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Hepatocellular carcinoma (HCC) is a major cause of cancer death in Egypt. There is still a risk for HCC development even after eradicating hepatitis C virus (HCV) by direct-acting antivirals (DAAs). Chitinase-3-like-protein-1 (CHI3L1), a biomarker for predicting many diseases, plays an essential role in inflammation, angiogenesis, and antiapoptosis. Tolloid-like protein 1 (TLL1) may be involved in hepatic fibrogenesis and carcinogenesis. This study aimed to determine the role and combined effect of CHI3L1 (rs880633), TLL1 (rs1503298), and an intergenic (rs597533) polymorphisms on the risk of developing HCC in Egyptian patients after achieving sustained virological response (SVR) by DAAs. Blood samples were collected from 68 HCC patients, 77 non-HCC subjects, and 80 healthy controls. The DNA was extracted and analyzed for rs880633, rs1503298, and rs597533 using Genotyping TaqMan™ assay. The result of the present study showed a significant difference in genotypes and alleles frequencies in both (rs880633) and (rs597533) in HCC group as compared to healthy control and also as compared to the non-HCC group. However, regarding to (rs1503298) genotypes and alleles between the HCC and non-HCC groups, there were no significant differences. Combined polymorphism in more than one gene simultaneously showed a higher risk to HCC after SVR than an individual locus. Both allelic and genotypic variations of the CHI3L1 gene (rs880633) and an intergenic (rs597533) seemed to be significant predictors confirming a great risk for HCC susceptibility in Egyptian patients achieved SVR. Patients with a polymorphism in more than one gene showed an increased risk to HCC after SVR rather than individual locus.

The cannabinoid system is involved in the immune regulation by modulation of Th cells type 1 and 2. It is composed of the CB2 receptor which is expressed at 10 to 100 folds greater levels on immune cells than the CB1 receptors. The CB2 is encoded by the cannabinoid CB receptor gene (CNR2) gene. This study aims to investigate the polymorphism in CNR2 gene variation rs 35761398 (Q63R) in Egyptian children with immune thrombocytopenic purpura and to investigate the relation between this gene polymorphism and either the susceptibility to or the chronicity of the disease. Forty children diagnosed as ITP were included in this study and 20 healthy children as normal control. CNR2 gene was investigated in those children by PCR RFLP technique (restriction fragment length polymorphism). CNR2 genotyping revealed that 45% of ITP patients had the QR heterotype, 50% had the RR homotype and 5% had QQ, the wild type with significantly higher frequency of homomutant genotype in comparison to controls. The relative odds ratio suggested a double risk for developing ITP in RR homotype (OR 2.152). A significant overpresentation of the RR genotype and of R allele was observed in the chronic patients (P=0.002 and 0.003, respectively). The associated risk to develop chronic ITP increased more than two folds for the RR homotype (OR=2.854). In conclusion, this study confirms the role of CNR2 Q63R polymorphism in the susceptibility to ITP in children and chronicity of the disease.

This paper investigates the use of abductive-network machine learning for modeling and predicting outcome parameters in terms of input parameters in medical survey data. Here we consider modeling obesity as represented by the waist-to-hip ratio (WHR) risk factor to investigate the influence of various parameters. The same approach would be useful in predicting values of clinical parameters that are difficult or expensive to measure from others that are more readily available. The AIM abductive network machine learning tool was used to model the WHR from 13 other health parameters. Survey data were collected for a randomly selected sample of 1100 persons aged 20 yr and over attending nine primary health care centers at Al-Khobar, Saudi Arabia. Models were synthesized by training on a randomly selected set of 800 cases, using both continuous and categorical representations of the parameters, and evaluated by predicting the WHR value for the remaining 300 cases. Models for WHR as a continuous variable predict the actual values within an error of 7.5% at the 90% confidence limits. Categorical models predict the correct logical value of WHR with an error in only 2 of the 300 evaluation cases. Analytical relationships derived from simple categorical models explain global observations on the total survey population to an accuracy as high as 99%. Simple continuous models represented as analytical functions highlight global relationships and trends. Results confirm the strong correlation between WHR and diastolic blood pressure, cholesterol level, and family history of obesity. Compared to other statistical and neural network approaches, AIM abductive networks provide faster and more automated model synthesis. A review is given of other areas where the proposed modeling approach can be useful in clinical practice.

Lupus nephritis includes a wide range of parenchymal injuries and severity. Better predictors to outcome are needed for patients newly diagnosed with lupus nephritis, so that an appropriate management strategy may be selected. This study aimed to determine whether the ratio of hepatocyte growth factor (HGF) to transforming growth factor beta 1 (TGF beta1) in lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at six months. Also, to determine whether a simple automated system for objective scoring of biopsies of lupus nephritis could be a prognostic factor for response to therapy with cyclophosphamide and steroids at 6 months. Consequently, renal biopsy findings and clinical parameters of thirty parasites-free patients with new onset lupus nephritis were recorded. Histopathologic, clinical, immune-histochemical and morphometric data at baseline served to define the predictive value for outcome after 6 months of therapy. The results showed a significant positive relationship between response to therapy and HGF IS (P= 0.007), HGF ES (P= 0.026), HGF IS/ TGFbeta1 IS ratio (P= 0.022) and HGF ES/ TGFbeta1 ES ratio (P= 0.001). A significant inverse relationship was proved between response to therapy and TGFbeta1 IS (P= 0.025) as well as TGFbeta1 ES (P= 0.017). Also, a significant inverse relationship was present between response to therapy and nuclear index, tubular index and matrix index (P = 0.03, 0.03 and 0.029 respectively).

