isolates. Fair agreement was found between the presence of class 1 integrons and ESbL production in E. coli CIs. A restrictive antibiotic subscription policy is needed to avoid increased selection pressure where integrons play a potentially significant role in the uptake and dissemination of resistance genes.

Objective The aim of the study was to investigate the effect of soluble Fas (sFas) on patients with chronic hepatitis C. Background Programmed cell death has been observed in leukocytes among patients with chronic Hepatitis C and hepatocellular carcinoma (HCC), and now there is a strong trend to use sFas as a predictive marker for chronic hepatitis C and tumorigenesis in HCC. Methods Seventy patients were divided into three groups. Group I included 30 patients with chronic hepatitis C infection due to hepatitis C virus (HCV) (cirrhotic and noncirrhotic). Group II included 20 patients with HCC with HCV infection. Group III included 20 healthy individuals without hepatitis C infection or any other disease, which served as the control group. Liver function tests, complete blood count, analysis of viral markers, analysis of HCV-RNA by PCR, and evaluation of serum sFas by enzyme-linked immunosorbent assay were carried out. Results Serum sFas level increases in chronic hepatitis C and HCC, with positive correlation between sFas and aspartate aminotransferase, alanine aminotransferase, total bilirubin, and direct bilirubin and negative correlation between sFas and Hb level, platelet count, serum albumin, prothrombin time, and viral load (PCR). sFas at cutoff of 6581.12 could predict patients with HCV with 83.3% sensitivity and 65% specificity. sFas at cutoff of 6960.91 could predict patients with HCC with 85% sensitivity and 30% specificity. sFas at cutoff of 9125.99 could discriminate between cirrhotic and noncirrhotic HCV patients with 80.0% sensitivity and 53.3% specificity. Conclusion sFas can be considered a predictive marker for chronic hepatitis C and tumorigenesis in HCC.

Objectives This study aimed to investigate the resistance patterns of nosocomial and community-acquired Staphylococcus aureus and coagulase-negative staphylococci (CoNS) and screen methicillin-resistant and vancomycin-resistant isolates by phenotypic and genotypic methods. It also aimed to determine the biofilm-forming capacity and detect icaA and icaD genes responsible for polysaccharide intercellular adhesion synthesis and analyze the association between the biofilm-forming capacity of staphylococcal isolates and their multidrug resistance patterns. Background Biofilms have dramatically increased resistance to antibiotics. The genes and products of ica locus [icaR (regulatory) and icaADBC (biosynthetic) genes] have been demonstrated to be necessary for biofilm formation and virulence. Materials and methods The study was carried out on specimens collected from Menoufia University Hospitals. Isolation, identification, and antimicrobial susceptibility of staphylococcal isolates were carried out using standardized microbiological methods. Phenotypic biofilm detection was carried out by microtiter plate adherence assay, the Congo red agar method, and the modified Congo red agar method. All clinical isolates (CIs) of S. aureus and CoNS demonstrating reduced susceptibility to methicillin and vancomycin and showing the ability to form biofilm were tested for the presence of methicillin-resistant gene (mecA), vancomycin-resistant genotypes (vanA and vanB), and biofilm-producing genes (icaA and icaD) by means of multiplex PCR. Results About 82.4% of S. aureus isolates were methicillin-resistant S. aureus, whereas only 76.5% of them were positive for the mecA gene. VanA-positive gene was detected in 10.3% of S. aureus isolates. Regarding CoNS isolates, 76.9% were negative for the mecA gene and 78.8% were methicillin-resistant coagulase-negative staphylococci. About 10% were positive for the vanA genes in CoNS isolates. Biofilm formation was detected in 45.6 and 41.2% of S. aureus and in 76.9 and 55.8% of CoNS isolates, as detected by microtiter plate and Congo red agar, respectively. Ica genes were detected in 38.2% of S. aureus CIs and in 63.5% of CoNS CIs. Conclusion The biofilm-forming ability of staphylococcal isolates correlated with clinical significance and drug resistance. Biofilm-forming ability in the absence of icaA and icaD genes highlights the importance of further genetic investigations of ica- independent biofilm formation mechanisms.

Objectives The aim of the study was to determine the incidence of carbapenem resistance among Klebsiella pneumoniae isolates in Menoufia University Hospitals and detect the production of Klebsiella pneumoniae carbapenemases (KPCs) and metallo-b-lactamases (MbLs) using phenotypic and molecular methods and correlate their presence with in-vitro susceptibility to carbapenems. Background Carbapenem-hydrolyzing b-lactamases are the most powerful b-lactamases. KPCs and MbLs are able to hydrolyze carbapenems, which cause resistance to multiple classes of antibiotics. Materials and methods The study was conducted on 128 K. pneumoniae isolates. Carbapenemase production was detected by antibiotic susceptibility testing against imipenem (IPM), meropenem, and ertapenem and by IPM minimal inhibitory concentration assays. Results were confirmed by the modified Hodge test, the phenylboronic acid combined disk (PBA-CD) test, and the IPM/EDTA combined disk (IPM/EDTA-CD) test. Detection of carbapenemase genes (blaKPC, blaVIM, and blaIMP) was performed by multiplex PCR. Results Eighty K. pneumoniae isolates were reported as IPM resistant. Class A carbapenemases (KPCs) were detected in 35% of IPM-resistant K. pneumoniae by the PBA-CD test. Class B carbapenemases (MbLs) were detected in 48.8% of IPM-resistant K. pneumoniae by the IPM/EDTA-CD test. Age, long hospital stay, invasive procedures, and history of drug intake (carbapenem) were high-risk factors for IPM-resistant K. pneumoniae. Among IPM-resistant isolates, 17.5% were positive for the blaKPC gene and 43.75% were positive for the blaVIM and blaIMP genes. In relation to PCR, the sensitivity and specificity of the PBA-CD test were 85.7 and 75.8%, respectively, whereas for the IPM/EDTA-CD test sensitivity and specificity were 94.3 and 86.7%, respectively. Conclusion Laboratory identification of carbapenemase-harboring clinical isolates is necessary for implementing contact precautions, for outbreak detection, and for proper choice of effective therapy. Phenotypic and molecular-based techniques identify carbapenemase producers with variable efficiencies.

Objective The aim of this study was to evaluate a method for rapid and direct detection of methicillin-resistant Staphylococcus aureus (MRSA), allowing clinicians to make prompt decisions for the management of patients with staphylococcal bacteremia. Background The prevalence of methicillin resistance in nosocomial staphylococci has increased in the past decade. There has also been a recent increase in community-acquired MRSA infections in patients without apparent recognized risk factors. Patients and Methods In this work, blood culture was performed for all cases for isolation of the causative organisms. Staphylococcal isolates were then identified by standard methods including Gram stain, catalase, and bacitracin susceptibility tests. This was followed by testing the staphylococcal isolates with oxacillin using the disc diffusion method. All positive blood cultures were subjected to a multiplex PCR assay targeting 16S rRNA, nuc, and mecA genes. Results Our results showed that blood cultures were positive for 85% of the patients. Staphylococci accounted for 58.8% of the positive cases. In total, 52% of the isolated staphylococci were S. aureus and 48% were coagulase-negative staphylococci (CoNS). 76.9% of S. aureus isolates were MRSA; 23.1% were methicillin-sensitive S. aureus. 91.7% of CoNS isolates were methicillin-resistant CoNS and 8.3% were methicillin-sensitive CoNS. The sensitivity and specificity of the oxacillin disk diffusion method in relation to mecA PCR were 95.2% and 87.5%. The total time required to perform the multiplex PCR assay directly from positive blood cultures was 3 h. Conclusion Current standard laboratory methods for detection of oxacillin resistance require at least 48–72 h for isolation, identification, and susceptibility testing. The multiplex PCR assay is a rapid, sensitive, and specific method for the detection of MRSA colonies and MRSA-positive blood culture bottles.

Objectives The aim of this study was to detect a relation between serum levels of interleukin-22 (IL-22) in patients with psoriasis and also to detect a relation of IL-22 with psoriasis area and severity index (PASI). Background IL-22 is highly expressed in several different chronic inflammatory conditions, including psoriasis, inflammatory bowel disease, and rheumatoid arthritis. The best studied function for IL-22 is within the skin, as it has an inflammatory role during skin inflammation. Materials and methods The study was conducted on 40 patients with psoriasis and 20 age-matched and sex-matched healthy individuals. All patients were subjected to history taking and complete medical examination. Serum levels of IL-22 were measured by enzyme-linked immunosorbent assay technique. Serum levels of IL-22 were statistically analyzed in relation to PASI. Results The serum levels of IL-22 were highly elevated in patients with psoriasis compared with healthy people (P < 0.001). The serum IL-22 was significantly higher in patients with severe psoriasis as compared with those with mild and moderate psoriasis. The serum levels of IL-22 were significantly higher in patients with psoriasis experiencing itching as compared with those not experiencing itching (P < 0.001). There was no statistically significant difference between the serum levels of IL-22 and smoking. Conclusion The significant elevation in the serum level of IL-22 in patients with psoriasis when compared with that of healthy controls and the significant elevation in the serum levels of IL-22 with advanced PASI score are suggestive of IL-22 playing a fundamental role in pathogenesis of psoriasis.

