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This study presents 46 patients from 23 unrelated Egyptian families with ALS2-related disorders without evidence of lower motor neuron involvement. Age at onset ranged from 10 months to 2.5 years, featuring progressive upper motor neuron signs. Detailed clinical phenotypes demonstrated inter- and intrafamilial variability. We identified 16 homozygous disease-causing ALS2 variants; sorted as splice-site, missense, frameshift, nonsense and in-frame in eight, seven, four, three, and one families, respectively. Seven of these variants were novel, expanding the mutational spectrum of the ALS2 gene. As expected, clinical severity was positively correlated with disease onset (p = 0.004). This work provides clinical and molecular profiles of a large single ethnic cohort of patients with ALS2 mutations, and suggests that infantile ascending hereditary spastic paralysis (IAHSP) and juvenile primary lateral sclerosis (JPLS) are belonged to one entity with no phenotype-genotype correlation.

Background: Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022. Methods: This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories. Results: In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE). Conclusions: The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%. [ABSTRACT FROM AUTHOR]

Helicobacter pylori is newly emerging bacteria and one of the most common infections worldwide with over one-half of the world is infected with this organism. The aim of this study was to determine the prevalence of H. pylori among sheep, camels, and humans in Matrouh Province, North-West Egypt using H. pylori stool antigen enzyme immunoassay and stool PCR. A total of 250 stool samples were collected from farm animals (sheep and Camels) and humans in Matrouh Province. Samples were examined using H. pylori Stool Antigen Enzyme Immunoassay test and H. pylori 16S rRNA PCR. Statistical analysis was applied using Chi2 and IBM SPSS Statistics 25. The overall prevalence of H. pylori infection in the study by HpSA and PCR were 27.6% and 24.4%, respectively. Based on the results of HpSA test, it was found that the prevalence was 12% and 26% in sheep and camels, respectively, with statistically significant association between the prevalence and locality or age of sheep. Moreover, the prevalence of H. pylori infection in human was 44% by HpSA test with statistically significant association between the prevalence and gender or locality being higher in males than females with greater rural prevalence than urban. On the other hand, there was a non-statistically significant differences between H. pylori prevalence and sex, breed, and health status of examined animals or age, residence, and occupation of enrolled individuals. Conclusively, H. pylori was detected in both animal and human samples is alarming in Matrouh Province. Therefore, there was an urgent need for implementing a proper control program. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. METHODS: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20). RESULTS: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p

Influenza-like illness (ILI) remains a major cause of severe mortality and morbidity in the elderly. Aging is associated with a decreased ability to sense pathogens and mount effective innate and adaptive immune responses, thus mandating the development of protective nutraceuticals. Biobran/MGN-3, an arabinoxylan from rice bran, has potent anti-aging and immunomodulatory effects, suggesting that it may be effective against ILI. The objective of the current study was to investigate the effect of Biobran/MGN-3 on ILI incidence, natural killer (NK) cell activity, and the expressions of RIG-1 (retinoic acid-inducible gene 1), MDA5 (melanoma differentiation-associated protein 5), and their downstream signaling genes ISG-15 (interferon-stimulated genes 15) and MX1 (myxovirus (influenza) resistance 1, interferon-inducible). A double-blind, placebo-controlled clinical trial included eighty healthy older adults over 55 years old, 40 males and 40 females, who received either a placebo or Biobran/MGN-3 (500 mg/day) for 3 months during known ILI seasonality (peak incidence) in Egypt. The incidence of ILI was confirmed clinically according to the WHO case definition criteria. Hematological, hepatic, and renal parameters were assessed in all subjects, while the activity of NK and NKT (natural killer T) cells was assessed in six randomly chosen subjects in each group by the degranulation assay. The effect of Biobran/MGN-3 on RIG-1 and MDA5, as well as downstream ISG15 and MX1, was assessed in BEAS-2B pulmonary epithelial cells using flow cytometry. The incidence rate and incidence density of ILI in the Biobran/MGN-3 group were 5.0% and 0.57 cases per 1000 person-days, respectively, compared to 22.5% and 2.95 cases per 1000 person-days in the placebo group. Furthermore, Biobran/MGN-3 ingestion significantly enhanced NK activity compared to the basal levels and to the placebo group. In addition, Biobran/MGN-3 significantly upregulated the expression levels of RIG-1, MDA5, ISG15, and MX1 in the human pulmonary epithelial BEAS-2B cell lines. No side effects were observed. Taken together, Biobran/MGN-3 supplementation enhanced the innate immune response of elderly subjects by upregulating the NK activity associated with reduction of ILI incidence. It also upregulated the intracellular RIG-1, MDA5, ISG15, and MX1 expression in pulmonary epithelial tissue cultures. Biobran/MGN-3 could be a novel agent with prophylactic effects against a wide spectrum of respiratory viral infections that warrants further investigation.

Blastocystis sp. is currently reported as the most frequent single-celled eukaryote inhabiting the intestinal tract of humans and a wide range of animal groups. Its prevalence is especially higher in developing countries linked with fecal peril. Despite a growing interest in this enteric protozoan, certain geographical regions potentially at high risk of infection, such as North Africa, remain under-investigated. Therefore, a large-scale molecular epidemiological survey, including 825 participants presenting digestive disorders or not, was conducted in five governorates located in Northern Egypt. A real-time polymerase chain reaction (qPCR) assay was performed to identify the parasite in stool samples, followed by direct sequencing of the positive PCR products for subtyping and genotyping of the corresponding isolates. The overall prevalence was shown to reach 72.4% in the Egyptian cohort, coupled with a variable frequency depending on the governorate (41.3 to 100%). Among the 597 positive participants, a large proportion of them (39.4%) presented mixed infections, as determined by sequencing. The remaining individuals with single infection were predominantly colonized by subtype 3 (ST3) (48.3%) followed by ST1 (39.5%), ST2 (10.8%), ST14 (1.1%), and ST10 (0.3%). This was the first report of ST10 and ST14 in North Africa. Age, sex, digestive symptoms, and health status of the participants or contact with animals were not identified as significant risk factors for Blastocystis sp. occurrence or affecting the ST distribution. In contrast, substantial variations in the prevalence and ST distribution of the parasite were reported according to the governorate. Genotyping of isolates revealed the lower intra-ST diversity for ST3, followed by ST1 and then ST2. By combining subtyping and genotyping data, a widespread inter-human transmission was strongly suggested for ST3 within the Egyptian cohort. Regarding ST1 and ST2, additional animal or environmental sources of infection by these STs have been proposed, whereas the few cases of colonization by ST10 and ST14 were likely the result of zoonotic transmission from bovid. These investigations clearly emphasized the active circulation of Blastocystis sp. in Northern Egypt and the necessity for health authorities to implement prevention campaigns towards the population and quality control of drinking water, with the aim of reducing the burden of this enteric protozoan in this endemic country. [ABSTRACT FROM AUTHOR]