Schistosomiasis haematobium precancerous lesions of urinary bladder included group 1: preneo-plastic non papillary (flat) lesions [reactive atypia, flat hyperplasia, keratinizing squamous metaplasia, glandular metaplasia, dysplasia, carcinoma in-situ (CIS)] and group 2 preneoplastic papillary lesions (typical papillary hyperplasia, atypical papillary hyperplasia, papilloma). The present work studied the content of the schistosomiasis precancerous lesions of the urinary bladder using image analyzer, thereby shedding more light on the significance on the early diagnosis of the high risky group. A total of 140 previously diagnosed schistosomiasis urinary bladder lesions (124 precancerous and 16 cancers as controls) were stained by HE, and Feulgen stain. The mean SPF was high in CIS (22.7), dysplasia (19.6)low in atypia (7.91). DNA ploidy, non-diploidy DNA was high in CIS (53%), papilloma, dysplasia and atypical papillary hyperplasia than flat hyperplasia, glandular metaplasia, keratinizing squamous metaplasia and typical papillary hyperplasia that were diploid indicating more tendency and aggressiveness of the first group to turn malignant than the second group.

In this study, three bile aspirates taken from 10 fascioliasis patients (30.0%) showed HCV positivity by PCR/RNA. Also, four duodenal aspirates (66.7%) taken from six HCV/PCR-RNA positive patients and three duodenal aspirates (20%) taken from 15 pure fascioliasis patients showed HCV positivity by PCR/ RNA. This is the first time to demonstrate HCV/PCR-RNA in the bile and duodenal aspirates of fascioliasis patients and in the duodenal aspirates of HCV patients. So, PCR can be used for the detection of HCV in the bile and/or duodenal aspirates of HCV suspected patient. On the other hand, this outcome results may incriminate HCV infection as a concomitant with fascioliasis or incriminate fascioliasis as paving the way to HCV.

In this study, twenty HCV/PCR-RNA positive patients with neither infection nor infestation were 15 males and five females with ages ranging between 17-78 years old. Liver function tests: S. albumin was decreased in 15 patients (75%), total protein decreased in 3 patients (15%), total bilirubin increased in 7 patients (35%), AST/ALT increased in 3 patients (15%). Globulin value increased in 15 patients (75%). A/G ratio decreased in 12 (60%). Ten normal individuals (five malesfive females), gave normal findings. However, a 19 years-old female had non significant elevation (0.26 mg/dl) in direct bilirubin. Liver function tests: one patient had increased AST/ALT, Globulin value decreesed (-0.2) in another one (10%) and A/G ratio increased (+0.3 to +0.6) in three (30%) individuals. Twenty randomly selected patients (15 males and five females) HCV/3rd generation ELISA showed ALT elevation in 17 (85%), AST in all (100%), S. albumin decreased in 9 (45%), and increased in 1 (5%). Total protein decreased in 3 (15%), total bilirubin increased in 7 (35%) and direct bilirubin in 4 (20%), AST/ALT value increased in 3 patients (15%), Globulin value increased in 15 patients (75%). A/G ratio decreased in 12 (60%). Three patients had schistosomiasis, one 30 years old male had increased AST/ALT, normal globulin, increased A/G and positive HBs-Ag. The second one was a 33-year-old male had normal AST/ALT, normal globulin, increased A/G and positive HBs-Ag. The third patient was a 19-year-old female with normal AST/ALT and normal globulin, increased A/G and positive HBs-Ag. Two patients had fascioliasis, one was a 20-year-old male with increased AST/ALT, globulin normal, A/G normal and negative HBs-Ag. The second one was a 26-year-old female with normal AST/ALT and normal globulin, increased A/G and positive HBs-Ag. The other four positive HBs-Ag patients were parasite-free. Also, the other HCV/ELISA positive were negative for HBs-Ag. HCV/ELISA may have cross-reacted with HBs-Ag and/or with elevated ALT and gave false positive HCV. The 3rd generation ELISA in detection of HCV was not as sensitive as PCR/RNA. Out of 41 fascioliasis patients (26 males15 females), 14 were positive HCV/ELISA (34.1%), but only six were positive HCV/PCR (14.6%). ALT increased in 18 fascioliasis patients (43.9%), AST in 23 patients (56.1%) but, albumin decreased in 7 patients (17.1%), total protein decreased in 5 (12.2%), but total bilirubin increased in 14 (34.1%) and direct bilirubin increased in 2 (4.9%). Liver function tests of 14 fascioliasis and ELISA positive HCV showed AST/ALT increased in 6 (42.9%), globulin increased in 3 (21.4%) and decreased in 6 (42.8%). A/G decreased in 4 (28.6%) and increased in 8 (57.2%). Liver function tests of pure 27 fascioliasis patients showed that AST /ALT increased in 8 (29.6%), globulin increased in one patient (3.7%) but decreased in 10 (37.0%) and A/G ratio increased in 13 (48.1%).