Objective The aim of this study was to assess the expression level of microRNA-122 (miRNA-122) in the serum as a diagnostic marker of liver injury in chronic hepatitis C, liver cirrhosis, and hepatocellular carcinoma (HCC). Background MicroRNAs are small RNA molecules including the liver specific, miRNA-122, which acts as a critical regulator of hepatic gene expression and an essential factor for hepatitis C virus (HCV) replication. Patients and methods A total of 112 participants who were divided into four groups were included in the study. Group I included 27 patients with chronic hepatitis C infection. Group II included 27 patients with HCC. Group III included 30 patients with chronic liver cirrhosis. Group IV included 18 healthy individuals without hepatitis C infection or any other disease who served as a control group. Liver function tests, α-fetoprotein, complete blood count, hepatitis C antibody, hepatitis B surface antigen, HCV-RNA using PCR, and detection of miRNA-122 in the serum using real-time PCR were carried out for all groups. Results The expression level of serum miRNA-122 displayed a significant fold increase in serum miRNA-122 in the HCV group compared with the other groups (P ≤ 0.0001). Patients with HCC showed a nonsignificantly higher expression level of miRNA-122 as compared with controls. miRNA-122 fold change at cutoff less than 1.64 could predict patients with HCC with 81.4% sensitivity and 48% specificity. Conclusion Measurements of serum miRNA-122 may be useful in the evaluation of HCV patients, by permitting with a serum test, the diagnosis of HCC with high predictivity and sensitivity.

Objectives The objectives of the study were to determine the prevalence of multidrug-resistant Enterobacteriaceae spp. isolated from different ICUs at Menoufia University hospitals; to detect the presence of extended-spectrum β-lactamases (ESβLs), AmpC β-lactamases, and carbapenemases among the isolated pathogens by using phenotypic methods; and to investigate the presence of bla_KPCand bla_NDMresistance genes using real-time PCR. Background ESβL producers are associated with increased morbidity and mortality, especially among patients in ICUs. Carbapenemases are diverse enzymes that vary in the ability to hydrolyze carbapenems and other β-lactams. Materials and methods This study involved 270 clinical specimens from 160 patients. ESβL production was detected by resistance to third-generation cephalosporins and aztreonam and confirmed by combined disk test. AmpC production was detected by cefoxitin disk test and confirmed by AmpC disk test. Carbapenemases were detected by resistance to imipenem, meropenem, and ertapenem, and then confirmed by modified Hodge test, phenylboronic acid combined disk (PBA-CD) test, and imipenem/EDTA combined disk (IPM/EDTA-CD) test. Carbapenemase gene (bla_KPCand bla_NDM) detection was performed by real-time PCR. Results In all, 52.89% of Enterobacteriaceae isolates were extreme drug resistant, 26.45% were pandrug resistant, and 14.88% were multidrug resistant. Carbapenem resistance was 60.33% for imipenem, 65.29% for meropenem, and 85.95% for ertapenem. Risk factors associated with ICUs were ICU stay greater than and equal to 14 days, exposure to invasive procedures, and comorbid conditions. ESβL production occurred in 41.32% and AmpC occurred in 32.23% of Enterobacteriaceae spp. Carbapenemase production was detected in 69.86%; Klebsiella pneumoniae carbapenemase (KPC) was detected in 60.27%; and metallo-β-lactamase was detected in 75.34%. bla_KPC gene was detected in 26.03% of imipenem-resistant Enterobacteriaceae spp., whereas bla_NDMgene was not detected in all tested isolates. Conclusion Surveys of the prevalence, antibacterial susceptibility patterns, and identification of resistance patterns of bacterial isolates are important for determining appropriate empirical therapy for infections in critically ill patients.

Objectives The objective of this study was to assess the rate of bacteremia, the most common bacteria, its antibiotic sensitivity pattern, and the role of immunity in its occurrence in diabetic patients. Background Bacteremia constitutes the most severe end of the spectrum of frequent community-acquired infections, and the prevalence, and thus disease burden, of bacteremia has increased during the past decades analogous with diabetes. Materials and methods A total of 160 individuals (93 male and 67 female with a mean age of 48.0 ± 9.7 years) were divided into the following groups: 60 diabetics with infections (group I), 70 nondiabetics with infections (group II), and 30 apparently healthy persons as controls; the studied groups were subjected to full medical history, clinical examination, and bacteriological examination of blood, antibiotic sensitivity pattern for the isolated microorganisms, measurement of serum IgM, IgG by radioimmunodiffusion, and T lymphocyte level by flow cytometry. Results The rate of bacteremia in group I was significantly higher than in group II (P = 0.007), the level of IgM and CD3 in group I was significantly higher than in group II (P = 0.003), and total leucocytic count in group I was significantly higher than in group II (P < 0.001). Staphylococcus aureus was the most common organism isolated form blood of diabetic patients, and 90.9% of them were sensitive to amikacin, followed by imipenem, vancomycin, and ceftriaxone (81.8%). Conclusion Diabetes increases the risk of exposure to bacteremia and affects the immune response to bacteremia.

Objectives The aims of this study were as follows: to determine the incidence of multidrug-resistant Enterobacteriaceae isolated from the urine of patients admitted in different departments at Menoufia University Hospitals; to detect the presence of extended spectrum β-lactamases (ESβLs), AmpC β-lactamases, and carbapenemases among the isolated pathogens using phenotypic methods; and to investigate the presence of bla KPC and bla NDM genes using real-time PCR. Background Urinary tract infections are the most common type of nosocomial infections. ESβLs and AmpC β-lactamases are clinically significant because they may confer resistance to multiple classes of antibiotics. Carbapenemases are diverse enzymes that vary in the ability to hydrolyze carbapenems and other β-lactams. Materials and methods This study included 260 urine samples collected from 260 patients. ESβL production was detected on the basis of resistance to third-generation cephalosporins and aztreonam and then confirmed using the combined disk test. AmpC production was detected using the cefoxitin disk test and confirmed using the AmpC disk test. Carbapenemases were detected on the basis of resistance to imipenem, meropenem, and ertapenem, and then confirmed using the modified Hodge test, the phenylboronic acid combined disk test, and the imipenem/EDTA combined disk test. Carbapenemase gene (bla KPC and bla NDM) detection was performed using real-time PCR. Results Carbapenem resistance was 42.5% to ertapenem, 40.8% to meropenem, and 45% to imipenem. Risk factors associated with Hospital aquired infection were hospital stay of 14 days or more, exposure to invasive procedures, and comorbid conditions. ESβL production occurred in 55.8% and AmpC occurred in 30.8% of Enterobacteriaceae spp. Carbapenemase production was detected in 87%, Klebsiella pneumoniae carbapenemase (KPC) was detected in 37%, metallo-β-lactamase was detected in 54%, and bla KPCgene was detected in 24% of imipenem-resistant Enterobacteriaceae spp. However, bla NDM gene was not detected in all tested isolates. Conclusion Surveys of the prevalence, antibacterial susceptibility patterns, and identification of resistance patterns of bacterial isolates are important for determining appropriate empirical therapy for infections in critically ill patients.

Objectives To study the experimental induction of Sarcocystis spp. infection in rats and to identify the Sarcocystis spp. through parasitological, histopathological, and electron microscopic studies. Background Sarcocystis spp. is an obligatory intracellular parasite of humans and animals. The genus Sarcocystis comprises about 130 species with differences in their life cycle and pathogenicity and represents important members of the cyst-forming coccidian. Materials and methods Macroscopic sarcocysts were isolated manually from 80 selected buffaloes that were slaughtered in Sirs Ellian City, Menoufia Governorate. The extracted sarcocysts samples were used to infect rats and were also preserved and prepared for species identification by histopathological and electron microscopic studies. Sixty rats were classified into six groups, with 10 rats/group (one control not infected and five infected groups), according to the date they were killed. Every rat was infected by feeding on 10 g of sarcocysts containing about 20 visible intact sarcocysts. Stool examination every day until the time they were killed and histopathological and electron microscopic studies for intestinal tissue specimens were performed. Results Histological and electron microscopic identification of sarcocyst specimens extracted from infected buffaloes revealed Sarcocystis fusiformis(thick wall 3.5 μm and cauliflower villar protrusions). A parasitological study of the infected rats' stools revealed excretion of Sarcocystis sporocysts (measuring 9–11 × 7 μm) in 40% of the infected rats at 1 week postinfection (group IV), in 60% at 2 weeks postinfection (group V), and continuous shedding of sporulated oocysts occurred in 40% of the rats at 1 month postinfection (group VI). Histopathological and transmission electron microscope examination of the infected rats' intestinal tissues revealed dividing oocysts (16 × 12.5 μm) with two sporocysts (11 × 7 μm) in the lamina propria of the small intestine in group V. Conclusion Rats could be considered as an experimental definitive host for S. fusiformis and could play a role in Sarcocystis spp. transmission to domestic animals.

Objectives The objective of this study was to study the histopathological changes in different tissues in experimentally Trypanosoma evansi-infected mice. Background There is variation in the pathogenicity of different host species. Animals that are subjected to stress, malnutrition, pregnancy, or work are more susceptible to this disease. The pathogenesis of T. evansi is complex and the cause of death is still somewhat obscure. Materials and methods The T. evansi isolate used in the present study was obtained from the blood of naturally infected camels. The strain was maintained in mice, where their infected blood was used for inducing the experimental infection. Giemsa-stained blood films were prepared for detection of infection and estimation of parasitemia. A total of 64 mice were divided into two main groups as follows: group I (the infected group), which included 40 mice inoculated with T. evansi strain, and group II (the control group), which included 24 mice used as uninfected healthy controls. Results In the present study, trypanosomes were observed using wet blood films and Giemsa-stained blood films at 48 h after infection in infected mice (group I) and there was high parasitemia on approximately the fifth day after infection (subgroup I-b). Mice from the uninfected control group (II) remained negative for trypanosomes until their death. Gross examination of various tissues from the infected mouse subgroups (infected group I) revealed splenomegaly, hepatomegaly, and marked congestion of lungs. All degrees of inflammation were detected in these tissues. Moreover, most of the examined tissues showed trypanosomes. It was noted that these pathological changes were more obvious in subgroup I-b when the parasitemia had reached its peak. Conclusion Microscopic examination showed significant histopathological changes in different organs, and in most examined tissues the parasites were detected in high numbers, especially in subgroup I-b (on the fifth day).

