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BACKGROUND F18-FET PET has an established diagnostic role in adult brain gliomas, here we analyzed image derived static & dynamic parameters with available conventional MRI, histological, clinical & follow up data in assessment of pediatric brain tumor patient at different stages of the disease. METHODS Forty-four pediatric patients with median age 7 years, diagnosed with brain tumors and underwent forty-seven 18F-FET PET scans either initially (20 scans) or post-therapy (27 scans) were enrolled. Standardized analysis of Summed FET PET images early from 10-20 min and late from 30-40 min post-injection were used for static (mean & maximum Tumor to Brain Ratio "TBR" & Biological Tumor Volume "BTV") parameters evaluation as well as the Time Activity Curve "TAC". RESULTS 19 out of 20 initially assessed patients had pathologically &/or clinico-radiologically proven neoplastic lesions and one patient had pathologically proven abscess. Receiver Operator Curve (ROC) marked early TBR max 2.95, early TBR mean 1.76, late TBR max 2.5 and late TBR mean 1.74 as discriminator points with diagnostic accuracy reaching 90% when TBR max was combined with dynamic parameters. Significant association was found between initial FET scans, early & late BTV & Event Free Survival "EFS" (P value =0.042 & 0.005 respectively). In post-therapy assessment, the diagnostic accuracy of conventional MRI was 81.48% when used alone and 96.30% when combined with F18-FET PET scan findings. A cutoff point of 3.2 cm3 for late BTV, in posttherapy scans, was successfully marked as a predictor for therapy response (P-value 0.042) and was significantly associated with EFS (P-value 0.002). In FET-avid / MRI non-enhancing lesions, early TBR max was able to detect highly malignant processes (high-grade tumors in initial scans & residue/recurrence in post-therapy scans) with 80% sensitivity & 100% specificity when cutoff value of 2.25 was used (P-value =0.024). In patients with FET-avid brainstem lesions, whether enhancing or non-enhancing in MRI scans, 81.8% were associated with high risk diagnoses and 68.2% of them were associated with poor therapy outcome. The degree of FET uptake matched tumor-grading, but did not show significant association with OS or EFS (P-value >0.05). CONCLUSIONS F18-FET PET seems to be an evolving pediatric neuroimaging technique with valuable diagnostic & prognostic information at initial and post-therapy evaluation.

The bursal cytokine gene expression and apoptosis were compared in vaccinated chickens with either live or immune-complex infectious bursal disease virus (IBDV) vaccines with or without virulent IBDV challenge. The cytokine gene expressions were evaluated at 5 and 12 day-post-challenge (DPC). The apoptotic marker Caspase-3 was determined by IHC on collected bursae, thymus, spleen, and kidneys at 12 DPC. A significantly decreased bursal cytokine levels were observed in the all-vaccinated birds except for IL-6 in the classic IBD vaccines at 5DPC. A significant upregulation of the IL-2 was observed in the live IBD vaccinated birds. No significant differences in the bursa and thymus Caspase-3 positive cells. However, splenic and renal apoptosis was significantly higher in the live IBD vaccine groups. Results indicate that both vaccine types reduce the IBDV-induced bursal proinflammatory cytokines and apoptosis. However, classic IBD vaccines failed to clear the challenge virus or reduce splenic and renal apoptosis.

Background. Type 2 diabetes (T2DM) and its complications are highly prevalent in Egypt and are considered a major health problem. Insulin resistance arising from visceral obesity is the main pathological mechanism of T2DM. Leptin is an adipokine secreted from visceral adipose tissue and its level is proved to be higher in patients with T2DM, but its association with microvascular complications is not yet well-established, for this aim the present study was conducted. Methods. This cross-sectional study was conducted among 120 participants with T2DM recruited from the diabetes outpatient clinic of Alexandria Main University Hospital, Alexandria, Egypt. Each participant was subjected to full history taking, complete physical examination and laboratory investigations. Results. Serum leptin level was significantly positively correlated with diabetes duration, BMI, WC, systolic and diastolic blood pressure, FPG, HbA1c, serum insulin level, HOMA-IR, total cholesterol, triglycerides and LDL-C. Regarding microvascular complications, serum leptin level was highly significantly positively correlated with UACR, peripheral neuropathy and retinopathy (P < 0.001) and significantly negatively correlated with e-GFR (P = 0.003). Conclusions. Serum leptin level is significantly correlated with microvascular complications in patients with T2DM in Alexandria, Egypt.