Hepatitis C and human fascioliasis are two of the most important public health problems locally and internationally. Each one has its own complications regarding spreading to man, clinical picture, laboratory and serologic diagnosis, treatment and prevention. Concomitant human infection with both magnified the complications. Clinically, both diseases (HCV and fascioliasis) have their own broad signs and symptoms. In concomitant infection, the clinical pictures of both showed some variations. The most common feature in fascioliasis and HCV patients was easy fatigability in 78.6% and the lowest was 7.18% for each of tympanic abdomen, tender colon, tender right upper quadrant, itching, arthritis, epi-gastric pain, and right quadrant pain. The eosinophilia % ranged from 5-24 and the haemoglobin ranged from 7-11.1 gm/dl. In patients with fascioliasis alone, the most come feature was pallor in 96.15% and the lowest was 3.85% for each of splenomegaly, ascites and itching. Eosinophilia % ranged from 1 to 22 and haemoglobin ranged from 6-12 gm/dl. In general, the double infection with both HCV and fascioliasis magnified the laboratory and clinical pictures of such patients.

In 35 parasitologically proven zoonotic cutaneous leishmaniasis patients, the histopathological and immunohistochemical picture were studied. The haematoxylin and eosin stain, the monoclonal antibodies for TB lymphocytes, peroxidase anti-peroxidase for P53 protein, and Feulgen staining for DNA imaging cytometry to DNA contents and S-phase (DNA synthesis of cycling cells were evaluated. The out-come results revealed that P53 and S-phase fraction and DNA content must be in mind when dealing with a human cutaneous leishmaniasis. Consequently, the early detection of any nuclear mutation and cellular proliferation in the skin leishmaniasis lesion(s) must be taken into consideration to avoid the miserable formation of the skin cancer.

No doubt, Hepatitis C virus (HCV) is a real health problem worldwide. The liver function tests (S.ALT, S.AST, Albumin, Total Protein, Total Bilirubin and Direct Bilirubin) were evaluated in 20 PCR-RNA positive HCV-patients and 10 cross matched apparently healthy population. All the HCV-patients and controls were free from liver helminthes. The results showed that in the HCV-patients, there was elevation in the level of S.ALT (17/20 or 85%), S.AST (20/20 or 100%), Total Bilirubin (7/20 or 35%), and (4/20 or 20%). Besides, there was neither a correlation between sexes nor the degrees of viraemia and the elevation of these four parameters. However, serum levels of Albumin, and Total Protein were within the normal range. On the other hand, in the controls the levels of the six tests were within the normal range. Nevertheless, only one control subject who had positive HBs-Ag, showed elevated Total Bilirulin and Direct Bilirubin. Consequently, these tests are indicative as useful and dependable markers in the non-invasive diagnosis of the hepatitis C virus (HCV).

This study found a correlation between some serum markers [AST/ALT ratio, level of matrix metalloproteinase 9 (MMP9), level of viraemia and HCV serotype] and severity of liver fibrosis in HCV-infected patients. The study included 72 human cases referred to the Early Cancer Detection Unit, for liver biopsy assessment. The severity of liver fibrosis was staged using the METAVIR scoring system into 4 stages. The level of viraemia did not differ significantly in the different stages of liver fibrosis. Also, the type of HCV had no effect on the severity of liver fibrosis. However, the transaminases ratio differed significantly in the different fibrosis stages (P0.01). This serum test has a relatively high sensitivity and specificity (92.6% and 94.3%, respectively) in diagnosing severe fibrosis and cirrhosis. The level of MMP9 was, however, inversely correlated with the fibrosis stages and was found to have an 88.9% sensitivity and an 88.6% specificity when diagnosing severe fibrosis and cirrhosis. Although, the sensitivity of these serum markers did not reach 100%, yet their use can reduce the number of liver biopsies when diagnosing and treating HCV-infected patients.

Four hundred blue Fulgen-stained nuclei were measured from each lesion by using DNA image cytometry. The histopathological and cytopathological observations revealed that (52 cases, 69.3%) had a variable degrees of chronic hepatitis, (12cases 16 %) were emerging into cirrhosis, while (11 cases 14.7%) represented different grades of HCC. Most of the cases with minimal or mild chronic hepatitis were female, while most of male had moderate or severe chronic hepatitis, cirrhosis and HCC. DNA image analysis data gave the support of to the histological observations. All of chronic hepatitis C and cirrhotic cases showed normal diploid and/or tetraploid histograms, although increasing S-phase fraction s' values of the highly diseased chronic hepatitis and cirrhotic cases. Hepatocellular carcinomas and one cirrhotic case only revealed aneuploidy (diploid and tetraploid), while one case of poorly differentiated HCC revealed multiploid histogram. So, histopathological severity in cases of progressive chronic hepatitis seems to be associated with the age and sex of Egyptian society. Also, demonstrates the potential usefulness of image cytometry for the evaluation of the different histopathological problems.