Objectives This article aims to evaluate the role of lactoglobulin-specific IgE and lactalbumin-specific IgE in cow milk allergy. Background Allergy to cow milk is the most common food allergy in infants and young children. Symptoms of milk allergy reaction can range from mild symptoms such as hives, to severe symptoms, such as anaphylaxis. The allergy is most likely to persist in children who have high levels of cow milk antibodies in their blood. The aim of this study is to assess the value of lactalbumin-specific IgE and lactoglobulin-specific IgE in the diagnosis of cow milk protein allergy. Participants and methods This study was carried out on 70 participants classified into the following groups: group 1: it included 50 infants with suspected cow milk protein allergy, who were diagnosed with chronic diarrhea with a history of recent introduction of cow milk and a positive elimination test. Group 2: it included 20 age-matched and sex-matched apparently healthy participants. Their ages ranged between 8 and 18 months. All individuals included in this study were subjected to full history taking, clinical examination, complete blood count, and determination of serum total IgE, lactoglobulin-specific and lactalbumin-specific IgE which was carried out using the enzyme-linked immunosorbent assay technique. Results The diagnostic accuracy of lactoglobulin IgE in the diagnosis of cow milk protein allergy was 84%, with sensitivity of 78%, specificity of 100%, positive predictive value of 100%, and a negative predictive value of 65% at the cutoff point of 0.345 IU/ml. The diagnostic accuracy of lactoalbumin IgE in the diagnosis of cow milk protein allergy was 83%, with sensitivity of 84%, specificity of 80%, positive predictive value of 91%, and negative predictive value of 67% at the cutoff point of 0.335 IU/ml. Conclusion Lactalbumin-specific and lactoglobulin-specific IgE assays are important in the diagnosis of cow milk protein allergy and their combination may give better diagnostic accuracy than the total IgE assay.

Objectives To compare different levels of amino acid and acyl carnitine profiles to give an insight about metabolic pathways in cholestasis and biliary atresia (BA) in pediatric patients compared with controls. Background Early detection is the most effective way to improve the clinical outcome of BA. Emerging metabolomics such as amino acid and acyl carnitine provide a powerful platform for discovering new biomarkers and biochemical pathways to improve early diagnosis. Participants and methods This study includes 35 BA patients, 35 patients with neonatal cholestasis (NC) rather than BA, and 35 healthy controls. Liver function tests, abdominal ultrasound, and liver biopsy were performed on all participants. The amino acid and acyl carnitine profile using high-performance liquid chromatography tandem mass spectrometry (LC-MS/MS) was performed. Results Data revealed a statistically significant increase in methionine, glutamate, and citrulline (P < 0.001, P < 0.001 and P = 0.02, and P < 0.001, respectively) and a decrease in the branched-chain amino acid and fisher ratio (P = 0.02 and 0.001 and P = 0.001, respectively) in both the studied patient groups compared with the control group; there was also an increase in ornithine (P = 0.04) and a decrease in glycine (P = 0.04) amino acid in the BA group compared with the control group and an increase in arginine (P = 0.004) and aromatic amino acids (P = 0.001) and a decrease in the simplified fisher ratio (P < 0.001) in the non-BA group compared with the control group. Results also indicated a statistically significant increase in both patient groups compared with the control group regarding free carnitine (P < 0.001) and almost all studied acyl carnitines, whereas there was a significant decrease in the fisher ratio (P = 0.005) and the simplified fisher ratio (P = 0.004) and a significant increase in butyryl carnitine (C4) (P = 0.004) and octadecanoyl carnitine (C18) (P = 0.006) in the non-BA group compared with the BA group. Conclusion There is a common metabolic pathway for both BA and other causes of NC; however, there is a metabolic profile shift of amino acid and acyl carnitine in BA from other causes of NC detected by LC-MS/MS. This metabolic shift can be potentially developed into a useful diagnostic tool and can contribute towards understanding the disease mechanism.

Objectives The present work was designed to investigate whether vitamin D status has a relationship with the pulmonary function test results of asthmatics and assess the impact of vitamin D on interleukin-10 (IL-10). Background The incidence of bronchial asthma and other allergic disorders has increased over the past decades in nearly all nations. Many studies have suggested the role of vitamin D deficiency in both T-helper-1 and T-helper-2 diseases. Asthma is characterized by a shift toward a Th2 cytokine-like disease, either as overexpression of Th2 or as underexpression of Th1; however, the association between vitamin D, IL-10, and asthma remains uncertain. In this study, the associations of vitamin D level and IL-10 with asthma were evaluated. Patients and methods This study was conducted on 75 adult participants, aged 18 years or above, who were divided into three groups. Group I consisted of 25 adults with bronchial asthma who were treated with a classic regimen; group II consisted of another 25 adults with bronchial asthma who were treated with a combination of classic regimen and vitamin D supplementation at a dose of 2000 IU (50 mg) for 3 months; and group III consisted of 25 adults who served as controls. All patients were assessed at the beginning of the study (groups Ia, IIa, and IIIa) and at the end of 3 months (groups Ib, IIb, and IIIb). Results There was an inverse relationship between BMI in asthmatic patients and vitamin D level. Vitamin D level had direct and significant correlations with both IL-10 (r₁ = 0.206,P≤ 0.001) and predicted forced expiratory volume in 1 s (FEV₁) (r₂ = 0.083,P≤ 0.001). There were significant associations between vitamin D level and the number of hospitalizations or unscheduled visits (P < 0.05). Conclusion These results showed that serum 25-hydroxy vitamin D levels were deficient in asthmatics, and there was a direct and significant relationship between vitamin D levels, IL-10, and pulmonary function test outcomes in asthmatic patients.

Objective The aim of this study was to investigate plasma amino acid profile as a possible diagnostic/prognostic method in patients with hepatocellular carcinoma. Background Many previous reports have shown that metabolism is notably altered in cancer cells. Thus, various methods for cancer diagnosis and prognosis have been developed based on metabolite analysis. Among whole metabolites, amino acids were proposed as suitable candidates for focused metabolomics as they are either ingested or synthesized endogenously and they play an essential physiological role both as basic metabolites and metabolic regulators. Patients and methods This study included 71 hepatocellular carcinoma patients (60 male and 11 female) and 30 chronic hepatitis C virus patients (20 male and 10 female) in addition to 30 healthy controls (25 male and 5 female). Laboratory investigations including complete blood picture, liver function tests, serum α-fetoprotein, hepatitis viral markers (HBsAg and anti-HCVAb) were carried out for all participants. Amino acid assay was carried out using ultra performance liquid chromatography–electrospray ionization-mass spectrometry. Results The study showed a statistically significant increase in methionine, tyrosine, ornithine, citrulline, glycine, phenylalanine, alanine, glutamate, proline, and arginine and a decrease in valine, aspartate, leucine/isoleucine, branched tyrosine ratio (BTR), and Fischer's ratio in hepatocellular carcinoma compared with the control group. Moreover, the study indicated that there was a statistically significant correlation between BTR and platelets, alanine transaminase, albumin, bilirubin, and α-fetoprotein and significant differences in BTR among Child-Pugh A, B, and C. Conclusion Our results suggested that the plasma free amino acid profile is considered valuable for diagnosis and nutritional care in cancer patients. Furthermore, BTR reflects the pathological liver background with a high degree of correlation with other liver functional markers.

Objectives The objective of this study was to assess the usefulness of relative quantification of endothelin-1 (ET-1) in peripheral blood mononuclear cells in diabetic retinopathy (DR). Background DR is one of the most serious complications of diabetes mellitus (DM) that can lead to blindness. Alterations in activity of the ET system are believed to underlie the development of chronic complications of type 2 diabetes mellitus (T2DM). Patients and methods This is a clinical study carried out at Medical Biochemistry and Ophthalmology Departments. It included 50 patients divided into three groups: group I (included 14 diabetics without DR), group II (included 26 diabetics with DR), and group III (included 10 normal healthy controls). All studied patients were subjected to full history taking, clinical and ophthalmological examination, and laboratory investigations including fasting blood glucose, glycated hemoglobin (HbA1c), lipid profile, serum creatinine, urinary albumin, and creatinine and ET-1 mRNA level in peripheral blood mononuclear cells using real-time quantitative reverse transcription PCR. Results The mRNA level of ET-1 was significantly higher in diabetics with DR than those without retinopathy and was higher in diabetics than in controls. In diabetics with DR, the blood mRNA level of ET-1 was significantly higher in patients with proliferative diabetic retinopathy than in those with nonproliferative diabetic retinopathy. Increased expression of ET-1 mRNA was associated with severity of DR, duration of DM, insulin therapy, and serum creatinine level. Decreased expression of ET-1 mRNA was associated with sulfonylureas treatment. Expression of ET-1 mRNA was not affected by age, sex, BMI, smoking, and control of blood sugar. Conclusion Expression of ET-1 is associated with severity of DR in T2DM. Expression of ET-1 is positively correlated with duration of DM, serum creatinine, and urinary albumin. A larger study is needed to confirm the role of ET-1 mRNA determination in the progression of retinal changes in patients with T2DM.

