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Background: Adolescence is a transitional phase characterized by multiple physiological and psychosocial factors that make glycemic control more difficult, and often results in hyperglycemia and/or hypoglycemia-related emergencies, and increases the risk of chronic complications. Insulin analogs were introduced with the aim of overcoming such difficulties. Objective: To study the role of long acting insulin analog (insulin glargine) in glycemic control of adolescents with poorly controlled type 1 diabetes who suffer from frequent hypoglycemic attacks and marked glucose variability, and to compare its effectiveness and cost versus intermediate acting insulin (NPH) in a country with limited resources like Egypt. Subject and method: A non-randomized open label treat to target trial that included twenty-nine adolescents (10–18 years), with T1DM. They were on MDI regimen. All had unsatisfactory glycemic control with frequent hypoglycemia and/or recurrent glucose excursions. All were shifted from twice daily NPH to single bedtime injection of insulin glargine (Lantus), and followed up for a minimum period of 6 months. Results: Switching to insulin glargine was associated with a statistically significant reduction in attacks of hypoglycemia and DKA (p

In this study, a sample of 96 Egyptian manufacturing small and medium enterprises (SMEs) was studied inrelation to human factors (HFs) dependent quality management system (QMS). These were in three distinctindustry groups: food & beverage, textiles & garments and leather & footwear. Human factors considered arederived from the seven criteria of the Egyptian Quality Award (EgyQA) and were used as the basis of aquestionnaire survey.The SWOT analysis for the survey results revealed the urgent need for developing governmental strategieswhich should focus on improving organizations performance, developing QMS and establishing total qualitymanagement (TQM) basic infrastructure for the Egyptian manufacturing SMEs.This paper has provided two proposed practical framework models for improving the performance of theEgyptian manufacturing SMEs and for developing their competitiveness in both domestic and internationalmarkets, and thus activate their main role in the Egyptian economy.

In adults with the acquired immunodeficiency syndrome, long-term monotherapy with zidovudine selects for human immunodeficiency virus type 1 (HIV-1) strains with substantially reduced in-vitro susceptibility to the drug. We have assessed the relation between in-vitro resistance to zidovudine and clinical outcome in children, in whom disease progression is more rapid than in adults. We studied 23 children with symptoms of HIV-1 disease during extended monotherapy with zidovudine. An in-vitro assay was used to determine the concentration of zidovudine required to inhibit by 50% the replication of viral isolates (IC50) obtained after 9 to 39 months of treatment. Viral stocks of high enough titre to yield reproducible results were obtained from 19 of the children. During the following 6 months of therapy, 9 children were stable, 7 deteriorated, and 3 died. There was a highly significant relation between decreased zidovudine susceptibility and poor clinical outcome (p less than 0.001) but no relation between IC50 and age at start of therapy or length of time on treatment. Age-adjusted CD4 lymphocyte counts were lower at the start of treatment (p = 0.02) and at the time of sampling (p = 0.01) in children whose viral isolates had an increased zidovudine IC50. Initial serum p24 antigen levels were not predictive of subsequent emergence of resistant virus, but at the time of sampling for viral sensitivity higher p24 antigen levels were associated with raised IC50 (p = 0.004). The findings suggest that most children who become unresponsive to monotherapy with zidovudine, as judged by clinical criteria, will have changes in in-vitro sensitivity to the drug. In these children, an alternative antiretroviral therapy should be considered.