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

Novel series of pyrazoline carbothioamides, acetyl pyrazoles, pyridine-3-carbonitriles, pyridine-2-carbonitriles, and nicotinonitriles were synthesized. The structures of the newly synthesized compounds were established based on their spectral data, elemental analyses and alternative synthetic routes whenever possible. Also, the newly synthesized compounds were screened for their in vitro anticancer activity against T-47D (breast cancer human cell line) and UACC-257 (melanoma human cell line) by MTT assay (a colorimetric assay for assessing cell metabolic activity). Experimental results demonstrated that compounds 3a, 4a, and 8c showed excellent in vitro activity against T-47D cell line, while compounds 3d, 6d, and 5b exhibited excellent activity against UACC-257 cell line. Molecular docking studies were performed on compound 4a, as it showed the most promising activity against T-47D cell line, using Molecular Operation Environment (MOE 2008.10) software. Also, drug-likeness, pharmacokinetics, and toxicity assessment studies were carried out.

Background Pyrazolines show different biological activities. In recent years, interest in the chemistry of hydrazonoyl halides has been renewed. 1,3,4-Thiadiazoles are one of the most common heterocyclic pharmacophores with a wide range of biological activities. Results Ethyl 2-(5-(furan-2-yl)-3-(p-tolyl)-4,5-dihydro-1H-pyrazol-1-yl)-4-methyl-thiazole-5-carboxylate, 2-(5-(furan-2-yl)-3-(p-tolyl)-4,5-dihydro-1H-pyrazol-1-yl)thiazol-4(5H)-one, and 1-(2-(5-(furan-2-yl)-3-(p-tolyl)-4,5-dihydro-1H-pyrazol-1-yl)-4-methylthiazol-5-yl)ethan-1-one were synthesized from the reaction of 5-(furan-2-yl)-3-(p-tolyl)-4,5-dihydro-1H-pyrazole-1-carbothioamide with different halogenated compounds. Thiazole, 1,3,4-thiadiazole and pyrano[2,3-d]thiazole derivatives were also synthesized. The structures of the newly synthesized compounds were elucidated based on elemental analysis, spectral data, and alternative synthetic routes whenever possible. Additionally, the newly synthesized compounds were screened for antimicrobial activity against various microorganisms. Conclusions A new series of novel functionalized 1,3,4-thiadiazoles, 1,3-thiazoles, and pyrazoline-containing moieties were synthesized using hydrazonoyl halides as precursors and evaluated for their in vitro antibacterial, and antifungal activities. The antimicrobial results of the examined compounds revealed promising results and some derivatives have activities similar to the references used. Electronic supplementary material The online version of this article (10.1186/s13065-019-0566-y) contains supplementary material, which is available to authorized users.

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

A “health promoting polyclinic” based on the “health promoting setting concept” has been developed in Tirana, the capital of Albania. This paper discusses the implementation and intervention of the project, whereas the final evaluation results will be presented in another article. An important aspect of the whole program is the training of the administrators and staff members in the necessary skills relating to their allocated roles, such as creating a healthy environment, health education, outreach activities and total quality management. In this approach the International Relief Organization (IRO) acting as an external agent took the initiative of enabling, mediating and advocating, as well as providing support for the polyclinic's staff and its clients. The model appears to be effective in promoting health at the secondary health care level (the polyclinic). This may encourage health planners to adopt a similar concept at other settings i.e. general or specialized hospitals.

This study reports the competence of nurses and physicians in primary care setting. Analysis of their diagnostic and treatment practice revealed significant agreement with a consultant family physician's and a general practitioner's (GP) prescribing and treatment status. The consultant's opinion was used as a golden reference. Analyzing the data using KAPPA Statistic (K), indicated the presence of an excellent reproducibility for one nurse and good reproducibility for the other nurses. After analyzing the data according to disease category, none of the nurses were found to miss any life threatening conditions. Most of the disagreements with the GP and the consultant in diagnosis and treatment were in mild health problems. Nurse practitioners (NP) are competent to practice in refugee camps without risking patients' lives. These findings are similar to other studies and suggest that letting NP's participate actively in patient management may be an enabling factor that supports their practice in medically un...

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

The objective of this cross-sectional study was to assess the health education outcomes provided hyprimary health care (PHC) centres in Al Khobar City; the knowledge, attitude, practice (KAP) about the role of the PHC centre; and five important health problems – diarrhoea, accidental poisoning, jaundice, fever, and anaemia. Information concerning KAP towards vaccination was also recorded. The degree of satisfaction with health education offered by the PHC centres’ team was assessed. This was attempted through assessment of the KAP of a random sample of adult PHC centres’ attendants towards common health problems and other related issues. A total of 279 attendants were selected randomly and interviewed using a questionnaire designed for this purpose.Results of this study showed that KAP scores towards the role of PHC centres accounted for the lowest (mean = 36.8%). Although there were striking and statistically significant variations among different PHC centres, KAP scores to health problems were s...