Objective The aim of this study was to assess the differential expression of survivin gene in tumorous versus nontumorous liver tissue of hepatocellular carcinoma (HCC) patients and determine the possible influence of survivin gene polymorphism −31G/C and +9809T/C on its expression and its association with the risk for HCC in Egyptian patients. Background Mechanisms of hepatic carcinogenesis are not completely understood, but HCC development and progression could be attributed to accumulated genetic alterations as other malignancies. Survivin has functional involvement in apoptosis and proliferation, and is upregulated in malignancy. It attracts considerable interest as a potential diagnostic, prognostic tumor marker and a new target for cancer treatment. Patients and methods This study was performed on 30 HCC patients and 30 unrelated apparently healthy individuals who served as a control group. Genotyping of survivin gene at −31G/C and +9809T/C was performed for HCC cases and controls using TaqMan allelic discrimination Assay. Real-time PCR was performed for survivin mRNA in paired tumorous and nontumorous liver tissue specimens of the HCC patients. Results No significant difference was found between HCC patients and controls as regards different genotypes and alleles of survivin −31G/C and +9809T/C polymorphism. Moreover, none of these genotypes and alleles was associated with risk for HCC. Survivin mRNA was expressed in all tumorous and nontumorous tissue specimens in HCC cases and its expression was significantly higher in tumorous tissues compared with nontumorous tissues by 13 folds. Survivin expression in tumorous tissue was significantly increased with high α-fetoprotein, larger size of the tumor, vascular invasion, absence of cirrhosis, recurrence within 1 year, and low survival rate. The advanced stage of the tumor was the independent variable for survivin expression (P < 0.05). Conclusion Genetic variations of survivin gene had no effect on the susceptibility to HCC in Egyptian patients. Survivin was significantly overexpressed in HCC cases with advanced tumor stage.

Objective The aim of this study was to evaluate the role of microRNA-21 and Phosphatase and Tensin Homolog (PTEN) in hepatocellular carcinoma (HCC). Background MicroRNAs are conserved, small (20–25) nucleotides, noncoding RNAs that negatively regulate the expression of mRNAs at the post-transcriptional level. MicroRNA signature is altered in different disease states, including cancer, and some microRNAs act as oncogenes or tumor suppressors. Materials and methods To identify the causal role of microRNA-21/PTEN in HCC, 30 newly diagnosed HCC cases of different stages, 20 hepatitis C virus-positive cases, and 20 healthy controls were tested for circulating microRNA-21 and the tumor suppressor gene PTEN using whole blood at the National Liver Institute, Menoufiya University. RNA and microRNA extraction, amplification, and real-time PCR were performed on all samples along with various other biochemical analyses. Results Real-time PCR analysis demonstrated upregulation of oncogenic microRNA-21 and showed reduced expression of the tumor suppressor gene PTEN at different stages of HCC. However, there were no significant microRNA-21 and PTEN changes in the hepatitis C virus or control groups. Receiver operating characteristic curve study showed that the best cutoff value for microRNA-21 was 3.93 (fold expression) with a sensitivity of 93% and specificity of 90%. The cut-off value for Alpha feto protein was 91.7 (ng/ml), with a sensitivity of 75.2% and specificity of 92.3%. Conclusion Increased expression of microRNA-21 could contribute to HCC growth and spread by affecting PTEN expression.

Objective The aim of this study was to evaluate the structural, ultrastructural, and biochemical changes in albino rats' liver treated with different doses and durations of ketoconazole and the possible recovery after cessation of treatment. Background Ketoconazole is an imidazole drug commonly used in treatment of fungal infection. It induces variable degree of hepatotoxicity. Materials and methods Fifty adult male albino rats were used in this study. The rats were divided into five groups. Group 1 was the control group. Group II (low dose treated) included 10 rats treated with ketoconazole at a dose of 40 mg/kg body weight orally for 7 days. Group III (high dose treated) included 10 rats treated with ketoconazole at a dose of 100 mg/kg body weight orally for 14 days. Group IV (arrested low dose) included 10 rats treated with low dose ketoconazole for 7 days followed by cessation of treatment for 7 days. Group V (arrested high dose) included 10 rats treated with high dose ketoconazole for 14 days followed by cessation of treatment for 14 days. At the end of each experimental period, animals were killed, blood samples were collected for biochemical study, and liver tissue samples were obtained for histological study. Results Ketoconazole-treated rats showed destructive changes of liver tissue in the form of marked congested dilated blood vessels, hepatocyte necrosis and complete tissue loss, periportal fibrosis, and elevated serum transaminase. However, nearly complete recovery of liver tissue and improvement in serum enzymes occurred among those treated with low dose, whereas those treated with high dose still showed persistence of some changes. Conclusion Ketoconazole induced marked histological changes in the liver tissue especially with high dose.

Objective The aim of this study was to evaluate the effect of sleep deprivation on vascular reactivity in adult male albino rats. Background Sleep deprivation can be due to either insufficient duration of sleep or a fragmented sleep period or a combination of both factors. Materials and methods This study was conducted on 140 adult male rats. Rats were divided into four groups: group 1, the control group; group 2, the sleep-deprived group; group 3, the 24-h sleep recovery group; and group 4, the 48-h sleep recovery group. Arterial blood pressure was measured. Vascular reactivity to noradrenaline, indomethacin, vasopressin, ACh, and sodium nitroprusside and the levels of serum adrenaline, noradrenaline, adrenocorticotropic hormone, cortisone, and C-reactive protein (CRP) were studied. Results Induction of sleep deprivation was associated with a significant increase in arterial blood pressures and vascular reactivity to noradrenaline, vasopressin, and indomethacin. The percentage of vasodilation to ACh significantly decreased. Serum levels of adrenaline, noradrenaline, ACTH, cortisone, and CRP significantly increased. In the 24-h recovery group, arterial blood pressures significantly elevated. Vascular reactivity to noradrenaline, vasopressin, and indomethacin were still significantly high. CRP was also still significantly elevated, whereas adrenaline and noradrenaline returned to control levels. In the 48-h recovery group, blood pressure, vascular reactivity, CRP, adrenaline, and noradrenaline returned to control levels. Conclusion Twenty-four-hour recovery period was not sufficient to restore normal vascular reactivity, whereas 48-h recovery period was essential to restore normal vascular reactivity after acute total sleep deprivation.

Background The antioxidant effect of swimming exercise and melatonin may combat against brain oxidative stress, hippocampal damage, and spatial learning and memory impairment induced by chronic exposure of rats to d-galactose. Objective This work aimed to study the effect of swimming exercise and/or melatonin on spatial learning and memory impairment induced by d-galactose in rats. Materials and methods Thirty adult male albino rats (each weighing 250–370 g) were divided into five equal groups: the control group (C), the d-galactose-treated group (G), the exercised d-galactose-treated group (EG), the melatonin and d-galactose-treated group (MG), and the combined exercised melatonin and d-galactose-treated group (CEMG). The duration of concomitant administration of treatments was 10 weeks. At the end of the 10^th week of the study, spatial learning and memory of all groups were assessed using the Barnes maze test for 5 days; malondialdehyde and superoxide dismutase enzyme activity were estimated in brain tissue homogenate and histopathological changes in rat hippocampus were assessed. Results In the EG, MG, and CEMG groups, the mean errors and mean escape latency per day on day 1 of the acquisition phase and the probe phase of the Barnes maze test were significantly lower than that in the G group, denoting a significant improvement in spatial learning and memory. In addition, these three groups showed a significant decline in hippocampal damage and malondialdehyde level compared with the G group. In the EG and CEMG groups, superoxide dismutase activity in brain tissue homogenate was significantly higher than that in the G group, but it was nonsignificantly changed in the MG group. Conclusion Swimming exercise and/or melatonin reduced brain oxidative stress, hippocampal damage, and consequently improved spatial learning and memory impairment induced by d-galactose. Combined treatment showed better synergistic antioxidant and neuroprotective effect compared with either treatment alone.

Objectives The objective of this study was early detection of attention deficit hyperactivity disorder (ADHD) and/or epilepsy by oxidative stress biomarkers. Background ADHD is a developmental disorder with an etiopathology not fully understood. According to the prevailing view, oxidative metabolism may be involved. Patients and methods The study sample consisted of 100 children. Children were equally divided into four groups (25 children/group): group I (control group); group II (ADHD group); group III (epilepsy group); and group IV (ADHD with epilepsy group). Each participant was subjected to a multidisciplinary clinical interview using a comprehensively devised semistructured sheet covering sociodemographics, psychiatric and pediatric history, and physical examination. Patients were diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders, 4^th ed. criteria. Venous blood samples were collected from all groups; serum malondialdehyde and glutathione S transferase levels were assessed. Results The mean value of serum malondialdehyde was significantly increased in the ADHD group, epilepsy group, and ADHD with epilepsy group when compared with the corresponding mean value in the control group. The mean value of serum glutathione S transferase was significantly decreased in the ADHD group, epilepsy group, and ADHD with epilepsy group when compared with the corresponding mean value in the control group. Conclusion Our study points out that changes in oxidative metabolism may have a role in the pathophysiology of ADHD and epilepsy.