To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour.A cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recorded.A cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P 0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%).Hypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients' responses are varied and call for more formal pre-Ramadan education.

Bovine tuberculosis is a transboundary disease of high economic and public health burden worldwide. In this study, post-mortem examination of 750 cattle and buffalo in Tanta abattoir, Centre of the Nile Delta, revealed visible TB in 4% of animals and a true prevalence of 6.85% (95% CI: 5.3%-8.9%). Mycobacterial culture, histopathology and RT-PCR targeting all members of M. tuberculosis complex were performed, upon which 85%, 80% and 100% of each tested lesions were confirmed as TB, respectively. Mpb70-targeting PCR was conducted on ten RT-PCR positive samples for sequencing and identified nine Mycobacterium (M.) bovis strains and, interestingly, one M. tuberculosis (Mtb) strain from a buffalo. Bioinformatics tools were used for prediction of mutations, nucleotide polymorphisms, lineages, drug resistance and protein-protein interactions (PPI) of the sequenced strains. The Mtb strain was resistant to rifampicin, isoniazid and streptomycin, and to the best of our knowledge, this is the first report of multidrug resistant (MDR)-Mtb originating from buffaloes. Seven M. bovis strains were resistant to ethambutol and ethionamide. Such resistances were associated with KatG, rpoB, rpsL, embB and ethA genes mutations. Other mutations and nucleotide polymorphisms were also predicted, some are reported for the first time and require experimental work for validation. PPI revealed more interactions than what would be expected for a random set of proteins of similar size and had dense interactions between nodes that are biologically connected, as a group. Two M. bovis strains belonged to BOV AFRI lineage (Spoligotypes BOV 1; BOV 2) and eight strains belonged to East-Asian (Beijing) lineage. In conclusion, visible TB was prevalent in the study area, RT-PCR is the best to confirm the disease, MDR-Mtb is associated with buffalo TB, and mycobacteria of different lineages carry many resistance genes to chemotherapeutic agents used in treatment of human TB constituting a major public health risk.

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.

Objective To evaluate the role of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the pathogenesis of distal symmetrical polyneuropathy (DSPN) in patients with type 2 diabetes mellitus, and to analyze the relationship between these apoptotic markers with clinical parameters and electrophysiologic profile of DSPN, as well as with different diabetic factors among those patients. Patients and methods The study included 60 Egyptians with type 2 diabetes mellitus. All patients were evaluated clinically for DSPN by using Michigan Neuropathy Screening Instrument. Electrophysiological diagnosis of DSPN was based on the criteria suggested by the European Standardized Telematic tool to Evaluate Electrodiagnostic Methods group. Diabetic patients were divided into two groups according to the electrophysiological findings: group A included patients with DSPN (N=42), and group B included patients without DSPN (N=18). The severity of DSPN among group A patients was assessed clinically using Toronto Clinical Neuropathy Score and electrophysiologically by the severity score proposed by Hidasi and colleagues. The study also included 30 healthy volunteers as a control group. Serum levels of sFas and sFasL were assessed in all the studied groups. Results Serum level of sFas was significantly elevated in diabetic patients with DSPN compared with diabetics without DSPN and nondiabetic control (P=0.029 and 0.000). Receiver operating characteristic (ROC) curve analysis detected that sFas was statistically significant in discriminating between diabetic patients with DSPN from those patients without DSPN with an accuracy of 66%. The cutoff point that has the highest sensitivity (61%) and specificity (62%) was 33.3 ng/ml. Serum level of sFas showed a positive significant correlation with the electrophysiological severity of DSPN (P=0.020). Serum level of sFasL did not show statistically significant difference between all the studied groups. Conclusion Fas-mediated apoptosis has an important role in the development of diabetic DSPN and is correlated with its electrophysiological severity.

Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a ‘glucocentric’ approach to a ‘patient-centered’ approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes. Funding: Novo Nordisk, India.