Chronic occupational exposure to organophosphorus pesticides (OPs) is consistently associated with deficits on behavioral tests when compared to unexposed comparison groups. However, a dose-response relationship has yet to be established, leading some to doubt an association between occupational OP exposure and behavioral deficits. Pesticide application teams in Egypt who are primarily exposed to one OP, chlorpyrifos (CPF), were recruited into a field assessment. Trail Making A and the more challenging Trail Making B tests were administered to 54 engineers (who supervise the pesticide application process, usually from the side of the field), 59 technicians (who guide the pesticide applicators in the field), 31 applicators (who mix and apply pesticides using knapsack sprayers), and 150 controls (who did not work in the fields) at two different times during the OP application season as well as immediately after applications had ended and 1.5 months later. All participants were males since only males work on pesticide application teams in Egypt. Urinary levels of 3,5,6-trichloro-2-pyridinol (TCPy), a specific metabolite of CPF, confirmed the pattern of lower to higher CPF exposures from engineers to technicians to applicators, and these were all greater than urinary metabolite levels in controls. A consistent relationship between job title and performance speed on the behavioral task was observed: Controls had the best (fastest) performance on Trail Making A and B tests throughout the application season, and applicators had significantly slower performance than engineers on Trail Making A (p = 0.015) and B (p = 0.003). However, individual urinary TCPy, blood acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) levels did not predict individual performance. This study identifies a dose-related effect based on job title, which serves as a surrogate for chronic exposure in that differing job titles exhibit varying group exposure levels. The results establish that chronic occupational exposure to chlorpyrifos is neurotoxic and suggest that the classic biomarkers of recent CPF exposure are not predictive of chronic exposure effects.

Protests are one of the most common expressions of modern political conflict, and the wave of demonstrations that marked the onset of the Arab Spring contributed to a global increase in protest activity. Yet few studies have examined the effects of exposure to protests on population well-being even though such exposure may have profound and lasting effects, especially if experienced at critical stages of development over the life course. The aim of our study is to estimate the effects of exposure to political protests on the human capital accumulation and well-being of youth during the tumultuous political transition experienced in Egypt from 2011 to 2014. For a nationally representative panel of youth captured in the 2009 and 2013/2014 waves of the Survey of Young People in Egypt (SYPE), we exploit exogenous geospatial variation in the occurrence of political protests from the Armed Conflict Location & Event Data (ACLED) Project to estimate individual-level changes in social trust, uncertainty, education, and health outcomes for youth exposed to protests. In our panel, 31.1% of the sample lived in districts where riots or protests occurred. Exposure to protests increased overall perceptions of uncertainty about the future. Young men ever exposed to protests were slightly more likely to report good overall health, but experienced sizable worsening in mental health compared to young women ever exposed. Differences by own and family participation in protest events were found for perceptions of uncertainty and mental health. In the aftermath of the Arab Spring and other mass protest movements around the globe, these findings highlight the importance of examining the population-level impacts of different forms of political conflict, particularly as substantial numbers of youth in Middle East and North Africa and elsewhere progress to adulthood under conditions of political instability.

Background and Aim: In Egypt, there is a scarcity of recent data on trichinellosis in pigs and humans. Therefore, this study aimed to determine the epidemiological profile and risk factors associated with Trichinella spiralis infection as well as to assess the effectiveness of the trichinoscope and digestion technique in diagnosing trichinellosis. Materials and Methods: Data were collected on 33812 pigs slaughtered during a year at the Al-Basateen abattoir, Cairo Governorate, Egypt. The slaughtered pigs had already been examined by trichinoscope in the abattoir. The diagnostic effectiveness technique was randomly conducted on 170 pork muscle samples, which were examined using the digestion technique. Furthermore, 90 serum samples from high-risk individuals in Qena and Sohag Governorates, Upper Egypt, were analyzed using an enzyme-linked immunosorbent assay. Results: The investigation revealed that the overall prevalence was 1.06% in pigs by trichinoscope. Of the examined 170 samples, 2.35% and 3.35% were found to harbor Trichinella by trichinoscope and artificial digestion, respectively. Trichinella was identified as T. spiralis using a polymerase chain reaction (PCR) technique. A significant relationship was affirmed between the prevalence of trichinellosis and the sex and age of the examined pigs. Likewise, for the first time, there was a considerable seasonal trend in the prevalence of Trichinella with the maximum infection, which was observed during Autumn (1.18%). The prevalence of trichinellosis in humans was 10%, with a significant association with age. Conclusion: Our findings are intended to serve as a starting point for developing effective preventive and control measures for trichinellosis (as application of Hazard Analysis Critical Control Points (HACCP) in pig farms, stop feeding pigs on garbage as well as, preventing illegal slaughter of pigs outside the slaughterhouses). It also fortifies the establishment of the digestion technique because of its high specificity and sensitivity, although it is difficult to apply to a large number of samples.

PurposeIn 2015, to determine where interventions are needed to eliminate trachoma as a public health problem from Egypt, we initiated population-based prevalence surveys using the Global Trachoma Mapping Project platform in four suspected-endemic marakez (districts; singular: markaz) of the governorates of Elmenia and Bani Suef.MethodsIn each markaz, 30 households were selected in each of 25 villages. Certified graders examined a total of 3682 children aged 1-9 years in 2993 households, noting the presence or absence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI) in each eye. A total of 5582 adults aged ≥15 years living in the same households were examined for trachomatous trichiasis (TT). Household-level access to water and sanitation was recorded.ResultsThree of four marakez had age-adjusted TF prevalence estimates in 1-9-year olds of >10%; the other markaz had a TF prevalence estimate of 5-9.9%. Estimates of the age- and gender-adjusted prevalence of unmanaged TT in adults ranged from 0.7% to 2.3%. Household-level access to water and sanitation was high. (We did not, however, measure use of water or sanitation facilities.) Conclusions: Each of the four marakez surveyed has trachoma as a public health problem, with a need for implementation of the SAFE (surgery, antibiotics, facial cleanliness, environmental improvement) strategy. Further mapping is also required to determine the need for interventions in other areas of Egypt.