Objectives The aim of this study was to investigate the difference between germinal and nongerminal diffuse large B-cell lymphoma (DLBCL) cases regarding their clinicopathological features, including survival and response to therapy. Background DLBCL is the most common subtype of non-Hodgkin's lymphoma in Egypt. It represents about 49% of non-Hodgkin's lymphoma cases according to the latest registry of National Cancer Institute, Cairo University. DLBCL is a heterogeneous group, especially as regards biological behavior, which includes response to chemotherapy and ultimate outcome. Previous studies suggested that classification of DLBCL into germinal and nongerminal subtypes had prognostic importance. Patients and methods This retrospective study included 61 de-novo DLBCL cases collected from the archival material of Pathology Department, Faculty of Medicine, Menoufia University, and treated at Menoufia Cancer Institute. Results Using Hans' algorithm, 31 (50.8%) cases were of germinal center B-cell (GCB) and 30 (49.8%) cases were of non-GCB subtype. Non-GCB cases showed significant association with splenic involvement (P = 0.01) and larger tumor size (P = 0.03). Overall, 90% of DLBCL cases with poor performance status were of GCB subtype. No significant difference regarding overall survival was noticed between GCB and non-GCB subtypes. Conclusion DLBCL should be classified into GCB and non-GCB subtypes because they differ prognostically. Hans' algorthim is a simple and reliable method for the classification of DLBCL, but it should be applied on a large number of cases to be used as a routine method for DLBCL evaluation.

Objectives Study expression of cadherin-17 (CDH-17) in normal liver tissue and nonmalignant liver diseases. Background CDH-17 is present in the fetal liver and gastrointestinal tract during embryogenesis, and becomes silenced in healthy adult liver and stomach tissues. CDH-17 functions as a peptide transporter and a cell adhesion molecule to maintain tissue integrity in epithelia. Aberrant expression of CDH-17 occurs in major gastrointestinal malignancies including hepatocellular carcinoma (HCC), stomach and colorectal cancers and is clinically associated with tumor metastasis and advanced tumor stages. The aim of this study was the identification of expression of CDH-17 in normal liver tissue and nonmalignant liver diseases. Materials and methods This retrospective study included 99 cases of nonmalignant liver diseases, divided into 66 cases of cirrhosis adjacent to HCC, 22 cases of cirrhosis without HCC, seven cases of chronic hepatitis C virus infection, two cases of hepatocellular adenoma, two cases of focal nodular hyperplasia in addition to seven cases of donors for liver transplantation as a control group. Paraffin blocks were retrieved from the archives of Department of Pathology, National Liver Institute, Menoufia University during the period between March 2007 and March 2015. Results Regarding CDH-17 immunoexpression, 36 out of 66 cases of cirrhosis adjacent to HCC were positive, whereas all cases of each of cirrhosis without HCC, chronic hepatitis C virus infection, hepatocellular adenoma, focal nodular hyperplasia and liver donors were positive. Both the histoscore and the percentage of CDH-17 expression were high significantly increased in cases of cirrhosis without HCC than in cirrhosis with HCC (P < 0.001). Conclusion This study revealed positive expression of CHD-17 in normal adult liver tissue and in nonmalignant liver lesions, which may signify that it has the same function as the classical cadherin family.

Objective The aim of this study was to evaluate the effectiveness and the efficiency of the Egyptian Health Sector Reform Program in achieving universal coverage for all citizens with high-quality basic health services. Background The Government of Egypt launched the Health Sector Reform Program in 1997. The program introduces the family health model as the principle for reform, and aims to insure universal coverage of all citizens with a basic package of health services. Participants and methods A simple random sample of 10 family health units was selected from the total 220 units in Menoufia Governorate. Each selected unit was subjected to data collection and analysis of infrastructure, resources management, quality indicators, referral system, coverage, and utilization, and questionnaire was administered for a sample of patients and providers to measure their satisfaction. Results Coverage with family health fund was 83% for insured, 86% for uninsured, and 77% for exempted. Active enrollment was 44% for insured, 60% for uninsured, and 14% for exempted. The average utilization visit of the population was 1.1 visits per year. The percentage of different curative utilization visits as regards total curative visits was 47% for insured, 49% for uninsured, and 4% for exempted. There was low utilization of medical instruments. The overall patient satisfaction was 66%, and only 11% of providers were satisfied with their salaries. The final evaluation of all aspects of quality indicators according to the Egyptian Accreditation Program was 55%. The average total cost per visit was 33 LE, and the average revenue per visit was 6 LE. Conclusion Our study results show that the rate of active enrollment was low. There is underutilization among coverage people and low-quality indicators. Thus, there is a need for regular monitoring and evaluation to improve these indicators and increase customer satisfaction.

Objectives The aim of the study was to assess the knowledge, attitudes, and practices (KAP) among different healthcare workers (HCWs) with respect to nosocomial infections in the National Liver Institute. Background Healthcare-associated infections (HAIs) are infections that patients contract while receiving treatment for medical or surgical conditions. They are considered a serious problem in the healthcare services as they are common causes of illness and mortality among patients. HCWs are at high risk for acquiring HAIs and for transmitting to their patients and close contacts. Participants and methods A total of 100 HCWs, including physicians (n = 20), nurses (n = 60), and housekeepers (n = 20), were included in the study. A questionnaire was administrated to them to assess their KAP with respect to nosocomial infections. A scoring system was devised to grade the KAP scores. They were further subjected to another similar questionnaire after an interval of 2 months based on an education module. Results Comparison of the preintervention and postintervention scores for the total study population showed a significant increase in the postintervention cumulative KAP score, as well as in the KAP scores. Housekeepers, compared with nurses, showed the best response to the health education intervention with a significantly higher percentage change in the KAP score (P = 0.005). Conclusion Nurses had higher levels for attitude and practice with respect to HAI control measures compared with physicians and housekeepers. Continuous education and in-service training on prevention of HAIs is mandatory to protect HCWs, especially housekeepers.

Introduction Hypertension is a challenging disease in developing countries like India as majority of the cases remain undiagnosed in the community. Work related mental stress, improper diet, smoking, alcoholism and high level of oxidative stress are important factors which may contribute for development of hypertension among the cotton textile workers. Objectives To estimate the prevalence of hypertension and identify its associated risk factors among cotton textile workers of Kannur. Methodology It was a cross-sectional study conducted in Kannur district from Dec 2013 to Aug 2014. Sample size required for the current study was 400 and it was calculated using the formula 4pq/l². There are 35 cotton textile factories in Kannur out which 3 were selected using simple random sampling. These factories have various departments such weaving, spinning, dyeing, blowing, carding, roving, cone winding and packing. Using systematic random sampling, the required number of sample was selected. Data was collected using a pre-tested questionnaire among individuals aged 18 years and above. JNC-8 criteria were used for diagnosis of hypertension. Data analysis was done on SPSS 19. Results The prevalence of hypertension and pre-hypertension among cotton textile workers was 22.3% and 38% respectively. Increasing age, alcohol consumption, family history of hypertension, BMI >25 kg/m² and high waist-hip ratio were found to significant risk factors of hypertension. Conclusion The prevalence of hypertension among cotton textile workers was on par with the prevalence in general population of India which is 21%. Health education on behaviour change should be regularly conducted among the workers of these factories in order to reduce the risk factors of hypertension.

Objective The aim of this study was to study the reasons for discontinuation of contraception in rural and urban areas. Background Imperfect or incorrect use of contraception by women often leads to contraceptive discontinuation. Therefore, this study was conducted to assess the reasons for discontinuation of contraception. Materials and methods This retrospective study was performed on 500 married women of reproductive age (20–50 years) who were using or discontinuing the use of any type of contraceptive method. This study was performed from 2012 to 2013. Results The highest discontinuation rates were observed for pills (40%), followed by injectables (37%). IUD (intrauterine device) had the lowest discontinuation rate. Thus, the main reason for discontinuation of contraception was side effects of the methods. Conclusion The reasons for discontinuation of contraceptive use primarily include side effects, desire to conceive, and contraceptive availability and acceptability. Family planning programmers and providers need to reach far and rural areas to help the couples successfully maintain and continue contraceptive use.

Objectives The aim of the study was to estimate the prevalence and identify possible risk factors for obesity in a representative sample of primary school children (6–12 years) in Menoufia Governorate. Background Childhood obesity has more than tripled in the past 30 years. Patients and methods A case–control study nested in a cross-sectional study was carried out in Menoufia Governorate. It was conducted in El-Bagour district. The sample consisted of 306 students (148 boys and 158 girls). Children were asked to fill a predesigned questionnaire, and anthropometric measures were taken. Results The prevalence of obesity and overweight was 19.6%. It was significantly higher among girls (24.7%) than among boys (14.2%) and among urban participants (22.1%) than among rural ones (11.3%). The prevalence of obesity among children from families with sufficient income was significantly higher (22.4%) than that in children from families without sufficient income (9.2%), and in children with a positive family history of obesity (27.3%) than in those with a negative family history (14.6%). Obesity prevalence was significantly higher among children with intake of fast food more than three times per week (81.2%) than in children who consume fast food less than three times per week (1.7%). It was significantly higher among those who take high-calorie snacks like sweets or chips (30.9%) than in those who take low-caloric snacks like vegetables and fruits (13.3%). The prevalence of obesity among children who exercise for less than 2 h per day was significantly higher (34.6%) than that among those who exercise more than 2 h per day (8.9%). Conclusion Obesity is a serious health problem. To face this, there should be programs initiated by the government, especially by Ministries of Education and Health, targeted at both children and parents through different public media. Programs should focus on the nutritional needs and feeding habits of these children.