The objective of this study was to measure changes in the Primary Health Care (PHC) physicians` knowledge towards mental illnesses after a short-term training course.The interventive study consisted of a sample of 31 PHC physicians randomly selected from different PHC centers in Eastern Saudi Arabia. The physicians were exposed to a 4-day intensive training course in mental illnesses in June 1999. They were assessed using multiple choice questions testing before (pre-test) and after (post-test) to assess their knowledge regarding mental illnesses.The analysis of the accumulated data indicated that there was a significant improvement in the PHC physicians` knowledge of mental illnesses after the course (p0.0001). The effect of recall bias was excluded in the post-test evaluation. In addition, multiple regression analysis indicated that the undergraduate psychiatric training courses had a positive contribution in both pre- and post-tests.The authors surmised that a mental training course could improve the knowledge base of PHC physicians. Furthermore, by giving substantial weight to the undergraduate and internship psychiatric training might improve the delivery of mental health services at the PHC level.

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

Objective: To measure changes in the attitude of Primary Health Care (PHC) physicians towards mental illnesses after a short-term training course. In addition, to ascertain if this change would persist 6 months after the training course. Method: This is an intervention type study. Out of 296 PHC physicians working in Eastern Saudi Arabia, 191 were randomly selected and divided randomly into two groups. The Study groups were tested for pre and post exposure (immediate and 6months later), to the psychiatric training course. The Control group was not involved in the intervention. The course was run over a 4-day period in June 1999. A 26-item self-administered questionnaire to assess the PHC physicians’ attitudes was used. Results: The study group consisted of 45 trainees, 24 (53%) of whom were men. The control group, 121 out of 166 physicians, responded to the questionnaire, with an 83% response rate, men forming 49%. The data analysis indicated a significant improvement in the PHC physicians’ attitude after the course (P

Objective: To evaluate the quality of management of hypertensive patients attending Primary Health Care Center (PHC) in Dammam city and to determine factors that possibly affect it. Design: A cross sectional study and direct interview. Setting: Dammam city. Subjects: All doctors and nurses from a randomly selected sample of Primary Health Care Centers during April 1994. Main measures: Measuring the knowledge, attitude and practice of doctors and nurses about hypertension management. Results: Hypertension is regarded as an important health problem in Saudi Arabia in the opinion of majority of doctors (80′0) and nurses (69%). Almost half of the doctors and nurses believe that nurses are sufficiently qualified to measure blood pressure of patients. Most of the doctors (96.7%) and nurses (86%) depend merely on face-to-face education of patients Thirty percent of doctors and 34% of nurses think that the care for hypertensive patients in their Primary Health Care Centers is inadequate. Conclusions and recommendations: Offering on job training of both physicians and nurses on hypertension management. Producing a well planned protocol on the national level. Implementing a total quality management and medical audit system to PHC centers.

Objective: To evaluate antenatal referral rates from Primary Health Care (PHC) centres to the Maternity and Children's Hospital in Dammam and factors affecting it. Methodology: Four randomly Selected Primary Health Care Centres in Dammam city. A sample of 135 pregnant women referred to the hospital (cases) and 135pregnant women not referred (controls) were randomly selected. A double phase sampling scheme was adopted. Questionnaires regarding the characteristics of the general practitioners (GPs) were distributed to those GPs caring for antenatal patients in the 4 health centres. Results: There was a variation in the referral rates of the five generalpractitioners from 11.5 to 21.2 per 100 antenatal consultation. It was found thatS certain characteristics of the GPs had an important influence on the referral rates. High risk factors in pregnancy were present in some of the controls but they were not referred. Conclusion & Recommendations: There is a variation in the referral rates between the GPs. There is a need to monitor and improve the quality of the antenatal care and the referral process. Better training of the GPs and implementing shared obstetric care is recommended.

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

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

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

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

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

Sixteen different ecological areas in Sharkia Governorate were surveyed for adult Culex pipiens. The prevalence was investigated among 160 houses of 2800 individuals and their surrounding outdoors. The collected adults were 41488 from October 2003 to November 2004. The collection rates were higher in the rural areas than urban ones. Mosquitoes were common all the year round except January, February and March, with peaks in summer and autumn than in spring and winter. Larvae in descending order were Cx. pipiens the predominant larva followed by Ae. caspius, Culiseta sp. and then Cx. pusillus. Cx. pipiens was described as the most common larva.

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

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

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

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

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

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

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

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

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

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

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

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

Two univariate time-series analysis methods have been used to model and forecast the monthly patient volume at the family and community medicine primary health care clinic of King Faisal University, Al-Khobar, Saudi Arabia. Models were based on nine years of data and forecasts made for 2 years. The optimum ARIMA model selected is an autoregressive model of the fourth order operating on the data after differencing twice at the nonseasonal level and once at the seasonal level. It gives mean and maximum absolute percentage errors of 1.86 and 4.23%, respectively, over the forecasting interval. A much simpler method based on extrapolating the growth curve of the annual means of the patient volume using a polynomial fit gives the better figures of 0.55 and 1.17%, respectively. This is due to the fairly regular nature of the data and the lack of strong random components that require ARIMA processes for modeling.