This study investigated incidence, phenotypic-genotypic antimicrobial resistance in zoonotic Salmonellae from broiler chicken and human in Egypt. Two hundred and forty samples were randomly collected from broilers including (liver, gizzard, intestine, n.= 60 of each) and from workers (hand swabs, n.= 60) at poultry outlets. Isolation, biochemical and serological identifications of Salmonella spp. were performed. Antimicrobial susceptibility testing of Salmonella serotypes was done using disc diffusion method. The multiple antibiotic resistance (MAR) index of Salmonella serotypes was calculated. Genotypic detection of antimicrobial resistance genes [blaTEM, floR and tetA(A)] was identified in phenotypically resistant Salmonellae using PCR. The incidence of Salmonella spp. was 5% in each of liver and intestine of broilers, and 1.66% in gizzard of broilers; and 3.33% in hand swabs of workers. The serotypes of S. Typhimurium were distributed into liver of broilers (3 out of 4, 75%) and into intestine of broilers (1 out of 4, 25%). The distribution of S. Enteritidis was 33.3% (1 out of 3) in gizzard and 66.7% (2 out of 3) was distributed in intestine of broiler. Two isolates of S. Kentucky (100%) were distributed in hand swabs from workers. The peak resistance (100%) of 9 Salmonella isolates was found to each of chloramphenicol and ampicillin followed by a highest resistance (88.8%) to doxycycline The profile of each S. Typhimurium and S. Enteritidis isolates from broiler chicken reached the peak resistance (100%) for ampicillin, chloramphenicol and doxycycline The multiple antibiotic resistance (MAR) index of Salmonella isolates was ranged from 0.23 to 0.54 with an average of 0.34. The blaTEM, tetA(A) and floR genes were identified with similar distribution percentage of 66.7% in S. Typhimurium isolates from liver. all isolates of S. Enteritidis from gizzard, S. Typhimurium from intestine, S. Enteritidis from intestine and S. Kentucky from hand swabs harbored similar distribution percentage (100%) for each blaTEM, tetA(A) and floR gene. Further studies are required to predict biological tools such as bacteriophages during poultry production to minimize entry of multidrug resistant (MDR) Salmonellae from broiler chicken to human food chain. [ABSTRACT FROM AUTHOR]

Blastocystis sp. is currently reported as the most frequent single-celled eukaryote inhabiting the intestinal tract of humans and a wide range of animal groups. Its prevalence is especially higher in developing countries linked with fecal peril. Despite a growing interest in this enteric protozoan, certain geographical regions potentially at high risk of infection, such as North Africa, remain under-investigated. Therefore, a large-scale molecular epidemiological survey, including 825 participants presenting digestive disorders or not, was conducted in five governorates located in Northern Egypt. A real-time polymerase chain reaction (qPCR) assay was performed to identify the parasite in stool samples, followed by direct sequencing of the positive PCR products for subtyping and genotyping of the corresponding isolates. The overall prevalence was shown to reach 72.4% in the Egyptian cohort, coupled with a variable frequency depending on the governorate (41.3 to 100%). Among the 597 positive participants, a large proportion of them (39.4%) presented mixed infections, as determined by sequencing. The remaining individuals with single infection were predominantly colonized by subtype 3 (ST3) (48.3%) followed by ST1 (39.5%), ST2 (10.8%), ST14 (1.1%), and ST10 (0.3%). This was the first report of ST10 and ST14 in North Africa. Age, sex, digestive symptoms, and health status of the participants or contact with animals were not identified as significant risk factors for Blastocystis sp. occurrence or affecting the ST distribution. In contrast, substantial variations in the prevalence and ST distribution of the parasite were reported according to the governorate. Genotyping of isolates revealed the lower intra-ST diversity for ST3, followed by ST1 and then ST2. By combining subtyping and genotyping data, a widespread inter-human transmission was strongly suggested for ST3 within the Egyptian cohort. Regarding ST1 and ST2, additional animal or environmental sources of infection by these STs have been proposed, whereas the few cases of colonization by ST10 and ST14 were likely the result of zoonotic transmission from bovid. These investigations clearly emphasized the active circulation of Blastocystis sp. in Northern Egypt and the necessity for health authorities to implement prevention campaigns towards the population and quality control of drinking water, with the aim of reducing the burden of this enteric protozoan in this endemic country.

Volcanic eruptions provide tests of human and natural system sensitivity to abrupt shocks because their repeated occurrence allows the identification of systematic relationships in the presence of random variability. Here we show a suppression of Nile summer flooding via the radiative and dynamical impacts of explosive volcanism on the African monsoon, using climate model output, ice-core-based volcanic forcing data, Nilometer measurements, and ancient Egyptian writings. We then examine the response of Ptolemaic Egypt (305-30 BCE), one of the best-documented ancient superpowers, to volcanically induced Nile suppression. Eruptions are associated with revolt onset against elite rule, and the cessation of Ptolemaic state warfare with their great rival, the Seleukid Empire. Eruptions are also followed by socioeconomic stress with increased hereditary land sales, and the issuance of priestly decrees to reinforce elite authority. Ptolemaic vulnerability to volcanic eruptions offers a caution for all monsoon-dependent agricultural regions, presently including 70% of world population.The degree to which human societies have responded to past climatic changes remains unclear. Here, using a novel combination of approaches, the authors show how volcanically-induced suppression of Nile summer flooding led to societal unrest in Ptolemaic Egypt (305-30 BCE).

Amidst the recent political uprisings in the Arab region, physicians and other healthcare workers have found themselves in the crossfire. This paper focuses on Egypt's doctors, paying special attention to how many have both appealed to and practiced medical neutrality as its own potent and contested political stance, particularly since the period of military rule following Mubarak's removal from power. Our paper draws on interviews with physicians who served as volunteers in the field hospitals in the days of unrest and violence, and with others who played a major role in documenting protesters' injuries, police brutality, and other forms of state violence against unarmed citizens. Based on interviews with doctors who belong to organizations such as "Tahrir Doctors" and "Doctors Without Rights," our paper reveals how these doctors' commitment to professional ethics put them at odds with the orders of military personnel, rendering their appeal to "medical neutrality" a weighty political act in and of itself.