The natural history of hepatitis C virus (HCV) infection has a highly variable course. Many patients develop chronic infection, with its consequent risk of cirrhosis, liver failure and hepatocellular carcinoma. A key question is whether patients at high risk of disease progression can be distinguished from those with relatively benign disease course. The disease progression is influenced by other factors such as duration of infection, age at infection, sex, co-infection with hepatitis B virus (HBV), Epstein Bar virus (EBV), cytomegalovirus (CMV), the level of HCV viraemia and its type. Other endemic infections in the community as bilharziasis may have a role in progression of the condition to serious complications. These factors are correlated with newly proposed grades and stages of the disease. The studied (109) cases were divided into 6 groups according to the concomitant infection with HCV. The result proved that groups 1, 35 had a higher level of viraemia than other groups, and to be the high-risk groups as 56.4% and 34.6% were in G2S2 and G3S3, respectively. All cases of liver cell dysplasia and hepatocellular carcinoma in this study were seen in these groups. The conclusion showed that these factors play an important role in the progression of HCV infection. Death of the patients of this progressive condition occurs in younger age and is more due to liver failure than to HCC.

Aflatoxins, particularly aflatoxin B1 (AFB1) have been recognized as one of the most potent chemical carcinogen. In Egypt, HCV is prevalent. The progressive nature of HCV-related liver diseases was found to be influenced by other factors. In this paper, the role of aflatoxin contamination in the onset of liver cancer in HCV-infected patients was studied. The quantitative identification of the possible aflatoxins contamination in six urban and eleven rural areas using high performance liquid chromatography technique, revealed that corn, wheat, pea nut, lupine "termis", white rice, cowpea "lobiya", fava bean and brown rice showed the prevalence of AFB1 to be 64.7%, 53%, 53%, 47%, 47%, 41%, 29.4%29.4% respectively. A positive correlation was found between aflatoxin and positive HCV-PCR together with liver disease progression to G3S3, the indicative of hepatocellular carcinoma. Such correlation was not fully understood, but the oncogene amplification caused by HCV-infection may be aggravated by the consumption of aflatoxin contaminated raw food materials or their products.

It has become apparent that hepatitis C virus (HCV) infection is a major risk factor for the development of hepatocellular carcinoma (HCC) worldwide. The precise mechanism by which HCV causes HCC is not known. Unlike the hepatitis B virus (HBV), HCV is not a DNA virus and does not become integrated within the genome of hepatocytes. It is more likely that HCC occurs against a background of inflammation and regeneration, associated with liver injury due to chronic hepatitis. In this study, 40 of paraffin blocks liver tissues from HCV-PCR positive patients (HBV seronegative) were examined using DNA image cytometry to evaluate its role in diagnosing HCC associated with HCV infection. Fluorescent in situ hybridization (FISH) technique using LSIZNF 217 chromosome 20q 13.2 probe was applied as well. The results showed high percentage of S-phase fraction in cases of G2S2 and G3S3 with DNA diploidy. Only two cases of G3S3 showed DNA aneuploidy with severe amplification of chromosome 20q 13.2. Consequently, DNA imaging cytometry is a good approach in differentiating dysplasia from well-differentiated HCC on top of HCV infection. In conclusion HCV has an acquired role in development of HCC through amplification of the aggressive tumor behavior oncogene LSIZNF 217 at chromosome 20q 13.2.

Reverse transcriptase (RT) polymerase chain reaction (PCR) was used to detect hepatitis C Virus (HCV) RNA among heads, guts, larvae and eggs of Culex pipiens complex. The mosquitoes were trapped from homes of hepatitis C patients or among the same organs of symbiotic (normal gut bacteria) and aposymbiotic (without gut bacteria) mosquitoes fed HCV positive blood by an artificial membrane feeder. The eggs and larvae resulted from symbiotic females fed HCV positive blood was tested for HCV-RNA. Hepatitis C virus RNA was detected only in heads of symbiotic mosquitoes collected from homes of HCV positive patients at 3h and 6h after feeding. The virus was detected at 3d and 8d after being fed on HCV-RNA positive blood in guts of the same group. The virus was not detected in the eggs or larvae resulted from female mosquitoes fed on HCV-RNA positive blood. The results raise the possibility of the mechanical and/or biological transmission of HCV by Cx. pipiens, and pave the way to the ongoing study on the effect of gut bacteria of Cx. pipiens in a trial to identify an anti-HCV agent.

