Enzyme-linked immunosorbent assay for diagnosis of acute sporadic hepatitis E in Egyptian children

Hepatitis E virus (HEV) is thought to be a cause of enterically transmitted non-A, non-B (ET-NANB) hepatitis. Waterborne epidemics have been recorded in many developing countries, mainly affecting young-to-middle-aged adults; sporadic infection and overt illness in children are rare. However, a convenient and sensitive diagnostic test for HEV infection is not yet available. We now report the use of a solid-phase enzyme-linked immunoassay (ELISA) that detects IgM and IgG antibody to HEV. In a prospective study of endemic acute hepatitis during 1986 in rural Benha, Egypt, 15 (42%) of 36 children with NANB hepatitis (from whom convalescent-phase sera were available every 3 months to 9 or 12 months) were positive for anti-HEV-IgG by ELISA. Of 20 sera from healthy Benha children (controls), 5 (25%) were also positive for anti-HEV-IgG. When evaluated for anti-HEV-IgM, 6 of the 15 IgG-positive children, but none of the controls, were IgM positive and were thus regarded as having confirmed acute HEV infections. These 6 cases together with 2 presumptive cases (IgM negative, IgG seroconversion from positive to negative) presented sporadically over 9 months. This ELISA is a convenient method for the diagnosis of HEV infection; we have shown that the disease is present in Egypt, that it can occur endemically as sporadic cases, and that children do have overt infection.

Hysteroscopic and hysterosalpingographic study after intrauterine insertion of quinacrine pellets for non-surgical sterilization

60 fertile females seeking permanent contraception were included in this study. All cases received 3 applications of 7 36 mg quinacrine hydrochloride pellets during the proliferative phase of 3 consecutive menstrual cycles. The patients were randomly divided into 3 groups. Hysterosalpingography was performed on the 8th day of menstruation and hysteroscopy on the 10th day of the same cycle after 1st application in group A, after the 2nd application in group B, and after the 3rd application in group C. Hysterosalpingography showed 17 cases of bilateral obstruction, 1 case of bilateral patency, and 2 cases of unilateral patency in group A, while in groups B and C, all elicited bilateral tubal occlusion. Cornual obstruction was seen in 33%, 65%, and 85% in groups A, B, and C, respectively. Intramural obstruction was seen in 50%, 33%, and 10% in 3 groups. Hysteroscopy showed no abnormal findings in group A, while 35% and 85% of cases in groups B and C showed some changes. 4 types of ostial appearances could be recognized hysteroscopically: Type 0 (patent tubes), type I (distal tubal blockage), type II (intramural obstruction), and type III ( cornual obstruction). In group A, type 0 was seen in 10%, type I 80%, type II 50%, and type III 33%. The respective figures in group B were 0%, 2.5%, 33%, and 65%, while in group C, 0%, 5%, 10%, and 85%. 2 applications of quinacrine are 100% effective, the hysteroscopic endometrial changes detected were transient. The possibility of reversal of the procedure is outlined.

Hysteroscopic findings in complicated and non-complicated IUD users

The hysteroscopic findings in 100 IUD users have been evaluated. 50 women had no IUD-related problems and requested removal of the device, while the other 50 complained of either bleeding and/or pain or lost strings. Of the 29 cases with IUD-related bleeding and/or pain, hysteroscopy revealed malposition (n=6), partial expulsion (n=3), partial perforation (n=2), embedding (n=1), or disproportion (n=6). Disproportion presented as crumpling of the device in the uterine cavity or protrusion of the tip of the transverse arm inside the tubal ostia. Endometrial lesions were also more commonly seen in the study group than the control group, i.e., endometrial hyperplasia (n=8), endometrial polyps (n=8), intrauterine adhesions (n=5), and submucous fibroids (n=2). Of the 21 IUD patients with missing strings, there were previous failed trial of blind removal in 11 cases. Most lost IUDs were found inside the uterine cavity (81%) with curling and ascending strings. Partial perforation, abdominal translocation, and unnoticed complete expulsion were detected in 19% of the patients. Direct visualization of the endometrial cavity is invaluable in treating IUD users who complain of pain and/or bleeding and in locating and retrieving missing IUDs.