Using dead bodies for medical purposes has long been considered taboo in Egypt. Public health campaigns, physicians' pleas, and the urgings of religious scholars all failed to alter public opinion regarding the donation of dead bodies either for instructional material or for therapeutic treatments. Yet in 2011, amid revolutionary turmoil in Egypt, a campaign was launched for people to donate their eyes upon death; this time, people readily signed up to be donors. Focusing on mass eye trauma that occurred in Egypt amid the political uprisings of 2011, I raise questions about when and why Islam can explain people's attitudes and behaviors, particularly toward death and medicine. The case of mass eye trauma in Egypt and citizens' reformulations of questions once jealously controlled by state-aligned doctors, politicians, and religious scholars unsettles the boundaries between 'religion' and 'secularism' in medical practice. [Formula: see text].

BackgroundResults from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery.MethodsWe pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis.FindingsThe studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]).InterpretationOur results suggest an increased risk of childhood ALL after prelabour caesarean delivery. If this association is causal, maladaptive immune activation due to an absence of stress response before birth in children born by prelabour caesarean delivery could be considered as a potential mechanism.FundingNational Cancer Institute.

Background and Aim: Fresh produce farms represents a major source of concern since they are becoming increasingly antibiotic resistant. This study aimed to investigate t he occurrence of carbapenemase and extended-spectrum-betalactamases (ESBL) - producing genes in Klebsiella pneumoniae isolated from fresh produce farms in Egypt, irrigation water, and people working in these fields. Materials and Methods: One hundred tomatoes from typical farms were collected in plastic bags. The study also included 20 surface-water samples from different irrigation watersheds in fresh produce farms, as well as 50 feces samples from farmworkers. Suspected K. pneumoniae was grown on Eosin Methylene Blue agar for 24 h before being biochemically identified using the RapID ONE test. PCR was used to detect carbapenemase (blaKPC, blaOXA-48, and blaNDM) and ESBL (blaSHV, blaTEM, and blaCTX) expressing genes on isolates. Results: K. pneumoniae was identified in 30% of water and 10% of worker samples, while only one isolate was found in tomato samples. One of the six irrigation water isolates tested positive for carbapenem-resistant NDM. In contrast, two isolates tested positive for ESBL determinants, one of which was blaSHV and the other having both blaSHV and blaTEM genes. Two of the five K. pneumoniae isolates from farmworkers were positive for blaNDM, with one isolate also testing positive for blaSHV and blaTEM. The blaOXA-48 gene was also discovered in the carbapenem-resistant K. pneumoniae tomato isolate used in this study. Conclusion: Carbapenemase- and ESBL-producing K. pneumoniae were found in fresh produce farms, implying that these resistance genes were being passed down to Egyptian consumers. [ABSTRACT FROM AUTHOR]

Bartonellosis is a vector-borne zoonotic disease caused by the intracellular bacterium of genus Bartonella. The disease has a worldwide distribution and cats represent the major reservoir of this disease. Despite its global distribution, very limited previous studies have investigated the occurrence of bartonellosis in cats and their owners in Egypt. In an endeavor to explore this topic, we investigated the occurrence of Bartonella henselae (B. henselae) infection in 225 samples (blood, saliva, and claw) obtained from 75 healthy cats in Upper Egypt. These samples were routinely obtained during veterinary clinic visits. This study also involved an examination of 100 humans, including cat owners and people with a history of contact with cats. Attempted isolation and identification of B. henselae in cats were also performed. Furthermore, PCR was performed for molecular identification of B. henselae in blood samples from cats. Meanwhile, an immunofluorescent assay was performed to study the seroprevalence of B. henselae infection in humans. In this study, B. henselae could not be isolated from any of the examined blood, saliva, or claw samples from cats. Interestingly, B. henselae was identified molecularly in 8% (6/75) of blood samples from cats. The seroprevalence of B. henselae in humans was 46% and its occurrence was higher in females (46.6%) than in males (41.7%) (P = 0.748). B. henselae infection was higher among cat owners [51.4% (19/37)] than among people with a history of contact with cats [42.9% (27/63)] (P = 0.410). Infection was higher in rural regions [79.5% (31/39)] than in urban regions [24.6% (15/61)] (P < 0.001). Collectively, this data provide interesting baseline information about the occurrence of B. henselae in cats and humans in Upper Egypt, which reflects the potential zoonotic transmission of this bacterium. Future study is mandatory to explore the occurrence of B. henselae in major reservoirs in Egypt.

In this article, we demonstrate how living kidney donation is a particularly gendered experience. We draw on anthropologists' contributions to understanding the globalization of reproductive technologies to argue that kidney donation similarly endangers and preserves fertility, thereby unsettling and reifying gendered familial labor. Based on fieldwork in two ethnographic sites--Egypt and Mexico--we examine how kidney donation is figured as a form of social reproduction. In both settings, kidney recipients rely almost exclusively on organs from living donors. We focus on how particular gender ideologies--as evident, for example, in the trope of the "self-sacrificing mother"--can serve as a cultural technology to generate donations in an otherwise organ-scarce medical setting. Alternatively, transplantation can disrupt gender norms and reproductive viability. In demonstrating the pervasiveness of gendered tropes in the realm of transplantation, we unsettle assumptions about the "family" as the locus of pure, altruistic donation.

Obesity is a major health problem with increasing prevalence and directly contributes to the development of cardiovascular disease (CVD). Selenoprotein P (Se P) is a novel hepatokine that affects glucose metabolism, lipid metabolism, and correlating with insulin resistance, inflammation, and atherosclerosis. Plasma Se P level is one of the promising biomarkers for predictions or diagnoses/prognoses of the diseases. Evaluating the serum level of Selenoprotein P in overweight, obese, and lean individuals and its relation to insulin resistance and cardiometabolic parameters. A cross-sectional study was conducted in the Outpatient Endocrinology Clinics, Internal Medicine Department, Menoufia University Hospitals on 90 individuals that were divided into two groups: (group I) 50 overweight and obese individuals (with body mass index (BMI) in the range 25.0–29.9 kg/m2 and ≥30.0 kg/m2, respectively) and (group II) 40 lean individuals with BMI in the range (18.5–24.9) kg/m2. All subjects were subjected to detailed history taking, clinical examination, and laboratory investigations including fasting and 2 hours postprandial blood sugar, lipid profile, fasting serum insulin level, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and serum Se P. Se P concentrations were significantly increased in overweight and obese group than lean group (p < 0.001). Se P concentration was related to various cardio-metabolic parameters. In overweight and obese group there was a significant positive correlation between serum Selenoprotein p level and waist circumference (WC) (r −0.453, p <0.001), hip circumference (HC) (r = 0.464, p < 0.001), waist-hip ratio (WHR) (r −0.506, p < 0.001), visceral adiposity index (VAI) (r = 0.323, p = 0.022), fasting serum insulin (r = 0.585, p < 0.001), and HOMA-IR (r = 0.570, p < 0.001). Circulating Se P concentrations is elevated in obesity and related to insulin resistance, visceral adiposity, and atherogenic index of plasma. [ABSTRACT FROM AUTHOR]