Background: brain-derived neurotrophic factor (BDNF) is a27-kDa polypeptide that belongs to the neurotrophin family binding with high-affinity protein kinase receptors (Trk) and the unselective p75NGFR receptor. The BDNF gene has a complex structure with multiple regulatory elements and four promoters that are differentially expressed in the central or peripheral tissue. Aim of the Work: this study aimed to detect affection of follicular fluid neurotrophin level in different types of infirtility and its using as peredictor for ovarian reserve. Patients and Methods: this crosssectional study was carried out in Ain Shams University, Maternity Hospitals Assisted Reproductive Technology Unit (ART unit) in the period from Septemper2016 to June 2017. Results: the present study showed a cut-off value of BDNF for the patients who underwent this study was 2.7 pg/ml with sensitivity of 74.2%, specificity 95.5%, PPV 85.2% and NPV 91.4%. Conclusion: FF-BDNF measurement on the d-OPU in women with different types of infertility underwent COH for IVF-ET, had positive correlation with ovarian reserve and positive predictor of pregnancy which occurred in 25.8% of cases. Recommendations: BDNF has positive correlation with ovarian reserve and positive correlation with pregnancy outcome so we recommend to measure serum BDNF before starting IVF cycle as predictive factore and cost effective.

Context Diabetes mellitus is a common disease which is prevalent globally, presenting with chronic complications and constitutes a major risk to the patient. Diabetic foot ulcers are the single biggest risk factor for non-traumatic lower limb amputations in persons with diabetes. We aimed to screen for the chronic vascular diabetic complications in patients with diabetic foot ulcers (DFUs) and to assess the association of diabetic foot ulcers with these complications in the study group. Subjects and methods This cross-sectional study included 180 type 2 diabetic patients (aged 30–70 years) with diabetic foot ulcers who attended the Outpatient Clinic of Diabetes in Alexandria Main University Hospital. Full diabetic foot examination was done to all study subjects. DFUs were assessed using University of Texas Diabetic Wound Classification System. HbA1c, LDL-C, serum creatinine, and urinary albumin creatinine ratio (ACR) were measured for all study subjects. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Fundus examination was done for all study subjects. Results The prevalence of diabetic kidney disease (DKD) and diabetic retinopathy (DR) was 86.1% and 90% respectively among the study group. 86.7% of patients had neuropathic DFUs, 11.1% of them had ischemic DFUs and 2.2% had neuro-ischemic DFUs. Regarding diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) as risk factors for developing DFU, the prevalence of both of them respectively was 82% and 20% among the study group. There was statistically significant association between both DKD, DR and peripheral neuropathy. There was also statistically significant association between both DKD, DR and peripheral arterial disease (PAD). Conclusion Chronic vascular diabetic complications are common among type 2 diabetic patients with diabetic foot ulcers. There is statistically significant association between these complications and diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD).

Objective: Animal trade has an important role in the economy but in contrast, it causes the spread of infectious diseases overall the world, in particular, the trans-boundary animal diseases. Therefore, the aim of this study is to report the prevalence rate of some transboundary infectious diseases to assess the effectiveness of quarantine measure in the detection of exotic disease and clarify the role of live animal trade in infectious transboundary diseases spread. Materials and Methods: The study was done on 176 serum samples obtained from cattle imported from Sudan in order to determine the prevalence of foot and mouth disease (FMD), Peste Des Petits Ruminants (PPR), and Infectious Bovine Rhinotracheitis (IBR). Three serological tests were used; Serum neutralization test for FMD, Indirect enzyme-linked immunosorbent assay (i-ELISA) for PPR, and Competitive ELISA for IBR. Results: The seroprevalence of FMD in tested sera was; 77.27% in the serotype A (A-Iran), 68.18% in the serotype A (A-Africa), 93.82% in the serotype O (O-Pan Asia), and 35.227% in the serotype South African Territories-2 (SAT-2) SAT-2. While the overall seroprevalence of PPR was 49.431% and the IBR was 93.75%. Conclusion: The result indicates the serious role of live animal trade as hubs for infectious diseases spread. Subsequently, the common control measures must be taken to avoid the spread of the diseases through the animal trade; which include screening, surveillance, precautions at borders, and vaccination. [J Adv Vet Anim Res 2019; 6(1.000): 92-99]