To evaluate the relation between snoring and the presence of obstructive sleep apnea (OSA) in terms of relevant health parameters and questionnaire responses.Selective random sampling within a household survey in the cities of Al-Khobar and Dammam, Kingdom of Saudi Arabia over a 3 month period during the year 2000, was carried out. One hundred and fifty-two persons, aged 17-62 years, with a positive history of snoring as determined by the spouse or other members of the family were selected.The presence of OSA was determined using the Epworth sleepiness scale (ESS). The predictors included age, gender and body mass index. Snoring was found to be more associated with OSA as suggested by ESS in the study sample. The severity of snoring and its pattern are more associated with apneic patients.Snoring is common and may be a serious medical problem. This study revealed that snoring is associated with symptoms suggesting OSA syndrome as detected by ESS. The family doctor and his team should be aware of the condition, using simple screening test such as ESS, improves the patient care, and finding of suspected cases.

This paper reports a patient with intestinal amoebiasis in concomitant with amoebic ulcer in the thigh. The ulcer was suspected to be carcinoma, complicated cutaneous leishmaniasis or due to free-living amoebae. The diagnosis was confirmed by the pathological and parasitological demonstration of haematophagous trophozoites of E. histolytica. The patient was successfully treated with Metronidazole.

A local Personal Computer (PC) network program has been designed to improve training and patient care in Family and Community Medicine set-up. The software was designed to cope with the different clinical, preventive, promotive and statistical programs of the teaching set-up. This system serves multiple levels of patient priority, assigning each patient to an individual health team staff. The present software is designed to be used for IBM PC Pentium hardware with a Window's environment. This article is a summary of the main features of the program and its applications. Such a program is essential in comprehensive health care-related decision-making and in improving patient care. The authors recommend using similar programs in family practice and in primary health care centers.

Intestinal parasitic infections among refugees have been perceived as a public health problem for decades. A control program strategy to reduce morbidity and eventually transmission of intestinal parasites was initiated in 1993 by Mercy International (MI) for a group of Somalia refugee and has been implemented successfully. The management of the program operating within a comprehensive health care project and the control activities has been performed through the existing health facilities. This project was based on the "Comprehensive Health Care Approach" concept and applied to a collection of 10,000 Somali refugees. A project, which could be further, developed and modified for other similar situations. The strategy adopted was based on periodic chemotherapy of schoolchildren, intense health education in close collaboration with the local community leaders. An overall reduction in prevalence of intestinal parasitic infections of 53% was one of the targets achieved through this effort after three years of activities. 92% and 62% reduced the intensity of Ascaris lumbricoides and Trichuris trichiura infection, respectively. This approach in concert with the political commitment and limited operational costs is a warranty for the future sustainability of the control activities. Future control strategies are tailored to the results of evaluation surveys and are targeted to the identified high-risk areas. This project can be seen as a model in other refugee situation with the use of limited local resources.

The electron microscopic structure of the detrusor muscle in schistosomiasis patients with poor bladder contractility as evaluated by urodynamic measures had been compared with normal detrusor muscle from non-schistosomiasis patients. In the patients with poor bladder contractility the detrusor was formed of muscle fibers which were smaller in size, widely separated by collagen and showed degenerative changes and hyalinosis. No evidence of smooth muscle hyperplasia, mitosis or fibroblastic proliferation was seen. This pathological changes in the bladder of schistosomiasis patients may explain the cause of poor contractility.

A total of fifteen clinically and parasitologically proven adult cases of cutaneous leishmaniasis were studied for the demonstration of premalignant factor(s). The levels of antibodies against Leishmania parasite were measured with the indirect haemagglutination test (IHAT) and evaluated with the results of lymphoblast transformation test (LTT), a tumour suppressor gene (P53) and an asportic proteinase enzyme (Cathepsin D). Three patients (females) refused to be biopsied. The results showed a direct correlation between elevation of IHAT in 7/12 patients (Titers 1/128 to 1/512) and elevation of LTT in 7/12 patients (82 to 90%). On the other hand, two males with low (?) seropositive IHAT (1/64) and low LTT (2040%) gave positive P53 antibody and moderate (1) and marked (1) degrees Cathepsin D. So, it is concluded that cutaneous leishmaniasis infection particularly chronic one favours the premalignant changes in the granulomatous lesions.

The use of modern abductive machine learning techniques is described for modeling and predicting outcome parameters in terms of input parameters in medical survey data. The AIM (Abductory Induction Mechanism) abductive network machine-learning tool is used to model the educational score in a health survey of 2,720 Albanian primary school children. Data included the child's age, gender, vision, nourishment, parasite infection, family size, parents' education, and educational score. Models synthesized by training on just 100 cases predict the educational score output for the remaining 2,620 cases with 100% accuracy. Simple models represented as analytical functions highlight global relationships and trends in the survey population. Models generated are quite robust, with no change in the basic model structure for a 10-fold increase in the size of the training set. Compared to other statistical and neural network approaches, AIM provides faster and highly automated model synthesis, requiring little or no user intervention.