Maternal mortality attributable to post-abortion hemorrhage is often associated with delays in reaching or receiving definitive care. The nonpneumatic antishock garment (NASG), a low-technology first-aid device, has been shown to decrease blood loss and mortality among women experiencing hypovolemic shock secondary to obstetric hemorrhage etiologies. Women experiencing post-abortion hemorrhage face longer delays in receiving definitive treatment as a result of abortion-related stigma and lack of access to quality abortion care; thus the NASG has the potential to make an even greater impact within this population. We conducted a secondary analysis of data collected in Egypt, Nigeria, Zambia, and Zimbabwe in NASG trials, limiting our analytic sample to women who experienced post-abortion hemorrhage (n = 953). Blood loss significantly decreased when the NASG was added to standard hemorrhage management during the intervention phase, and there was a large, although not statistically significant, 52 percent decrease in mortality during the NASG phase. The results indicate that adding the NASG to post-abortion care among women experiencing severe hemorrhage and hypovolemic shock would decrease blood loss and mortality.

Introduction and hypothesisOur aim was to translate then assess the reliability of the culturally adapted Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire, International Urogynecological Association (IUGA)-Revised (PISQ-IR) to assess sexual health among Arabic-speaking women with pelvic floor disorders.MethodsPISQ-IR was modified to consider cultural characteristics of the Middle East. The final reliability study included 172 women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). Participants completed the questionnaire twice: at enrollment and 2 weeks later.ResultsAmong sexually active women, good internal consistency was observed for five of the six scales in the adapted instrument: Global Quality (Cronbach's coefficient α = 0.86), Condition Impact (α = 0.87), Desire (α = 0.82), Condition Specific (α = 0.74), and Partner Related (α = 0.75). Internal consistency was acceptable for the Arousal Orgasm subscale (α = 0.66). However, among not sexually active women, internal consistency was poor (α

Chlorpyrifos (CPF) and profenofos (PFF) are organophosphorus (OP) insecticides that are applied seasonally in Egypt to cotton fields. Urinary trichloro-2-pyridinol (TCPy), a specific CPF metabolite, and 4-bromo-2-chlorophenol (BCP), a specific PFF metabolite, are biomarkers of exposure, while inhibition of blood butyrylcholinesterase (BChE) and acetylcholinesterase (AChE) activities are effect biomarkers that may be associated with neurotoxicity. Urinary TCPy and BCP and blood BChE and AChE activities were measured in 37 adult Egyptian Ministry of Agriculture workers during and after 9-17 consecutive days of CPF application followed by an application of PFF (9-11 days), and a second CPF application (5 days) in 2008. During the OP applications, urinary TCPy and BCP levels were significantly higher than baseline levels, remained elevated following the application periods, and were associated with an exposure related inhibition of blood BChE and AChE. Analysis of blood AChE levels before and after the PFF application period suggests that individual workers with peak BCP levels greater than 1000 μg/g creatinine exhibited further inhibition of blood AChE with PFF application, demonstrating that PFF exposure had a negative impact on AChE activity in this highly exposed worker population. While large interindividual differences in exposure were observed throughout this longitudinal study (peak urinary BCP and peak TCPy levels for individuals ranging from 13.4 to 8052 and 16.4 to 30,107 μg/g creatinine, respectively), these urinary biomarkers were highly correlated within workers (r=0.75, p

Coronary artery aneurysms that occur in 25% of untreated Kawasaki disease (KD) patients may remain clinically silent for decades and then thrombose resulting in myocardial infarction. Although KD is now the most common cause of acquired heart disease in children in Asia, the United States, and Western Europe, the incidence of KD in Egypt is unknown. We tested the hypothesis that young adults in Egypt presenting with acute myocardial ischemia may have coronary artery lesions because of KD in childhood. We reviewed a total of 580 angiograms of patients ≤40 years presenting with symptoms of myocardial ischemia. Coronary artery aneurysms were noted in 46 patients (7.9%), of whom 9 presented with myocardial infarction. The likelihood of antecedent KD as the cause of the aneurysms was classified as definite (n = 10), probable (n = 29), or equivocal (n = 7). Compared with the definite and probable groups, the equivocal group had more traditional cardiovascular risk factors, smaller sized aneurysms, and fewer coronary arteries affected. In conclusion, in a major metropolitan center in Egypt, 6.7% of adults aged ≤40 years who underwent angiography for evaluation of possible myocardial ischemia had lesions consistent with antecedent KD. Because of the unique therapeutic challenges associated with these lesions, adult cardiologists should be aware that coronary artery aneurysms in young adults may be because of missed KD in childhood.

Emerging and re-emerging infectious diseases of zoonotic origin like highly pathogenic avian influenza pose a significant threat to human and animal health due to their elevated transmissibility. Identifying the drivers of such viruses is challenging, and estimation of spatial diffusion is complicated by the fact that the variability of viral spread from locations could be caused by a complex array of unknown factors. Several techniques exist to help identify these drivers, including bioinformatics, phylogeography, and spatial epidemiology, but these methods are generally evaluated separately and do not consider the complementary nature of each other. Here, we studied an approach that integrates these techniques and identifies the most important drivers of viral spread by focusing on H5N1 influenza A virus in Egypt because of its recent emergence as an epicenter for the disease. We used a Bayesian phylogeographic generalized linear model (GLM) to reconstruct spatiotemporal patterns of viral diffusion while simultaneously assessing the impact of factors contributing to transmission. We also calculated the cross-species transmission rates among hosts in order to identify the species driving transmission. The densities of both human and avian species were supported contributors, along with latitude, longitude, elevation, and several meteorological variables. Also supported was the presence of a genetic motif found near the hemagglutinin cleavage site. Various genetic, geographic, demographic, and environmental predictors each play a role in H1N1 diffusion. Further development and expansion of phylogeographic GLMs such as this will enable health agencies to identify variables that can curb virus diffusion and reduce morbidity and mortality.