Objectives The aim of this study was to estimate and compare the prevalence of iron-deficiency anemia (IDA) and identifying its possible risk factors among pregnant women in Menoufia Governorate, Egypt and Taiz Governorate, Yemen. Background Iron deficiency is the most prevalent nutritional disorder in the world. Nearly 2 billion people experience anemia. Iron deficiency is the most frequent cause of anemia especially in pregnant women. Participants and methods A cross-sectional case–control study was carried out in Shebin El-kom district and Taiz city in Menoufia Governorate, Egypt and Taiz Governorate, Yemen. The study sample consisted of 365 pregnant women (177 Egyptian pregnant women and 188 Yemeni pregnant women). Women were asked to complete a predesigned questionnaire. Blood samples were collected for complete blood count, and stool analysis was done. Results The prevalence of IDA was higher among Egyptian pregnant women than Yemeni pregnant women (52.5 and 32.9%, respectively). IDA was higher in second trimester among Egyptian pregnant women (65.7%) and higher in third trimester among Yemeni pregnant women (51.7%). IDA was higher in low socioeconomic standard families in Egyptian and Yemeni pregnant women (68.1 and 47.5%, respectively). Increased parity and lack of iron supplementation during pregnancy increase the risk of anemia among both studied groups There were significant relationships between pregnant women without anemia and those with anemia regarding dietary habits and other hematological values. Conclusion and recommendations The prevalence of iron deficiency is high among pregnant women, and the results of the present study could aid in the development of an IDA program that emphasizes iron supplementation and improved diet, including the consumption of iron-rich diet, among pregnant women in Egypt and Yemen. It should also encourage women for antenatal care during pregnancy.

Objectives The aim of this study was to assess the knowledge and practice of mothers as determinants of gastroenteritis among preschool children in Sedi-Salim District, Kafer Al-Sheikh Governorate. Background Diarrhea has been considered as a major cause of mortality in children younger than 5 years. Most of these deaths are due to dehydration and mismanagement or delayed management of the disease. Most diarrhea episodes are treated at home by mothers. Therefore, the mothers' knowledge in management of diarrhea is likely related to its mortality and morbidity. Patients and methods A cross-sectional analytical study was conducted involving 170 mothers of patients and 352 mothers of controls, who had at least one child aged 2–5 years old. The study was conducted in Elmofty and Shalma family health units as well as the family healthcare center of Sedi-Salim city, which are randomly selected representing the family healthcare facilities in Sedi-Salim District, Kafer Al-Sheikh Governorate. The questions were about demographic characteristics and knowledge and practice regarding childhood diarrhea, and they had been designed to obtain information through an interview. Results The study shows the number of mothers who had good and fair knowledge of diarrhea in the control group was higher than that in the case group. On the contrary, the number of mothers having poor knowledge of diarrhea in case group was higher compared with control group. The aforementioned differences between the two groups are statistically significant. Conclusion There is deficiency in mothers' knowledge and practice regarding dealing with gastroenteritis.

Objectives The aim of this study was to assess the knowledge and practice of healthcare providers (HCPs) as regards the safe practice during routine children vaccination in primary healthcare facilities. Background Primary vaccine failures can occur after high immunization coverage has been achieved. Healthcare workers' knowledge and practices are influential factors in preventing vaccine failures. Adequate knowledge and practices in the cold chain system, as well as handling and administration of different vaccines, are important to maintain the potency of vaccines and effectiveness of immunization. Participants and methods This cross-sectional study included 140 HCPs and 14 primary healthcare units and one center in Quewisna District, Menoufia, Egypt. A self-administered questionnaire and observational checklist were applied to collect data. The questionnaire assessed the knowledge of HCPs about the storage, handling, administration, scheduling, doses, routes, and contraindications of the different vaccines routinely used for children under 5 years of age in primary healthcare facilities. The checklist assessed the practice of HCPs as regards cold chain, room layout, preparation for vaccination session, and general and specific practice related to each vaccine. Results The total knowledge score was higher among high nurses (nurses with nursing bachelor degree) and HCPs who received training courses. The postvaccination practice was poor compared with prevaccination and during-vaccination practice. Conclusion According to these findings, the knowledge of HCPs as regards all vaccines is satisfactory, except for Hib vaccine. A regular training course to improve the HCPs' knowledge about immunization is highly recommended.

Objectives The objective of this study was to determine the prevalence and risk factors of nocturnal enuresis (NE) among primary school children in Zarka district, Damietta governorate, Egypt. Background NE is a common medical and psychological problem worldwide among school-age children. Participants and methods The study was a nested case–control study that was conducted during the academic year 2013/2014 on 325 students aged 6–12 years in Damietta governorate. A questionnaire was designed and was filled in by the parents of randomly selected children attending two different primary schools. A comparative study was conducted in which the children having NE (n = 50) were considered as the case group, and a randomly selected group of nonenuretics with matched age, sex, and socioeconomic criteria (n = 100) was considered as the control group. Results The prevalence of NE was 15.4%. Logistic regression analysis showed that NE was associated with stressful family events and a history of urinary tract infection. In 60% of the enuretic children living in rural areas, working mothers were found to have less enuretic children than housewives. NE was significantly associated with low socioeconomic status of families. NE was associated with a positive family history: the history of enuresis in the father was 4%, the history of enuresis in the mother was 6%, and in brothers or sisters it was 20%. In addition, intake of diuretic drinks has a significant role. In addition, the analysis of data shows a positive association of lack of comfortable sleep. Conclusion The prevalence of NE in primary school children in Damietta governorate constitutes about 15.4%. The family history was seen to have had a markedly significant impact on the occurrence of NE in the studied children. Risk factors include living in rural area, nonworking mothers, psychological troubles, and intake of diuretic drinks.

Objective The aim of this study was to assess rural mothers' knowledge, attitudes, and practices as regards first aid for home-related injuries among children under 5 years of age before and after implementation of educational program and to measure the prevalence of these injuries. This study was conducted to assess rural mothers' knowledge, attitudes, and practices toward home-related injuries and their first aids among children under 5 years of age before and after implementation of educational program. Background Accidental injuries are a major health problem in children. They are the most common cause of death in children under 5 years of age. Every year they leave many thousands permanently disabled. Most of the children at risk from a home accident are in the 0–5 years' age group. Most of these accidents are preventable through increased awareness, improvements in the home environment, and greater product safety. Materials and methods This cross-sectional interventional study included 270 mothers from Bijirim village, Queisna district, Menoufia, Egypt. A predesigned questionnaire was administered to them before and after application of educational program. The first part of the questionnaire included sociodemographic and economic characteristics of the mothers. The second part included mothers' knowledge about the causes, prevention, and first aid of home injuries. The third part included mothers' practice followed toward their children in case of exposure to any type of home injuries and its occurrence. Results The study result revealed that mass media were the main source of knowledge for 43.3% of the participants. There was a statistically significantly higher percent of satisfactory knowledge among highly educated mothers and those with middle and high socioeconomic level. There was a significant positive correlation between mothers' practice and either their education or their socioeconomic level. There was a significant correlation between socioeconomic level and either knowledge or attitude of mothers toward home injuries. There was a significant improvement in mothers' knowledge after intervention. Conclusion The study revealed that there was a significant improvement in mothers' knowledge and practice as regards home injuries after intervention.

Objectives Assessment of family physician knowledge regarding management of bronchial asthma as included in the national clinical practical guidelines for family physicians. Background Despite the development and dissemination of guidelines for the diagnosis and management of asthma, adherence to its recommendations is still suboptimal. Moreover, information is limited regarding adherence of the family physicians to the asthma guidelines in Egypt. Materials and methods A cross-sectional analytical study involving 82 family physicians engaged in direct asthma care in family health centers and units in Alexandria, Egypt. They were subjected to a self-designed questionnaire with multiple choices assessing their overall knowledge of bronchial asthma as recommended in the guidelines. The studied physicians were divided into two groups by years of experience in family medicine: group 1 with less than 5 years of experience in family medicine practice and group 2 with more than 5 years of experience. They were assessed using self-administered questionnaire with multiple choices. Results This study was conducted on 82 family physicians in Alexandria Governorate. Assessment of family physician knowledge regarding the national Egyptian bronchial asthma clinical practical guidelines showed significant difference between the two groups regarding diagnosis of bronchial asthma, drugs used in the management of bronchial asthma, role of reliever inhalation, prescription of asthma medications and asking about asthma as preventable disease. Conclusion There are variations in family physicians' knowledge regarding recommendation of national Egyptian guidelines for bronchial asthma for diagnosis, grading, and management.

Objective The aim of this study was to determine the prevalence of refractive errors among primary school children in the rural areas of Menouf district, Egypt. Background Visual impairment among school children is a prevailing problem. Besides affecting children's attendance at school it reduces their ability to study thus leading to impairment of their academic achievements. Participants and methods The sample size was calculated to be 435 students, which was increased to 480 students. The students were selected among all the primary school children in the selected area through a systematic random sampling of the classes in the studied schools during the scholastic years 2013–2014. All students were interviewed and underwent assessment for visual acuity. Results The screening revealed that 116 students out of 480 (24%) had refractive errors. Of them, 22% patients had myopia and only 2% had hypermetropia. The patients were found to be affected by watching television for long durations, in dim or yellow light, and at a distance less than the healthy recommended level. Conclusion Nearly one-fourth of the students were found to have refractive errors.

Objectives This study aimed to assess the patients' satisfaction towards safety measures in the family health centers in Elobour city to improve the family health cente's services utilization rate. Background In recent years, countries have increasingly recognized the importance of improving patient safety. Estimates show that in developed countries as many as one in 10 patients was harmed while receiving hospital care. Patients and methods This is a descriptive and analytical cross-sectional study conducted in three family healthcare centers in Elobour city – Alhaialawal, Alshabab, and Almostakbal – during a period of 1 month (August 2014). All the 275 participants were selected by simple random sample from all the patients who attended the clinics during the period of the study from the selected settings. The researcher used an interviewing questionnaire sheet, a modification of Ware questionnaire, in addition to the checklist of accreditation tools of Ministry of Health and Population, to measure the quality of health services in the prementioned centers. Results Most interviewees (97.2%) were totally satisfied with the overall quality of service at the centers. Moreover, 76.4.9% of them were satisfied with curative and healthcare services, 90.9% of patients were satisfied with safety and infection control measures, and 78.2 and 66.5% of patients were satisfied with facility services and dealing with the patient and patient rights, respectively. Conclusion This study demonstrates that 90.9% of patients were satisfied with the safety measures provided by healthcare workers in Elobour family health centers. However, a high percent of noneducated patients need more attention from healthcare workers toward educating patients about safety culture.