The setting-based approach to health promotion and education has been adopted in an Albanian village. The project requires a high degree of self-determination and self-help. External support comes from the International Islamic Relief Organization. Encouraging progress is being made as villagers acquire a wide range of skills, connected not only with the provision of care but also with such matters as fund-raising, health education and relations with public and private bodies.A model health promotion project organized by the International Islamic Relief Organization in an Albanian village demonstrates the significance of the principles of self-help and community participation. The first step in the process was a mass meeting where villagers identified their problems and needs and volunteered for committees and working teams. To obtain in-depth data on social, personal, and health characteristics, 115 of the village's 284 households were randomly selected for interviews with the female head. Priorities were selected on the basis of the following criteria: probability of excellent results, effect on the maximum number of villagers, prevention of future health problems, cost-effectiveness, fulfillment of perceived community needs, and potential for community planning and implementation. Endemic goiter, childhood diarrhea, and unsanitary refuse disposal were selected. Community leaders and working teams then created an intervention program and defined aims, indicators, instruments, and roles. Participants were provided with computer training, and electronic media were used to present ways of dealing with common health problems. To date, villagers have made improvements in the local school, established a room for oral rehydration therapy, obtained iodine tablets and iodized salt from the Ministry of Health and some nongovernmental organizations, and constructed special sites for the burning of refuse. As a result of this project, villagers have developed skills in organizing, supervision, education, and fund raising and have learned how to approach nongovernmental organizations and government agencies for support. The self-reliance that has emerged as a result is expected to provide a sound basis for sustaining the projects even after external agents depart.

Twenty biopsied material of the testicular tissue were obtained from patients with unilateral hydrocele (eight due to lymphatic filariasis and twelve of idiopathic causes). Twenty biopsies lymphatic were also obtained from the normal unaffected testes and were used as control. The data obtained from histopathological, histochemical and ultrastructural studies revealed alternation in the testicular tissue with hydrocele than in the normal control testis. In the filarial hydrocele 37.5% of the cases showed thickening of the basement membrane and fibrosis with arrest of the spermatogenesis at the level of secondary spermatocytes. In addition, 12.5% showed thickening with interstitial fibrosis. Microfilariae were seen in hydrocele fluid of 3/8 cases (37.5%). In the idiopathic hydrocele 50% of the testicular tissue showed marked collagen deposits and testicular atrophy with fibrosis and thickening of basement membrane. The second 50% of cases showed variable degree of maturation arrests. Explanation for these variations in the pathological and anatomical pictures in both types of hydrocele is suggested. In the filariasis hydrocele it is due to the inflammatory response that may subside and recurrent. In the idiopathic hydrocele, it is due to the irreversible hypoxia caused by the continuous mechanical pressure due to huge amount of hydrocele fluid resulting in irreversible degenerative process with marked fibrosis.

Some histopathological and histochemical studies were carried out on the intestines of an acute case of infantile visceral leishmaniasis. Macrophages-carrying amastigotes were seen mainly in the villous tips, mucin secretion inside the mucosal cells was mild, deposits of collagen and fibrin in the lamina propria were marked and the argentaffin cells were partially lost. The whole results were discussed.

Hepatosplenomegaly accompanied with different intestinal troubles is more or less a marked clinical manifestations in children. The histopathological and histochemical changes were studied in biopsied materials taken from the sigmoidal and rectal tissues of 49 children. These children had schistosomiasis mansoni (26), schistosomiasis and amoebiasis (4), schistosomiasis and tuberculosis (TB.) (2), amoebiasis (4), thalassemia (6), acute myeloid leukaemia (AML) (1), mucopolysaccharidosis (1) and bacillary dysentery (5). The pathological changes were erosion ulceration hyperplasia, atrophy, crypt-abscess and fibrosis (mucosa) and oedema, congestion, cellular infiltration (Lamina propria). The chemical changes were the mucin secretion, deposition of collagen and fibrin and activity of the argentaffin cells. Not all the disease agent had the same effect, but changes were marked mainly in children with S. mansoni and/or E. histolytica.

The histo- and immuno-pathological and electron microscopy (EM.) of the splenic red pulps studies were carried out for schistosomiasis mansoni patients and normal controls. The main pathological processes were interstitial haemorrhages, congestion, proliferation and hyperplasia of the red pulps of the schistosomiasis mansoni patients. The IgG showed marked reaction, moderate with IgA and mild with IgM. The E.M. showed an increase in the size of the different types of the reticular cells particularly those of the nuclear membrane with type II, nuclear degeneration, deposition of fibrin threads, marked fibrosis and phagocytosis and formation of pores at the sinusoidal basement membrane. It was concluded that these pathological processes and the alteration in the immunoregulatory system of the spleen of schistosomiasis mansoni patients reflect the role played and perpetrated in the development of splenomegaly.

This paper reports a 13 year old Yemenian boy with cutaneous leishmaniasis (CL.). The histopathological picture of the CL lesions showed marked dysplasia indicating premalignancy. The possibility that CL as one of the predisposing factors for skin malignancy was discussed.