There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI).Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation.Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before.Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

Pyrethroids are neurotoxic insecticides that exert their effects by prolonging the open time of sodium channels, which increases the duration of neuronal excitation. α-cypermethrin (αCM) is derived from the 8-stereoisomers that together make up the pyrethroid cypermethrin, which is one of the most common pyrethroids being used in agriculture throughout the world. The objective of this study was to characterize the occupational exposure to αCM in a cohort of Egyptian agriculture workers (n=37) before, during and after 6-10 consecutive days of application of αCM to cotton fields. Daily spot urine specimens were collected and analyzed by GC-MS NCI for the αCM metabolites 3-phenoxybenzoic acid (3-PBA) and cis-3-(2',2'-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA). Prior to αCM application, median urinary levels of 3-PBA (4.59nmol/g creatinine) were greater than cis-DCCA (0.33nmole/g creatinine) demonstrating low background exposures to pyrethroids. During the application period for αCM, median urinary levels of both biomarkers increased (13.44nmol 3-PBA/g creatinine and 7.76nmol cis-DCCA/g creatinine) and ranged from 2.3-93.96nmol 3-PBA/g creatinine and 0.09-90.94nmol cis-DCCA/g creatinine, demonstrating that workers had a wide range of exposures to αCM. The data also demonstrate that pesticide applicators had greater exposures to αCM than workers who play a supporting role in the seasonal application of pesticides on the cotton crop. Urinary cis-DCCA and 3-PBA concentrations were elevated at 7-11 days after the cessation of αCM application, compared to baseline levels. This study is the first to use these biomarkers to quantify occupational exposures specifically to αCM. This urinary biomarker data will be useful for estimating daily internal dose, comparing exposures across job categories within the Egyptian pesticide application teams, and for modeling human exposures to αCM.

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has become the leading cause of health care-associated infections. Treatment is difficult due to the lack of an effective antimicrobial therapy, and mortality is high. This study investigated the occurrence of CRPA in farm animals (buffaloes and cattle), livestock drinking water, and humans in Egypt.

Faunal evidence from the Fayum Neolithic is often cited in the framework of early stock keeping in Egypt. However, the data suffer from a number of problems. In the present paper, large faunal datasets from new excavations at Kom K and Kom W (4850-4250 BC) are presented. They clearly show that, despite the presence of domesticates, fish predominate in the animal bone assemblages. In this sense, there is continuity with the earlier Holocene occupation from the Fayum, starting ca. 7350 BC. Domesticated plants and animals appear first from approximately 5400 BC. The earliest possible evidence for domesticates in Egypt are the very controversial domesticated cattle from the 9th/8th millennium BC in the Nabta Playa-Bir Kiseiba area. The earliest domesticates found elsewhere in Egypt date to the 6th millennium BC. The numbers of bones are generally extremely low at this point in time and only caprines are present. From the 5th millennium BC, the numbers of sites with domesticates dramatically increase, more species are also involved and they are usually represented by significant quantities of bones. The data from the Fayum reflect this two phase development, with very limited evidence for domesticates in the 6th millennium BC and more abundant and clearer indications in the 5th millennium BC. Any modelling of early food production in Egypt suffers from poor amounts of data, bias due to differential preservation and visibility of sites and archaeological remains, and a lack of direct dates for domesticates. In general, however, the evidence for early stock keeping and accompanying archaeological features shows large regional variation and seems to be mainly dependent on local environmental conditions. The large numbers of fish at Kom K and Kom W reflect the proximity of Lake Qarun.

Why do patients in need of kidney transplants in Egypt decline offers of kidney donation from their family members out of reluctance to cause them harm? Is it not universally the case that a living donor could live in complete health with a single remaining kidney? To address this conundrum, I discuss a case study from Egypt, in which patients reveal social, political, and environmental stresses on organ function that challenge the presumed universal efficacy and safety of kidney transplantation. I demonstrate that the biomedical position on the tolerable risks posed to the living donor is conditional and premised on particular social and historical contingencies that can be misaligned when applied in other contexts. Drawing on the work of Margaret Lock, I illustrate how analytical contributions of medical anthropologists can shed light on a political and public health impasse about how to legally regulate organ transplantation in Egypt.

Profenofos is a direct acting phosphorothioate organophosphorus (OP) pesticide capable of inhibiting β-esterases such as acetylcholinesterase, butyrylcholinesterase, and carboxylesterase. Profenofos is known to be detoxified to the biologically inactive metabolite, 4-bromo-2-chlorophenol (BCP); however, limited data are available regarding the use of urinary BCP as an exposure biomarker in humans. A pilot study conducted in Egyptian agriculture workers, demonstrated that urinary BCP levels prior to application (3.3-30.0 μg/g creatinine) were elevated to 34.5-3,566 μg/g creatinine during the time workers were applying profenofos to cotton fields. Subsequently, the in vitro enzymatic formation of BCP was examined using pooled human liver microsomes and recombinant human cytochrome P-450s (CYPs) incubated with profenofos. Of the nine human CYPs studied, only CYPs 3A4, 2B6, and 2C19 were able to metabolize profenofos to BCP. Kinetic studies indicated that CYP 2C19 has the lowest Km, 0.516 μM followed by 2B6 (Km=1.02 μM) and 3A4 (Km=18.9μM). The Vmax for BCP formation was 47.9, 25.1, and 19.2 nmol/min/nmol CYP for CYP2B6, 2C19, and 3A4, respectively. Intrinsic clearance (Vmax/Km) values of 48.8, 46.9, and 1.02 ml/min/nmol CYP 2C19, 2B6, and 3A4, respectively, indicate that CYP2C19 and CYP2B6 are primarily responsible for the detoxification of profenofos. These findings support the use of urinary BCP as a biomarker of exposure to profenofos in humans and suggest polymorphisms in CYP 2C19 and CYP 2B6 as potential biomarkers of susceptibility.