Canine babesiosis is a common tick-borne disease of dogs worldwide. A number of Babesia sp. can infect dogs and the spectrum is increasing as molecular methods are developed to differentiate organisms. In the current study between March, 2014 and February, 2015, a total number of 200 dogs were examined for babesiosis. The clinical findings, the vector tick identification, hematological changesand parasitological diagnosis (blood film examination) of Babesia were investigated. Animals in cute form showed animals in this form showed fever (39.3 – 41.5o C), lethargy, icterus, splenomegaly, vomiting, congested mucous membrane, and hematuria. While chronic form characterized by intermittent pyrexia, partial anorexia, loss of body condition, pale mucous membrane. On the other hand, subclinical form shows no symptoms. Results of blood film showed that Babesia canis trophozoite existed in 2 morphological phenotypes either as piriform type or as an amoeboid type. Out of 200 dogs examined; 79 (39.5%) were naturally infected with hard ticks. The hard tick species were identified as Rhipicephalus sanguineus. The hematological findings showed that, there was significant decrease in RBCs count, Platelets count, Granulocytes count, HCT, and HGB in animals of infected group than healthy animals.

Multiple pathologies including diabetic neuropathy, peripheral vascular disease (PVD) and infection contribute to lower extremities amputation in diabetes.We examined the prevalence of diabetic foot problems and related risk factors in Egypt.Between July 2008 and December 2009, 1000 male and 1000 female consecutive adult patients with diabetes (≥ 18-year-old) attending the Alexandria University Diabetic Foot Screening Clinic were surveyed for history/presence of foot ulcers and/or amputations, skin/nail changes, joint mobility, sensory neuropathy (10 g-Semmes-Weinstein Monofilament) and peripheral vascular disease (PVD) using Ankle Brachial Index (ABI).The majority of patients had type 2 diabetes (96.75%) with a mean age of 57.30 ± 10.47 years and a mean disease duration of 11.76 ± 8.26 years. The mean body mass index was 32.84 ± 6.31 kg/m(2) with 29.55% being current or ex-smokers. In these subjects, 4.4% had a past history of non-traumatic amputation (male:female: 6.2% vs. 2.6%, p0.001); 6.1% had past history (10.3% vs. 7%, p = 0.009) and 8.7% had active foot ulceration (8.1% vs. 4.1% p0.001) with a male preponderance. The prevalence of sensory neuropathy was 29.3% (M:F: 30.7%: 27.9%) and peripheral vascular disease (PVD) was 11% (M:F 11.8%:10.2%). Diabetic foot complications were associated with disease duration (p0.001), history of coronary artery disease (p = 0.001), stroke (p = 0.009), PVD (p0.001), laser photocoagulation (p0.001), sensory neuropathy (p0.001) and renal replacement therapy (p0.001). On multivariate analysis, diabetes duration, foot fissures, Charcot's foot, limited joint mobility, PVD and sensory neuropathy remained independently associated with diabetic foot disorders.In Egypt, a mosaic of risk factors contributes to the high prevalence of diabetic foot disease in type 2 diabetes. These findings call for regular assessment of vascular, neuropathic and skin status to prevent these serious foot complications.