No doubt, double and triple infections are not uncommon features in some of the developing countries. In this paper, the effect of leishmanial infantum and schistosomal mansoni infection on the heart and lung of hamsters promoted many changes not seen in positive control with either parasite alone. Of these important changes, were the presence of leishmanial cardiac granulomas and earlier pulmonary granulomas in the lung were more or less the same as in positive schistosomal control. No doubt, with pulmonary schistosomiasis mansoni dangerous disease. Moreover, additional infection with pulmonary leishmaniasis increases the dramatic clinico-pathological picture.

In general, both Schistosoma mansoni and Leishmania, d. infantum affect more or less the same human organs. While the liver is the main organ affected, the intestine follows in importance. In the present study, L.d. infantum on tip of pre-existing S. mansoni in Syrian golden hamsters had delayed the appearance of both schistosomal and leishmanial granulomas in the intestine the positive control with either parasite alone. However, the leishmanial infection suppressed the schistosomal infection. Nevertheless, both types of granulomas caused shortening and broadening of the intestinal villi. The concomitant infection with leishmaniasis infantum and schistosomiasis mansoni promote the development of many pathological changes (liver, kidneys, intestine, blood picture etc.). No doubt, these changes lead to marked changes in the typical clinical picture of both parasites. Consequently, parasitological diagnosis of visceral leishmaniasis in concomitant infection is a must as in a case of VL. and HIV.

No doubt, double and triple infection in a patient is not an uncommon phenomenon in the Old World. Consequently, the histopathological picture of the liver of Syrian golden hamsters experimentally infected with Leishmania. d. infantum on top of pre-infection with S. mansoni was studied. The results showed that the liver was markedly affected by the concomitant infection than infection with either parasite alone. The superadded Leishmania infection caused the early appearance of cell necrosis and fatty changes. The schistosomal granulomas were rounded in shape and well circumscribed. However, they were smaller in size and less in number when compared with schistosomal control. Also, there was a comparative decrease in the number of their cellular constitutions but without changing in the cell types. The schistosomal granulomas were surrounded with a rim of amastigotes laden macrophages. On the other hand, the leishmanial granulomas, were irregular in shape but comparatively increased in size and in number on the behalf of the schistosomal granulomas. Their cellular constitutions comparatively increased as well. So, it is concluded that the L.d. infantum infection on the top of S. mansoni infection suppressed the schistosomal pathological picture in the liver of hamsters.

In Egypt, Schistosomiasis mansoni is one of the most important parasitic disease of man. Besides, in the last two decades, indigenous cases of infantile visceral leishmaniasis have been reported. These two parasites affect the kidney causing renal histopathological changes. Thus, it was aimed to study the concomitant infection of L. d. infantum on top of S. mansoni infection in Syrian golden hamsters, the model animal for both parasites. The results showed that the renal changes were more or less the same as infection with either parasite alone. Both parasites produce mesangial cell proliferation and mesangial matrix increase. Some glomeruli showed complete replacement of the capillary tuft with structureless homogenous material. In one S. mansoni positive control hamster Schistosoma eggs were seen within granulomas and atrophic glomeruli. However, the lesihmanial infection, more or less suppressed the schistosomal infection. The leishmanial infection itself became more prominent and the renal changes it caused appeared earlier and were more obvious.

In the 1980s, infantile visceral leishmaniasis was documented in Al Agamy (Alexandria). The causative agent is Leishmania d. infantum and the insect vector is Phlebotomus langeroni. In this paper, Syrian golden hamsters were chosen as a model animal for histopathological studies of L. d. infantum. Twenty four male hamsters were experimentally infected with L.d. infantum. Every week, two hamsters were sacrificed and parts from the liver, heart, lung, spleen, small intestine and kidney were paraffin sectioned and stained with haematoxylin and eosin or with Giemsa stain. The leishmanial granuloma was the main histopathological changes and the liver was the main organ affected. Leishmanial granulomas were common in the liver, but few in lung and small intestine. The hepatic granulomas increased in surface areas and in number in the late stage of the infection (6 weeks). They were formed mainly of histiocytes, less lymphocytes and very few eosinophils with necrosis inside and bridging in between granulomas mainly occurred in the late stage of infection. Neither fibrosis nor peripheral delimitation was seen. Kupffer cell hyperplasia was seen throughout the experimental period (12 weeks). The spleen showed expansion of the red pulp and atrophy of the white pulp. The kidney showed mesangial cell proliferation and the mesangial matrix increased accompanied with amyloid deposition. All the tissue sections were photographed and the results were discussed.

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

The immunoglobulins (IgG, IgM, IgE,IgA) and the complements (C3C4) were studied in hamsters as result of a single infection (S. mansoni or L.d. infantum) and as concomitant infection (L.d. infantum on top of S. mansoni). The immunological pattern showed profound IgG and IgA increase in the concomitant group than either infection alone. Also, concomitant infection induced more IgE increase than either infection alone. On the other hand, C3 and C4 showed more decrease in concomitant infection. The whole results were discussed.

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

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

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

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

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

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