Introduction: Leptospirosis is a neglected zoonosis in developing countries including Egypt where its burden is underestimated. Methodology: A cross sectional study was carried out to estimate the seroprevalence and associated risk factors of Leptospira interrogans serovar Hardjo infection among cows and leptospirosis among human patients in Mid-Delta of Egypt. Results: Out of 112 examined cows using ELISA, 3.6% were seropositive to L. interrogans serovar Hardjo infection. Seroconversion occurred in 5 animals (1 herd) of all examined animals in convalescent phase testing (5/112, 4.5%). Affected herd suffered acute outbreak with 43.3% within herd prevalence; signs of infection included abortions, bloody urine and sudden death of 2 cows. Highest risk for L. interrogans serovar Hardjo infection in cows was in animals drank from untreated surface water (6.7 times, p = 0.06). The seroprevalence of leptospirosis was 6.2% in all tested humans, 28.6% in nonspecific fever cases and 22.2% in non-viral hepatitis cases. The risk of leptospirosis among patients with nonspecific fever or non-viral hepatitis cases was 4 times higher than those with viral hepatitis (p = 0.01). Additionally, there was a significant association between leptospirosis and patients with livestock contact (Odds 8, p = 0.01). Conclusions: This is the first report of L. interrogans serovar Hardjo outbreak in cows in Egypt. The study also highlighted the role of leptospirosis as neglected cause of nonspecific fever/non-viral hepatitis in humans in study region. [ABSTRACT FROM AUTHOR]

Animal studies have shown that paraoxonase 1 (PON1) genotype can influence susceptibility to the organophosphorus pesticide chlorpyrifos (CPF). However, Monte Carlo analysis suggests that PON1 genotype may not affect CPF-related toxicity at low exposure conditions in humans. The current study sought to determine the influence of PON1 genotype on the activity of blood cholinesterase as well as the effect of CPF exposure on serum PON1 in workers occupationally exposed to CPF. Saliva, blood and urine were collected from agricultural workers (n=120) from Egypt's Menoufia Governorate to determine PON1 genotype, blood cholinesterase activity, serum PON1 activity towards chlorpyrifos-oxon (CPOase) and paraoxon (POase), and urinary levels of the CPF metabolite 3,5,6-trichloro-2-pyridinol (TCPy). The PON1 55 (P≤0.05) but not the PON1 192 genotype had a significant effect on CPOase activity. However, both the PON1 55 (P≤0.05) and PON1 192 (P≤0.001) genotypes had a significant effect on POase activity. Workers had significantly inhibited AChE and BuChE after CPF application; however, neither CPOase activity nor POase activity was associated with ChE depression when adjusted for CPF exposure (as determined by urinary TCPy levels) and stratified by PON1 genotype. CPOase and POase activity were also generally unaffected by CPF exposure although there were alterations in activity within specific genotype groups. Together, these results suggest that workers retained the capacity to detoxify chlorpyrifos-oxon under the exposure conditions experienced by this study population regardless of PON1 genotype and activity and that effects of CPF exposure on PON1 activity are minimal.

Translational research is needed to understand and predict the neurotoxic consequences associated with repeated occupational exposures to organophosphorus pesticides (OPs). In this report, we describe a research strategy for identifying biomarkers of OP neurotoxicity, and we characterize pesticide application workers in Egypt's Menoufia Governorate who serve as our anchor human population for developing a parallel animal model with similar exposures and behavioral deficits and for examining the influence of human polymorphisms in cytochrome P450 (CYP) and paraoxonase 1 (PON1) enzymes on OP metabolism and toxicity. This population has previously been shown to have high occupational exposures and to exhibit a broad range of neurobehavioral deficits. In addition to observational studies of work practices in the field, questionnaires on demographics, lifestyle and work practices were administered to 146 Egyptian pesticide application workers applying pesticides to the cotton crop. Survey results indicated that the application workforce uses standard operating procedures and standardized equipment provided by Egypt's Ministry of Agriculture, which provides a workforce with a stable work history. We also found that few workers report using personal protective equipment (PPE), which likely contributes to the relatively high exposures reported in these application workers. In summary, this population provides a unique opportunity for identifying biomarkers of OP-induced neurotoxicity associated with occupational exposure.

North African populations are distinct from sub-Saharan Africans based on cultural, linguistic, and phenotypic attributes; however, the time and the extent of genetic divergence between populations north and south of the Sahara remain poorly understood. Here, we interrogate the multilayered history of North Africa by characterizing the effect of hypothesized migrations from the Near East, Europe, and sub-Saharan Africa on current genetic diversity. We present dense, genome-wide SNP genotyping array data (730,000 sites) from seven North African populations, spanning from Egypt to Morocco, and one Spanish population. We identify a gradient of likely autochthonous Maghrebi ancestry that increases from east to west across northern Africa; this ancestry is likely derived from "back-to-Africa" gene flow more than 12,000 years ago (ya), prior to the Holocene. The indigenous North African ancestry is more frequent in populations with historical Berber ethnicity. In most North African populations we also see substantial shared ancestry with the Near East, and to a lesser extent sub-Saharan Africa and Europe. To estimate the time of migration from sub-Saharan populations into North Africa, we implement a maximum likelihood dating method based on the distribution of migrant tracts. In order to first identify migrant tracts, we assign local ancestry to haplotypes using a novel, principal component-based analysis of three ancestral populations. We estimate that a migration of western African origin into Morocco began about 40 generations ago (approximately 1,200 ya); a migration of individuals with Nilotic ancestry into Egypt occurred about 25 generations ago (approximately 750 ya). Our genomic data reveal an extraordinarily complex history of migrations, involving at least five ancestral populations, into North Africa.

BackgroundChlorpyrifos (CPF), a widely used organophosphorus pesticide (OP), is metabolized to CPF-oxon, a potent cholinesterase (ChE) inhibitor, and trichloro-2-pyridinol (TCPy). Urinary TCPy is often used as a biomarker for CPF exposure, whereas blood ChE activity is considered an indicator of CPF toxicity. However, whether these biomarkers are dose related has not been studied extensively in populations with repeated daily OP exposures.ObjectiveWe sought to determine the relationship between blood ChE and urinary TCPy during repeated occupational exposures to CPF.MethodsDaily urine samples and weekly blood samples were collected from pesticide workers (n=38) in Menoufia Governorate, Egypt, before, during, and after 9-17 consecutive days of CPF application to cotton fields. We compared blood butyrylcholinesterase (BuChE) and acetylcholinesterase (AChE) activities with the respective urinary TCPy concentrations in each worker.ResultsAverage TCPy levels during the middle of a 1- to 2-week CPF application period were significantly higher in pesticide applicators (6,437 µg/g creatinine) than in technicians (184 µg/g) and engineers (157 µg/g), both of whom are involved in supervising the application process. We observed a statistically significant inverse correlation between urinary TCPy and blood BuChE and AChE activities. The no-effect level (or inflection point) of the exposure-effect relationships has an average urinary TCPy level of 114 µg/g creatinine for BuChE and 3,161 µg/g creatinine for AChE.ConclusionsOur findings demonstrate a dose-effect relationship between urinary TCPy and both plasma BuChE and red blood cell AChE in humans exposed occupationally to CPF. These findings will contribute to future risk assessment efforts for CPF exposure.