Background: Carbamazepine "CBZ" (Tegretol) is an anticonvulsant and mood stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia. It has been assigned to pregnancy category D by the U.S Food and Drug Administration (FDA). CBZ can cause fetal harm when administered to pregnant women. Epidemiological data suggested that there may be an association between the use of CBZ during pregnancy and congenital malformations, specifically spina bifida and developmental disorders. The possible malformation-specific risks with CBZ use during pregnancy need to be considered, so the present work was conducted to evaluate the genotoxicity of two doses of CBZ (3.6 mg and 10.8 mg/ 100g body weight/ day) in pregnant female rats and their fetuses. Chromosomal aberration in bone marrow cells and histopathological examination of liver and kidney of pregnant rats were also determined. Materials and Methods: Fourty five pregnant Sprague Dawley rats were randomly divided into the groups. The first was administered oral doses of distilled water and served as control. The other two groups were administered oral doses of CBZ suspended in distilled water equivalent to 3.6 mg and 10.8 mg/100g body weight/day respectively for 15 day from the 6th day to the 20th day of gestation. Females were sacrificed on the 20th day of gestation. Results: Administration of CBZ 3.6 mg and 10.8 mg /100g body weight to pregnant rats from the 6th till the 20thday of gestation. Decreased fetal body weight, crown-rump length, increased resorbed and dead fetuses were observed compared to the control ones. Moreover, CBZ-high dose group(10.8mg/100g) causedmalformations that could be described as severe growth retardation. At the same time, bone marrow metaphases of CBZ-treated pregnant rats revealed structural chromosomal aberrations. Whereas, histopathological examination of liver and kidney of pregnant rats treated with both doses of CBZshowed cellular alterations.Conclusion:It has been found that usage of antiepileptic CBZ during gestational period may create risk, associated with maternal toxicity, hepato- and nephrotoxicity and chromosomal aberrations in pregnant rats, with intrauterine growth retardation which was manifested by low body weight, length reduction and malformations. These alterations were dose dependent. The benefits of taking CBZ must be weighed against the potential risks to boththe developing fetus and the mother.

Objective: To determine the best anthropometric measurement of obesity, and its optimal cutoff, that best predicts the presence of cardiovascular risk factors among adult Egyptian population. Methods: This is a cross-sectional study including a representative randomly chosen sample of the adult Egyptian population from all Alexandria Districts (the second largest governorate in Egypt) based on the multistage random technique. It included 3209 subjects (1567 men, 1642 women) aged 18–80 years from urban and rural areas. The response rate was 80.2%. History, blood pressure, and anthropometric measurements were taken. Laboratory investigations included fasting lipid profile, fasting plasma glucose, and serum uric acid. Different criteria of metabolic syndrome were used and compared. Receiver operator characteristic curve and Youden index were used to determine predictability and cutoffs. Results: Waist circumference (WC) is the best to predict at least two other components of the metabolic syndrome as defined by the International Diabetes Federation (IDF). The optimal WC cutoffs were 100.5 and 96.25 cm for Egyptian men and women, respectively. The Joint Interim Statement definition (JIS) of metabolic syndrome was the best to predict cardiovascular disease in both genders and diabetes mellitus in women. The prevalence of metabolic syndrome and abdominal obesity was 42.5%, 61%, respectively (ATPIII definition); 43.8%, 61% (American Heart Association definition); 44.3%, 76.4% (IDF definition); 33.8%, 51.7% (IDF definition with Egyptian cutoffs); and 41.5%, 51.7% (JIS with Egyptian cutoffs). Conclusion: WC cutoffs in Egyptians differ from those currently recommended. Prevalence of metabolic syndrome and abdominal obesity is high in Egypt, despite being lower on using the Egyptian cutoffs.

BackgroundPostural instability causes limitations in daily activities of diabetic patients. There is paucity of data regarding central motor pathway involvement in these patients and its relation to postural control.AimTo evaluate postural control and central motor pathway involvement in type 2 diabetic patients.Subjects and methodsThe study included 30 type 2 diabetic patients and 15 healthy, age and sex-matched control subjects. Both groups were subjected to physical and full neurological examination, in addition to electrophysiological study including peripheral conduction study and MEPs recorded from the feet muscles. Total neuropathy score was calculated. In addition, dynamic posturographic tests were performed including sensory organization test and MCT.ResultsMost of the dynamic posturographic parameters were significantly impaired in diabetic patient group. There were significant abnormalities in most of the parameters of the peripheral conduction study of the patients compared to the controls. According to the Total neuropathy score, 20 patients had peripheral neuropathy. In addition, there was significant prolongation of the left CMCT, decreased left MEP amplitude and increased MEP resting motor threshold on both sides in the patients compared to the control group. Dynamic posturographic parameters showed correlation with most of the parameters of the peripheral conduction study and few of the MEP parameters. Logistic regression analysis showed peripheral neuropathy as the main factor implicated in postural instability in these patients. However, significant correlation was found between MEP amplitude and MCT composite score in patients without peripheral neuropathy.ConclusionAlthough type 2 diabetic patients had prolonged CMCT, decreased amplitude and increased resting motor threshold of the MEP response, peripheral neuropathy was the main factor implicated in postural instability. However, the central motor pathway changes documented could be implicated as a possible cause.