Lymphatic leishmaniasis was reported as an indigenous infection in a 30 year old male from Abo Hamad, Sharkia, Egypt. Cervical lymphadenopathy was the only clinical sign and no visceral involvement. Diagnosis was based on histopathological examination of needle biopsied material. The patient was successfully treated with sodium stibogluconate as shown clinically and parasitologically. It was concluded that lymphatic leishmaniasis should be in mind when dealing with lymphanopathy of unknown aetiology.

Eighteen patients suffering mainly from schistosomal hepatosplenomegaly (B.H.S.M.) were selectedclassified into 3 groups according to the degree of B.H.S.M. Muscle biopsy for histopathological, histochemical and immunopathological studies were taken. The results showed that fatiguability as a symptom was present in all cases but motor weakness was present in four cases. Twelve cases had peripheral neuropathy in the form of glove and stocking hypothesia, while pyramidal tract lesion was present in four cases. Two cases, however, showed both peripheral neuropathy and pyramidal tract lesions. Histopathological and histochemical assessment revealed frank myopathic changes in 14 cases while only one case showed definite neuropathic changes. The remainder cases were inconclusive. Immunopathological examination revealed marked deposition of IgG in 50% of cases, while IgM and IgA showed mild to moderate reactions. It was concluded that muscular changes in schistosomal patients are myopathic in nature and that immunological mechanisms could be considered as a factor in the pathogenesis of this muscular disorder.

This study was carried out on 68 cases (50 bilharzial stricture lower ureter, eight vesico-ureteral reflux cases and ten control). In cases of reflux associated with bilharziasis heavy ova-deposition was obvious all through the ureteral wall especially per-ureteral sheath. Also heavy deposition in the bladder wall involved the detrusor and trigonal muscle with fibrosis and obliteration of Waldeyer's space and atrophy and fasciculation of detrusor and trigonal muscle. This implies ureteral rigidity, impaired mobility and compression against a firm detrusor buttress.

While cutaneous leishmaniasis (CL) is a protozoal parasite of the skin, basal cell carcinoma (BCC) is a malignant tumour of the skin. In this paper, we report the identification of cutaneous leishmaniasis and basal cell carcinoma in one patient, in the same site and same lesion. This raised the possibility that CL is a predisposing factor for BCC.

AG-NOR was determined in the nuclei of thirty-five urinary bladder lesions, varying between benign and malignant schistosomal lesions and non schistosomal ones. The results showed that the assessment of AG-NOR in urinary bladder lesions can be valuable in distinguishing benign from malignant lesions of the urinary bladder and can be used as a prognostic parameter.

Serum samples were collected from 40 patients with enlarged lymph nodes. Lymph node and bone marrow biopsies were performed and processed as usual. Tumor necrosis factor-alpha (TNF alpha) was determined in the sera by factor test human TNF alpha ELISA kit. Histopathological studies of lymph node and bone marrow biopsies were evaluated. The data obtained from this study showed that bone marrow was involved in only 5 patients and their TNF showed the lowest level in this study with a mean level 50 pg/ml. The highest level of TNF occurred in cases with granulomatous lymphadenitis (124 pg/ml) followed by reactive lymphadenitis (105 pg/ml). It can be considered that TNF reflects the immune status of the patient and its study in the serum can be of help in evaluating the progress of the disease. An extended study is need to evaluate the role of TNF-alpha as a prognostic marker in malignancy.

The light and electron microscopic structure of detrusor muscle of trabeculated urinary bladder from patients with urodynamically proved bilharzial outflow obstruction had been compared with normal detrusor muscle. In bilharzial outflow obstruction, the detrusor muscle bundles were formed of relatively smaller smooth muscle cells widely separated by dense connective tissue, fatty infiltration, bilharzial ova, inflammatory cells and hyalinosis. No evidence of smooth muscle hyperplasia, mitosis, or fibroblastic proliferation. At the level of electron microscopy. The connective tissue infiltration was proved to be microfibriles apparently in continuity of the basal lamina of the smooth muscle. These pathological changes can explain both the morphological and urodynamic changes in bilharzial urinary bladder outflow obstruction.

Nuclear DNA content of laryngeal epithelial cells in smears was carried out by DNA cytometry with automatic microscope and T.V. image analysis system in 6 adult papilloma and 10 keratosis of the larynx patients. The method had high degree of precision confirmed by whole tissue biopsy and serial sections. The method is non invasive and allows fair diagnosis of suspicious and early malignant cases.