There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI).Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation.Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before.Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

The present paper summarizes prevalence, epidemiology and clinical disease of natural Toxoplasma gondii infections in humans and animals from Egypt. The current situation of toxoplasmosis in Egypt is confusing. There is no central laboratory or group of researchers actively investigating toxoplasmosis in humans or animals, and no reports on the national level are available. Based on various serological tests and convenience samples, T. gondii infections appear highly prevalent in humans and animals from Egypt. Living circumstances in Egypt favour the transmission of T. gondii. Up to 95% of domestic cats, the key host of T. gondii , are infected with T. gondii ; they are abundant in rural and suburban areas, spreading T. gondii oocysts. Many women have been tested in maternity clinics, most with no definitive diagnosis. Toxoplasma gondii DNA and IgM antibodies have been found in blood samples of blood donors. Clinical toxoplasmosis in humans from Egypt needs further investigations using definitive procedures. Reports on congenital toxoplasmosis are conflicting and some reports are alarming. Although there are many serological surveys for T. gondii in animals, data on clinical infections are lacking. Here, we critically review the status of toxoplasmosis in Egypt, which should be useful to biologist, public health workers, veterinarians and physicians. [ABSTRACT FROM AUTHOR]

Campylobacter jejuni (C. jejuni) are able to colonise and infect domestic poultry and also pose a risk for humans. The aim of this study was to determine the extent of genotypic diversity among C. jejuni isolates recovered from avian and human sources in Egypt. Furthermore, the short variable region (SVR) of flagellin A (flaA) gene was analysed for the presence of allelic variants. Our results showed that C. jejuni isolates differ in their capacity to harbour each of the virulence genes alone or when present in various combinations. The flaA gene was detected in all C. jejuni strains and none of the strains had all the studied virulence genes together. When considering C. jejuni strains from the investigated sources, the cdtC gene was the most similar, while the cdtB and iam genes were the most dissimilar. We could identify 13 novel alleles in the analysed strains. The analyses of virulence gene patterns, flaA gene sequences and allelic variants showed that C. jejuni strains from different sources overlapped largely suggesting potential involvement of poultry in transmitting C. jejuni to humans. We also found that the strains isolated from the same host were highly heterogeneous, with chicken strains exhibiting the highest diversity. Moreover, the human strains were clustered closer to chicken ones than to those from pigeon. The results of this study should be taken into consideration when assessing the epidemiology and risk potential of Egyptian C. jejuni not only in poultry, but also in humans. [ABSTRACT FROM AUTHOR]

Aspergillus infection is widely distributed that may be found wherever the environmental condition is favorable for fungal growth. Beside the significant economic losses caused by aspergillosis in the poultry industry, it has great public health significance as a zoonotic disease. So the present study was performed to ascertain the presence of Aspergillus species in birds, environmental samples and humans in Qena Province, Egypt. Ninety laryngeal swabs were taken from chickens, ducks, and pigeons showed respiratory manifestations (30 from each), samples from soil, water, and air (30 from each), as well as 60 human samples were collected including 30 laryngeal swabs from those in contact with diseased birds and 30 sputum samples from patients admitted to Qena Chest Hospital with pulmonary complaints. The results displayed that all examined chickens were infected with Aspergillus while the incidences of Aspergillus infection in ducks and pigeons were 80 and 56.6%, respectively. Soil, water, and air were contaminated with Aspergillus in incidences of 66.6, 40 and 100%, respectively. The isolated Aspergillus species were identified phenotypically as A. fumigatus, A. flavus, and A. niger. These species were also isolated from 36.3% and 50% of human laryngeal swabs and sputum samples respectively. A phylogenetic analysis of A. fumigatus isolates based on ITS (Internal Transcribed Spacer) region was conducted. Similarity search was performed at NCBI for comparison with the reference sequences and identification. These results illustrate a relationship between the environmental contamination in poultry areas and infection of poultry and humans with Aspergillus species. [ABSTRACT FROM AUTHOR]

Highlights • Avian influenza viruses were only isolated from chicken samples (18%) and molecularly confirmed as subtype H5. • AIVs couldn't be isolated from ducks and wild egrets. • Influenza A (H1) pdm09 virus was identified in a single human case (1.54%). • All the isolated AI H5 viruses shared a high similarity rate at nucleotides and amino acid levels. • All the isolated AI H5 viruses were highly pathogenic and exhibited a multi-basic amino acid motif at H5gene cleavage site. Abstract This study aimed to investigate the prevalence of influenza A viruses in birds and humans residing in the same localities of Sharkia Province, Egypt and the risk factors' assessment in poultry farms. A total of 100 birds comprised of 50 chickens, 25 ducks and 25 wild egrets were sampled. Swab samples were collected from 65 people (50 poultry farm workers and 15 hospitalized patients). All samples were screened for the presence of influenza A viruses using isolation and molecular assays. Avian influenza viruses were only detected in chicken samples (18%) and molecularly confirmed as subtype H5. The infection rate was higher in broilers (40%) than layers (8.6%). Influenza A (H1) pdm09 virus was detected in a single human case (1.54%). All the isolated AI H5 viruses were clustered into clade (2.2.1.2) and shared a high similarity rate at nucleotides and amino acid levels. In addition, they had a multi-basic amino acid motif (ـــPQGEKRRKKR/GLFـــ) at the H5 gene cleavage site that exhibited point mutations. Chicken breed, movement of workers from one flock to another, lack of utensils' disinfection and the introduction of new birds to the farm were significant risk factors associated with highly pathogenic AI H5 virus infection in poultry farms (p ≤ 0.05). Other factors showed no significant association. The HPAI H5 viruses are still endemic in Egypt with continuous mutation. Co-circulation of these viruses in birds and pdm09 viruses in humans raises alarm for the emergence of reassortant viruses that are capable of potentiating pandemics. [ABSTRACT FROM AUTHOR]