Context: Chemerin is one of the adipokines that regulate fat metabolism. High-sensitivity C-reactive protein (hs-CRP) may be considered as a cardiovascular risk predictor. Measuring intima-media thickness of the CCA (C-IMT) is a well-evidenced tool for the detection of early stages of atherosclerosis. We aimed here to study both serum chemerin and hs-CRP as markers of subclinical atherosclerosis in Egyptian patients with type 2 diabetes, who are angiographically free of coronary artery disease (CAD). Subjects and methods: This cross-sectional study was conducted on 180 subjects divided into two groups: Group A included 90 type 2 diabetic patients without CAD and group B including 90 nondiabetic control subjects. All study subjects were having normal coronary angiography. Serum chemerin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated haemoglobin (HbA1c), lipid profile, hs-CRP as well as C-IMT were assessed in all study subjects. Results: There was a statistically significant difference between the 2 groups regarding serum chemerin level, HOMA-IR, hs-CRP and C-IMT; being higher in the diabetic patients than in the control group ( p = 0.006, 0.024, 0.040 and Conclusion: Both serum chemerin and hs-CRP could be considered as markers of subclinical atherosclerosis, and hence, may be utilized for the early detection of macrovascular disease, in Egyptian patients with type 2 diabetes.

This study was carried out to investigate clinical, epidemiological and histopathological findings associated with gastrointestinal nematodes infection in sheep with special reference to Haemonchus contortus infection during the period from January, 2008 to June, 2010 at Gharbia Governorate, Egypt. The prevalence of gastrointestinal nematode among examined sheep was 62.38%. Trichostrongylus spp. was the most detected nematode. The highest prevalence was reported in females, during spring and in the age group over 2 years. The clinical findings observed in infected sheep were emaciation and pale mucous membrane. Infected sheep showed anemia and decrease in serum total proteins, albumin and globulins levels.

The aim of the present study was to explore the prevalence and potential risk factors associated with infestation by Psoroptes spp. mites in buffalo at smallholder farms in the Nile Delta region, Egypt. A total of 318 out of 1234 buffalo in 77 small scale herds were examined. The age of buffalo varied from three months to seven years. In all, 53 (16.66%) buffalo were recorded to be infested; 51 (16.35%) with Psoroptes spp. mites and two cases (0.31%) with Chorioptes spp. mites. Multivariate logistic regression was performed for significant risk factors at univariate analysis on both animal and herd level. The results of multivariate analysis showed that, on the animal level, the prevalence was affected by animal age (P < 0.01; OR: 0.71; CI 95%: 0.441-1.11), season (P < 0.01; OR: 1.20; CI 95%:0.541-1.15), indoor management (P < 0.001; OR: 6.625; CI 95%:2.489 -17.631) and rearing with other animals (P < 0.01; OR: 2.22; CI 95%:1.340 -7.132). However, on the herd level, the prevalence was affected by indoor rearing (P < 0.05; OR: 22.4; CI 95%:2.75-16.431), mixed rearing with other animal species (P < 0.05; OR: 4.5; CI 95%:1.66-7.941), and season (P < 0.01; OR: 2.3; CI 95%:0.575-2.426). Clinically, mild skin lesions with mild pruritus were significantly prevalent in buffalo with the infestation by Psoroptes spp. mites (P < 0.001), where 33/51 cases showed mild lesions. Also, psoroptic mites had significant association with inappitence (P < 0.001). The result of the present study indicates that Psoroptes spp. mites are the most prevalent in buffalo in the Nile Delta Region, Egypt. Moreover, recognition of risk factors associated with mange mites in buffalo may enable the practitioner to establish the most appropriate control measures.