Fifty children aged 3 to 12 years presented with cervical or inguinal lymph nodes enlargement were selected from Zagazig University Hospitals. They were subjected to routine laboratory examination as well as histopathologicalimmunopathological studies. The results revealed eosinophilia and intestinal parasites in 80 percent. Besides, pediculosis and flea dermatitis were also demonstrated in 30 and 12 percent respectively. Histopathological studies of the nodal tissues revealed sinus hyperplasia (ten cases), reactive paracortical hyperplasia (30 cases) and necrosis and caseition (ten cases). Infiltration with eosinophils was demonstrated in the nodal tissues of 40 cases. Immunopathologyical studies revealed cytotoxic T-cells in all the cases, and helper T lymphocytes in only 15 cases. It is concluded that this may give an explanation of some causes of lymphadenopathy in Egyptian children other than malignancy.

Nowadays, renal stone is one of the medical complaints. Many theories have been suggested to account for its formation. The present work aimed to find out a correlation between schistosomiasis affection of the kidney and the formation of renal stones. Three groups of patients with renal stones were selected. They had Schistosoma mansoni infection (1st group), with Schistosoma haematobuim infection (2nd group) and Schistosoma free (3rd group or control). The results showed pathological changes in the kidney biopsied materials, particularly the glomerulus, ranging from periglomerular fibrosis to complete atrophy and lymphoid follicles in the interstitium. Sometimes, distal-tubular atrophy was seen. The serum and tissue immunoglobulins, particularly the IgA, in schistosomiasis patients were above normal as compared to control ones. It is concluded that the schistosomiasis affection of the kidney, and the resulting immunopathological changes were factors predisposing, in one way or another, to the formation of renal stones.

A total number of selected 252 patients with prolapsed lumbar intervertebral discs (92 extruded and 160 protruded) were operated upon in Neurosurgery Department Zagazig University Hospital during the period extended from January, 1988, to October 1990. In this study we reviewed their clinical and operative data. Surgical biopsies were taken from randomly selected 120 patients of them (50 extruded and 70 protruded discs) and were subjected to histopathological, histochemical and immunopathological studies. Ultrastructural study was performed for randomly selected 14 cases (7 extruded and 7 protruded discs). The results were compared with 7 normal intervertebral discs obtained from these studies showed that there were no differences between extruded and protruded discs at the histochemical level. Cell mediated immunity could be added as a factor in the pathogenesis of the degenerative process that lead to disc prolapse (in 20% of cases with extruded discs and 57.1% of cases with protruded discs). At the ultrastructural level 85.3% of extruded discs were prolapsed nucleus pulposus while 14.7% were prolapsed annulus fibrosus alone or with nucleus pulposus. All protruded discs were prolapsed annulus fibrosus with nucleus pulposus. These findings may have an impact on the management of this common problem.

One hundred sixty one placentae were examined grossly and microscopically, 131 specimens belonged to seropositive patients and 30 specimens belonged to seronegative patients and used as control. 63.3% of the placentae of seropositive patients were macroscopically normal, 9% were hydropic, 21% were of mixed or partially hydropic pattern, 6% had areas of infarction0.7% showed areas of calcifications. The most consistent microscopic finding was focal low grade chronic villitis with mononuclear inflammatory infiltrate. In hydropic placentae villous edema was of very variable degree from one placenta to another and from one area to another in the same placenta. Nucleated red blood cells were demonstrated in villous capillaries. The patients had Rh positive factor in their blood.

Bilharzial bladder tumour of 28 patients staged pre-operatively by transurethral ultrasound and computerized tomography (CT). The accuracy varied from 66.6% to 77.7% in different stages as compared with pathological stage. The bilharzial reaction could be play a role in this accuracy and the histopathological study is the accurate way to express the depth of infiltration of the tumour in the bladder wall as well as the depth of vascular invasion which may be greater than the primary tumour itself.

The HLA-DR antigen type was studied in fifty-four patients with bilharzial bladder carcinoma and in ten patients but with non malignant bilharzial bladder lesions as controls. The monoclonal antibodies were used to identify the pattern of the distribution of lymphocytes subset and the natural killer cells. These immunohistochemical studies through some light on the relation between the different immunocompetent cells in the bladder tissue and suggested their functional role particularly in bilharziasis and in the tumour surveillance.

Fifty cases of proven human cutaneous leishmaniasis were histopathologically studied. In twenty biopsies the picture was vascular alternations with or without fibrinoid necrosis and fibrin thrombi in both arteries and veins within the area of the inflammation in the lesions. Hyalinosis and intimal proliferation were also seen. On the other hand, immunoperoxidase staining of CL. lesions showed IgG and IgA within the endothelial cells, in the media and the perivascular space of the diseased vessels. It seems that the formation of immune complexes in the infected skin was responsible for the vascular changes.

Cutaneous leishmaniasis (CL) is a granulomatous skin disease. The healing of the CL. lesions is attributed to the delayed immunity developed against the amastigotes of the parasite. However, in some cases in spite of the development of strong delayed hypersensitivity CL. lesions failed to heal. In this paper, it was intended to assess the role of immunity in the lesions of human cutaneous leishmaniasis. The results showed that the helper cells predominated the suppressor ones, the mean percentage of B lymphocytes was 25 and the immunoglobulins particularly the IgG were demonstrated by being positively stained. On the other hand, the complement (C3) was within the normal range.