Objectives The aim of this study was to estimate the frequency of urinary tract infection (UTI) during pregnancy and the possible risk factors. Background UTIs during pregnancy are among the most common health problems worldwide, especially in developing countries. It has several adverse outcomes not only on the mother but also on the fetus. Patients and methods A case–control study nested in a cross-sectional investigation was carried out on 250 pregnant women who were attending Berket El Sabae Family Health Center in Menoufia Governorate. Data were collected from the first of September to the end of November 2014. Each participant was assessed using a predesigned questionnaire, which included age, personal history, occupation, present history, past history, obstetric history, and personal hygiene. Urine sample was collected from the studied women for analysis. According to history and urine analysis women were divided into two groups: group I had UTI and group II did not have UTI. Results The result of this study revealed that the frequency of UTIs during pregnancy was 32%, with 63.3% of them having moderate infection. UTIs were more significant among women with an intermediate socioeconomic score (37.9%). The most important risk factors associated with UTI in the studied group were unsatisfied personal hygiene, positive history of diabetes mellitus, anemia, and past history of UTI. Conclusion This study concluded that about one-third of pregnant women had UTI with different degrees of severity. The most important risk factors associated with UTI during pregnancy were unsatisfactory personal hygiene, history of UTI, diabetes mellitus, and anemia. Therefore, the study recommends health education on personal sanitary hygiene and frequent complete urine analysis during pregnancy.

Objective The aim of this study was to assess knowledge about self-care among type 2 diabetic patients attending primary healthcare centers. Background Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning how to survive with the complex nature of diabetes in a social context. Because the vast majority of day-to-day care in diabetes is handled by the patients and/or their families, there is an important need for reliable and valid measures for self-care in diabetes. Patients and methods The study was a cross-sectional study carried out on 200 diabetic patients attending the outpatient clinic in Ramlet Bolak Primary Health Care Unit in west Cairo city who were registered during 2014–2015. The sample size was calculated on the basis of the total number of type 2 diabetic patients during the past 12 months and the prevalence rate from previous studies, which was from 4.07 to 19.8%, using Epi Info at 95% confidence interval. The center was chosen because of its high flow of diabetic patients who were visiting the health unit regularly every month across different socioeconomic strata. The selected patients were assessment on their knowledge and practice of self-care and were subjected to laboratory investigations (HbA1c). Results The studied groups were divided on the basis of HbA1c into the controlled and the uncontrolled group. The mean score of knowledge on what is diabetes, its complications, symptoms of hypoglycemia, symptoms of hyperglycemia, importance of kidney function follow-up, follow-up by ECG, and follow-up by fundus examination was higher in the controlled group. Further, the mean score of practice regarding diabetes self-care, such as following a diet regimen, physical activity, foot care, frequency of visiting the physician, and self-monitoring of blood glucose and taking medication was higher in the controlled group. Conclusion There was a statistically significant relation between the level of knowledge about diabetes self-care and lifestyle modification and HbA1c. This means that, with increasing knowledge and practice about self-care, good diabetic control will be achieved.

Objectives The aim of the present study was to determine the prevalence of self-medication among attendants to a family health center and identify the determinants of participants practising self-medication. Background Self-medication is the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms. It includes the use of nonprescription drugs and a range of different alternative medicines such as herbal remedies and traditional products. In most illness episodes, self-medication is the first option, making it a common practice worldwide. Materials and methods In this cross-sectional study, a validated self-administered questionnaire was used to collect data among attendants in the studied area. The study was conducted in a family health center in Al Sadat city, Menoufia governorate, Egypt, from April 2014 to March 2015. The sample size of the study was 368 participants. Results Of the 368 participants, 47.8% were males and the remaining 52.2% were females –71.5% were in the age group of 12–65 years. Overall, 32.6% participants were students, whereas 35.3% were unemployed; 66.8% of the participants consumed over the counter (OTC) medications. The most common source of information about self-medication was pharmacist (37%). Minor illness (39.8%) and previous good experience (17.9%) were the most frequent reasons for self-medication. Conclusion Easy availability of OTC drugs is a major factor responsible for the consequences such as antimicrobial resistance and increased load of morbidity. There is a need for concerned authorities to make existing laws regarding the purchase of OTC drugs more stringent for their rational use.

Objective The aim of the study was to assess degree of compliance of Monshaat Sultan Family Health Center (FHC) with current Egyptian Primary Health Care (PHC) Accreditation Standards. Background Evaluation of healthcare quality is an essential component of health system research; all healthcare-related activities should be evaluated. The main purpose of quality assessment is to improve performance. More accurately, it is to identify points of weakness that call for strengthening and strengths for better use of them. Methods This is a cross-sectional descriptive study conducted on Monshaat Sultan FHC. The study used the PHC Accreditation Program Standards, designed, tested and finalized in February 2001 by the Egyptian Ministry of Health and Population, to assess the compliance rate of Monshaat Sultan FHC with these standards, where all activities were reviewed during the period from May 2014 to August 2014. The quality of performance of these activities was analyzed and the results were reported from September 2014 to April 2015. Results The study revealed that the overall compliance of Monshaat Sultan FHC with current Egyptian PHC Accreditation Standards was 33.64%. Among the eight dimensions of quality, patient care showed the highest compliance (46.65%), and quality improvement program showed the lowest compliance (12.12%). Patient rights compliance was 13.73%, safety was 38.70%, support services was 43.89%, information management was 23.81%, family practice model was 24.07%, and organization management was 12.82%. Conclusion Monshaat Sultan FHC is now only 33.64% compliant with current Egyptian PHC Accreditation Standards, whereas it was 80.18% in the year 2004. Lack of continuous evaluation and training is the leading cause of this low compliance.

Objective To assess the impact of Helicobacter pylori (Hp) eradication on the patient's quality of life. Background Functional dyspepsia (FD) is a common clinical problem that is seldom life-threatening, but impairs health-related quality of life. It was found that Hp gastritis was present in 30–60% of patients with FD. Patients and methods This study was carried out on 318 patients (18–55 years old) who fulfilled the ROME III diagnostic criteria for FD. They attended the Munshaat Sultan Family Health Center, Menouf district, Menoufia, Egypt, during the period from January 2013 to January 2014. Patients were invited to complete a baseline quality of life in patients with reflux and dyspepsia questionnaire (QOLRAD), and were classified as Hp+ and Hp− by Hp stool antigen testing. Hp+ patients received a 1-week course of Hp eradication. Hp+ and Hp− patients received a 4-week course of proton pump inhibitors (PPIs), prokinetics, and lifestyle modification, followed by on-demand therapy (PPIs, prokinetics) and lifestyle modification for 6 months. Reassessment of the patient's quality of life using the QOLRAD questionnaire by the two groups was performed 6 weeks and 6 months from the start of the treatment. Results Out of 318 patients with FD attended Munshaat Sultan Family Health Center a006Ed fulfilled ROME III criteria the percentage of Hp was 41.8%. QOLRAD were significantly lower in Hp+ than Hp− patients (P < 0.001). There was a highly statistically significant improvement in QOLRAD and dyspeptic symptoms 6 weeks and 6 months after the intervention among Hp+ and Hp− patients (P < 0.001) Conclusion In patients with FD, Hp eradication in infected patients and PPIs and prokinetics in Hp− patients reversed low QOL scores and improved global QOL during the 6-month follow-up period. Thus, we recommend the test and treat strategy for Hp for the management of patients with FD attending primary care clinics.

Objective The aim of this study was to assess knowledge and attitude as regards sexual health among medical students in Menoufia University. Background Sexual health promotion is a worthwhile activity to prevent reproductive health hazards, sexual dysfunction, marital distress, divorce, and family breakdown. This will save the society and allow people to enjoy life. Materials and methods This cross-sectional study was conducted in the Faculty of Medicine, Menoufia University, during the period from March 2015 to December 2015. The sample size was 300 students. The students were selected from the last 3 academic years. Students were selected from each grade through the proportional allocated method. A questionnaire was designed to assess overall knowledge and attitude of students as regards different sexual health items. Results The majority of the students had low knowledge on sexual health problems (91.7%) and their total attitude as regards different items of sexual health issues was equivalent (53.7%). There was a highly significant difference among students of the last 3 years in the overall knowledge (χ² = 34.4;P= 0.000) as regards sexual health and a significant difference in their overall attitude (χ² = 10.8;P= 0.03). There was a nonsignificant difference between male and female students as regards their overall knowledge (χ² = 0.9;P= 0.6). There was a nonsignificant difference between urban and rural students as regards their overall knowledge (χ²=2.9;P= 0.2) and their overall attitude (χ² = 1.5;P= 0.5). Conclusion Menoufia undergraduate medical students' knowledge on sexual health was inadequate. Overall, students expressed equivalent attitude toward different items of sexual health issues. Students would benefit from courses on sexuality to prepare them for challenging lives as medical practitioners.