The aim of the present study was to carry out comparative therapeutic effect of moxidectin pour on, doramectin and ivermectin on psoroptes infestation in buffalo. A total of 318 buffalo in 77 small scale herds suspected to have mange mites were examined clinically and parasitologically. Fifty-three (16.66%) buffalo in 25 herds were recorded to be infested; 51 (16.35%) with psoroptic mites, and two (0.31%) with chorioptic mites. Buffalo with psoroptic mites were randomly allocated into three groups (17 buffalo each). First group was treated with moxidectin pour on at a dose rate of 0.5 mg kg(-1). The second group received doramectin (200 microg kg(-1) twice subcutaneously, 14 days apart). The third group received ivermectin (200 microg kg(-1) twice subcutaneously, 14 days apart). Adjunct to each drug, deltamethrin was applied to the surrounding environment twice at a two week interval. Treatment outcomes of 51 buffalo with psoroptic mites showed that moxidectin pour on and doramectin had a significant higher effect on mite count reduction (MANOVA, P < 0.01; Walks' Lambda, P < 0.01) and clinical sum scores (MANOVA, P < 0.05; Walks' Lambda, P < 0.05) compared with injectible ivermectin. On clinical level, the number of clinically recovered buffalo in moxidectin and doramectin treated groups was significantly (P < 0.05) higher than that of ivermectin treated group. The result of the present study indicated that psoroptic mites are the main cause of mange in buffalo in Lower Egypt. This is the first report that describes the effect of moxidectin in buffalo. Moxidectin is a good alternative and easily applied drug for treatment of psoroptes infestation in buffalo.

Background Diabetes is a metabolic disorder characterized by chronic hyperglycemia and has long standing complication including both micro and macro vascular ones. One of the common underdiagnosed complications of diabetes is cardiovascular autonomic neuropathy (CAN), which encompasses damage to the autonomic nerve fiber that innervates the heart and blood vessels. Objective The aim of this work was to assess the prevalence of CAN in Egyptian people with type 2 diabetes. Patients and Methods The study was conducted on 120 subjects with type 2 diabetes. CAN was assessed by a group of defined cardiovascular autonomic reflex tests including (Resting heart rate, Heart rate response to standing, Beat-to-beat HRV, Blood pressure response to standing, Diastolic blood pressure response to isometric exercise and QTc interval). Patients with CAN were subsequently divided into three groups, Early, Definite and severe CAN. Results and Conclusion The prevalence of CAN is high in Egyptian people with type 2 diabetes amounting to 60%. Percentage of patients that had early, definite and severe CAN was 15%, 36.7% and 8.3% respectively. Positive significant independent correlation was found between CAN, HbA1c and serum total cholesterol.

Aims We investigated the pharmacokinetics and safety profile of oral ganciclovir coadministered with trimethoprim in HIV-and CMV-seropositive patients. Methods In an open-label, randomized, 3-way crossover study, 12 adult males received oral ganciclovir 1000 mg every 8h, oral trimethoprim 200 mg once daily, or both drugs concomitantly in a sequence of three 7-day treatment periods. Pharmacokinetic parameters were determined and adverse events recorded for each treatment. Results The presence of trimethoprim significantly decreased CLr (12.9%, P=0.0068) and increased t1/2 (18.1%, P=0.0378) of ganciclovir. However, these changes are unlikely to be clinically meaningful. There were no statistically significant changes in trimethoprim pharmacokinetic parameters in the presence of ganciclovir, with the exception of a 12.7% increase in Cmin. Ganciclovir was well tolerated when administered alone or in combination with trimethoprim. Conclusions There was no clinically significant pharmacokinetic interaction between oral ganciclovir and trimethoprim when coadministered.

Objective. The effect of a proprietary formulation of trans-resveratrol (t-RSV) on manifestations of diabetic foot syndrome (DFS) was studied in type 2 diabetic patients with newly diagnosed diabetic foot ulcers. Method. Placebo-controlled, examiner-blinded, parallel-group randomized controlled pilot clinical trial (ACTRN Clinical Trial Registry number 12610000629033) involving 24 patients with DFS (15 males and 9 females, average age of 56.4±9.1 years) divided into the placebo and RSV-treatment groups was performed. 50 mg of t-RSV or placebo capsules was given to each patient twice a day over a 60-day time period. Results. Reduction in the parameters reflecting diabetic ulcer size was more profound in the RSV group as compared to placebo. RSV-treated patients also had a marginally improved performance in the foot pressure test. A statistically significant decline in the plasma fibrinogen level, but not CRP, was also found in the RSV-treated patients. Some improvement in the plasma lipid profile and fasting glucose levels were not related to RSV-treatment, since they have been seen on both the RSV and placebo groups, revealing the effectiveness of medical supervision and education in the newly diagnosed patients with DFS. Conclusion. t-RSV supplementation promotes reduction of the foot ulcer size and reduces plasma fibrinogen level in type 2 diabetic patients.

Canine babesiosis is a worldwide spread disease with high economic and welfare impact. This disease has not been studied intensively in developing countries. The current study was carried out in an endemic area with canine babesiosis of the Middle East, Egypt. Between March 2014 and February 2015, 200 dogs were examined clinically for Babesia spp. infection. Blood samples were taken from examined animals to look for the intraerythrocytic stage of Babesia spp. PCR was carried out on 5 positive whole blood samples of dogs positive to blood films to identify the causative agent. A Multivariate logistic regression model, with positive animals as the response variable, was used to study the association between the potential risk factors and babesiosis positive status. Blood film examination showed that 17 (8.5%) of examined dogs were infected with Babesia spp. (95%CI: 4.5 - 12.5%). Most of infected dogs showed intermittent pyrexia, partial anorexia, loss of body condition, pale mucous membranes. The identification of Babesia spp. using PCR showed that only Babesia canis vogeli was found in examined infected animals. Dogs infested with ticks were at risk of getting Babesia spp. infection 3 times more than non-infested dogs. Age and sex are not risk factors for Babesia spp. infection among dogs. In conclusion, Babesia canis vogeli is the causative agent of canine babesiosis in Egypt with moderate endimicity and most of infected dogs show mild clinical signs except puppies.

Two open-label, randomized, multiple-dose, three-way crossover studies were performed to assess the pharmacokinetics and safety of oral ganciclovir 1000 mg q8h in asymptomatic patients seropositive for human immunodeficiency virus and cytomegalovirus. Ganciclovir was administered alone and in combination with zalcitabine 0.75 mg q8h (study 1) or stavudine 40 mg q12h (study 2). In the presence of zalcitabine, the only statistically significant change in the pharmacokinetic parameters of ganciclovir was a 22.2% mean increase in AUC0-8. However, there was no significant change in the renal clearance of ganciclovir when coadministered with zalcitabine, suggesting that the increase in serum ganciclovir concentration cannot be attributed to competition for active renal tubular secretion. No change in zalcitabine pharmacokinetics was observed in combination with ganciclovir. There were no significant changes in the pharmacokinetics of ganciclovir or stavudine when coadministered. Ganciclovir was well tolerated when given alone and in combination with either zalcitabine or stavudine.

Background Postoperative pulmonary dysfunction is one of the common complications after cardiac surgery that may lead to serious morbidity and mortality. In this study, we investigated the potential benefit of continued lung ventilation while on cardiopulmonary bypass (CPB) to minimize postoperative lung injury whether resulting from CPB alone or from non-CPB causes. Patients and methods It is a prospective study including 60 patients who were randomized into two groups, each of 30 patients. One group underwent modified CPB (the MB group) where the lungs were ventilated with low tidal volume 3 ml/kg and PEEP of 5 cmH 2 O, whereas the other group underwent the conventional CPB (CB group) with total ventilation arrest and no PEEP. Parameters such as PaO 2 /FiO 2 ratio, alveolar arterial oxygen gradient [D (A-a) O 2 ], extravascular lung water, static and dynamic lung compliance, extubation time, and postoperative chest complications such as pleural effusion, atelectasis, and pulmonary edema were compared in the two groups. Results In the MB group, there were significantly higher post-bypass extravascular lung water, lower static and dynamic lung compliance, higher post-bypass PaO 2 /FiO 2 ratio, lower D (A-a) O 2 , and shorter extubation time. However, postoperative complications on first and fourth postoperative days were insignificant in both groups. Conclusion Lung ventilation with low tidal volume during CPB can reduce the potential of post-CPB lung injury by improving lung oxygenation, reducing lung ischemia, and decreasing postoperative lung atelectasis, resulting in shorter extubation time and less postoperative pulmonary complications.

Summary The pathogenesis of osteoarthropathy is discussed; the importance of the role of the vagus nerve is stressed, and a case is described where division of the vagus nerve in the neck produced dramatic relief of pain and regression of H.P.O.A.