Objectives To estimate the prevalence of smoking among university students and to identify patterns of smoking, family condition, and possible motives for smoking among the groups studied. Background University students are at a high risk of developing smoking habits as they become exposed to greater availability of cigarettes and close associations with smoking peers. Also, they face social, emotional, and educational challenges when they enter the university. Participants and methods A cross-sectional study was carried out at Kafr El-Sheikh University. All faculties at Kafr El-Sheikh University in Kafr El-Sheikh city were included in the study. The sample size was calculated using EPI-INFO program, version 7 depending on the total number of students registered in all faculties of Kafr El-Sheikh University during the year 2015–2016. All students who participated in the study were evaluated using a predesigned questionnaire through directed interviews with students. Results The prevalence of smoking among university students was 11%, with a higher percentage, 54.2%, at the Faculty of Commerce than other faculties of Kafr El-Sheikh University. The prevalence of smoking was higher among men than women, and other sociodemographic factors such as mother's occupation, presence of divorcing between parents, presence of smokers in the family, last year results, and working students were related significantly to the prevalence of smoking. Expression of virility 45.8% and smokers parents 12.5% were the most common motives for smoking. Conclusion and recommendations The prevalence of smoking among Kafr El-Sheikh University students was relatively high. Special focus should be directed toward male students and students at the Faculty of Commerce when targeting the problem of smoking.

Objectives The aim of this study was to assess the prevalence of female genital mutilation (FGM) among women attending Manwahla family health unit and compare between circumcised and uncircumcised women on their awareness (knowledge) and attitude toward FGM. Background FGM, circumcision, is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal. In Egypt, the practice was nearly universal until recently. FGM has no health benefits, and it harms girls and women in many ways. Participants and methods This study was carried out in Manwahla family health unit from 1 March 2015 to the end of May 2015; the sample included 400 married women selected from among interview attendants to Manwahla family health unit using a validated predesigned questionnaire to assess the prevalence of circumcision among them and other variables related to awareness and attitude toward FGM. Results The prevalence of FGM was 83%. The mean age of the studied participant was 31.1 ± 6.9 years. Approximately 53.2% of the women studied were of low socioeconomic status; the main causes for conducting mutilation were the belief that it was good for girls, 35.2%, and because it is a tradition, 33.8%. The study found that 64.3% of circumcised women had good knowledge, whereas 74.6% of noncircumcised women had good knowledge, and both circumcised and noncircumcised women had a high positive attitude, 63.4%, among circumcised women and 74.6% among noncircumcised women. The frequency of circumcision among daughters of the groups studied was 17.7% among circumcised women and 5.2% among uncircumcised women. Conclusion The FGM is wide spread their is no well established knowledge and negative attitudes. Maintaining the chastity of a woman and preserving tradition are the backbone causes for it's persistence.

Objectives The objective of this paper was to assess the effect of diabetes mellitus (DM) and hypertension on work productivity and job satisfaction. Background Work is a basic human activity through which every individual realizes their own livelihood. DM and hypertension are diseases with a high prevalence of growth globally; the question of the ability of this patient's to be productive is extremely important in terms of work productivity and job satisfaction evaluation. Patients and methods The study was a nested case–control cross-sectional study. A total of 800 participants were recruited (400 patients and 400 controls). They were enrolled from urban and rural family health units as follows: 223 DM patients, 177 hypertensive patients, and 400 participants in the control group. All the participants were interviewed using a prestructured questionnaire and their medical record was revised. The questionnaire contained an Arabic validated version of work productivity and impairment, the general health version (WPAI: GH), and job satisfaction questionnaire. Results Work absenteeism, work productivity loss, and impairment were more with the diabetic patients than with the hypertensive patients (P < 0.000). There was a statistically significant difference between studied groups and job satisfaction, where job satisfaction score was lower for diabetic patients than for hypertensive patients. There was a positive correlation among the studied groups regarding job satisfaction score and work productivity score. Conclusion DM appears to reduce an individual's ability-to-work in comparison with patients with hypertension.

Objective This work aimed to study the effect of zinc supplementation on growth of preterm infants. Background Preterm infants have impaired zinc status because of low body stores, as 60% of fetal zinc is acquired during the third trimester of pregnancy. In addition, this can be attributed to their limited capacity to absorb and retain micronutrients, coupled with increased endogenous losses associated with organ immaturity. Patients and methods The present study was carried out on 60 healthy preterm infants below 37 weeks of age divided into two groups: a zinc-supplemented group fed with breast milk and supplemented with zinc (2 mg/kg/day) since the first day of life, and a non-zinc-supplemented group fed with breast milk (without zinc supplementation). Both groups were followed up for 6 months for growth and serum levels of zinc and hemoglobin at the age of 6 months. Results The zinc-supplemented group showed a significant increase (P<0.05) in both weight and length at the age of 6 months. There was a highly significant increase in the serum zinc and hemoglobin levels in the zinc-supplemented group compared with the non-zinc-supplemented group, in addition to a significant positive correlation between zinc level and hemoglobin level at day 1 and at 6 months. Conclusion Zinc supplementation for preterm low birth weight babies was found effective in enhancing the growth in early months of life and has a positive effect on their linear growth.

Objectives The aim of this work was to evaluate acute antipsychotic poisoned cases through studying all patients admitted at Menoufia Poison Control Center over 1 year regarding sociodemographic factors (age, sex, residence); mode of exposure; clinical manifestations (symptoms and signs); and the relation between antipsychotic drug overdose and severity grades of the studied cases, according to poison severity score. Background Toxicological exposures and fatalities associated with neuroleptic agents continue to increase in the world in past 10 years. Consequently, it is important for the practising clinician to be familiar with the pharmacology and toxicology of these medications. Materials and methods The study was conducted on patients who arrived at Menoufia Poison Control Center with antipsychotic poisoning seeking for medical advice throughout 1 year (from 1 October 2012 to 30 September 2013). The data were collected from a previously designed clinical admission sheet (including the patient's age, sex, history, and clinical assessment data) and from investigations results. Results The suicidal mode of poisoning comprised the highest frequency. Cases under 10 years old had taken the overdose accidentally, and all cases of 10 years old or more had taken the dose intentionally to commit suicide. Female cases had the highest percent of suicidal mode and male cases in accidental and homicidal mode. Palpitation and abnormal movements were the most common symptoms. According to poison severity score, most of the cases were of moderate degree, and the least were of severe and fatal degrees. Sinus tachycardia was the most prominent of the ECG changes. Conclusion Antipsychotic overdose produces a gamut of manifestations that affect multiple organ systems. The most serious toxicity involves the cardiovascular system and the central nervous system. Acute overdose seldom results in death.

Objective This study aimed to evaluate the toxic effects of the dependence of tramadol, diazepam, and their combination on the liver of adult albino rats. Background Nowadays, tramadol is the most common drug of abuse; it has been associated with a wide range of drug abuse such as benzodiazepines. The combination of tramadol and benzodiazepines has serious detrimental effects on the liver. Materials and methods In this study, 40 adult albino male rats weighing 180–200 g were obtained from the breeding animal house in Menoufia University; they were divided into four groups: group 1 (control) received 1 ml/day normal saline (0.9%) by oral tube, group 2 (tramadol dependent) received increasing doses of tramadol by oral tube for 1 month, group 3 (diazepam dependent) received increasing doses of diazepam by oral tube for 1 month, and group 4 (combination of both drugs) received increasing doses of tramadol and diazepam by oral tube for 1 month. At the end of the experimental period blood samples were taken from all groups for evaluation of the liver function, after which the rats were killed. In addition, histopathological and immunohistochemical examinations of the liver were carried out. Results Tramadol and diazepam dependence affect the liver function parameters, as alanine transaminase and aspartate transaminase were significantly elevated. Liver enzymes were much affected by their combination; these results were proved by the histopathological and immunohistochemical examination of the liver tissue. Conclusion Tramadol or diazepam dependence for a long time might affect the hepatic cells and the combination of both of them leads to more hepatotoxic effect. Therefore, it is recommended that tramadol or diazepam should be taken only with the prescription of doctor and that self-medication of these drugs may be hazardous.

Objectives The aim of this study was to measure serum undercarboxylated osteocalcin (ucOC) and bone mineral density (BMD) in premenopausal patients with rheumatoid arthritis (RA) and their correlation with each other and with disease activity. Background Osteocalcin is a molecule synthesized as a prepro-osteocalcin. After proteolytic cleavage and vitamin K-dependent carboxylation processes, it is released and circulates in the blood as carboxylated osteocalcin or ucOC. Participants and methods In total, 60 premenopausal patients with RA and 30 healthy premenopausal controls with matched age were included in this study. All patients and controls were subjected to demographic data, clinical examination, and laboratory investigations including serum level of ucOC, disease activity assessment by DAS-28 score, and BMD measurement in the lumbar spine L2–L4, hip, and distal radius by dual-energy X-ray absorptiometry equipment. Results; The level of ucOC was significantly higher in patients of RA than controls (P < 0.001). BMD in patients was found to be significantly lower than in controls in spine, femoral neck, and distal radius areas. The most frequent osteoporotic site according to Z-score was the spine (16.7%) followed by the femoral neck (8.3%) and then the distal radius (6.7%). Moreover, the commonest osteopenic site according to Z-score of -1 or less was the spine (31.7%) followed by the femoral neck (21.7%) and then (16.7%) the distal radius. This work showed that ucOC level was found to be high in premenopausal patients with RA with higher DAS values than those with lower DAS value (P < 0.001). In this work, BMD measured by dual-energy X-ray absorptiometry scan was found to be lower with higher DAS values, and vice versa. Conclusion Serum level of ucOC (which is a mirror of vitamin K deficiency) was found to be higher in premenopausal patients with RA than controls and correlated positively with disease activity and inversely with BMD measurement.