The impact of endemic schistosomiasis on acute viral hepatitis

One hundred forty-four of 166 adults with acute viral hepatitis (AVH) admitted to an Egyptian fever hospital were followed for 12 months. The hepatitis B surface antigen (HBsAg) carrier rate in 95 with hepatitis B virus (HBV) hepatitis decreased from 53% at three months to 13% at 12 months. At 12 months, 22% of the male patients had persistent HBsAg compared with only 7% of the female patients. The HBsAg carrier rate was 25% at 12 months in those with schistosomiasis compared with 9% in those with only acute HBV infection. Splenomegaly persisted in those with palpable spleens at the initial examination and others developed splenomegaly. The prevalence of splenomegaly increased from 11% on admission to 20% at 12 months in those with only AVH, and from 40% to 69% in those with concomitant schistosomiasis. Patients with concomitant schistosomiasis had higher mean values for liver function test results and a greater proportion had abnormal liver function test results during hospitalization and follow-up than those with AVH only. Concomitant schistosomiasis increased the prevalence and prolonged splenomegaly and morbidity due to AVH. Both male sex and concomitant schistosomiasis prolonged the HBsAg carrier state. We propose that AVH frequently converts uncomplicated intestinal schistosomiasis to hepatosplenic schistosomiasis.

Inhibition of elastase enzyme release from human polymorphonuclear leukocytes by N-acetyl-galactosamine and N-acetyl-glucosamine

We studied the effect of aminosugars on the elastase enzyme released from cytochalasin-B treated polymorphonuclear neutrophils (PMN) and stimulated by F-Met-Leu-Phe (FMLP). Both N-acetyl-galactosamine and N-acetyl-glucosamine can inhibit the release of leukocyte elastase enzyme. N-acetyl-galactosamine was a potent inhibitor of elastase enzyme release in a dose-related fashion. Inhibition ranged from 91.9% up to total inhibition. N-acetyl-glucosamine showed a mild inhibitory effect on elastase enzyme release; however, it too acted in a dose-related fashion. The range of inhibition was 17.17%-8.18%. Mannosamine showed an inhibitory effect in some donors, but this effect was not statistically significant. No effect on elastase enzyme release was shown with other sugars such as D-glucose and L-fucose. These results show that N-acetyl-galactosamine can inhibit the respiratory burst, which suggests that the aminosugars might do more than interfere with the carbohydrate lectin interaction.

Hepatitis B vaccination in children infected with Schistosoma mansoni: correlation with ultrasonographic data

Forty-one schoolchildren with positive stools for Schistosoma mansoni eggs and 39 age- and sex-matched children with negative stools were given 3 doses, 5 micrograms each, of a plasma derived hepatitis B vaccine. Their sera were examined 3 and 9 months after the third dose for hepatitis B surface antibody (anti-HBs). At 9 months after vaccination, both the number of responders and the mean of antibody titers were significantly higher in the control group than in the group infected with S. mansoni (97% vs. 56% and 334.8 +/- 192.9 vs. 67.7 +/- 74.4 mIU/ml). There was a negative correlation between anti-HBs titers and the long diameter of the spleen as well as between the titers and the long diameter of the spleen and the liver span in the mid-clavicular line (right lobe) taken together. There was also a positive correlation between anti-HBs titers and the diameters of the portal vein. There was no correlation between anti-HBs titers and any of the following 3 parameters: liver span in the mid-clavicular line (right lobe) alone, liver span in the middle line (left lobe) alone, and the degree of thickness of the periportal fibrosis. There was also no correlation between anti-HBs titers and egg counts in the stools. An interpretation of these findings was made in the light of the role of phagocytic activity of the liver and spleen as well as of porta-caval shunts in the immune mechanism.

Changes in the circulating levels of hemoglobin, hematocrit, serum iron and total iron binding capacity after four methods of surgical tubal sterilization

One-hundred women requesting voluntary surgical sterilization were included and enrolled into four groups (each n = 25). Four sterilization modalities were used namely: Falope ring, electrocoagulation, clip and Pomeroy ligation. The circulating levels of hemoglobin, hematocrit, serum iron and total iron binding capacity were studied before sterilization and at 3, 6 and 12 months thereafter. No significant changes were observed at 3 and 6 months post-sterilization. At 12 months a significant increase in the hemoglobin and serum iron was observed with a significant decrease in total iron binding capacity. Falope ring, clip and Pomeroy ligation were of a higher rank in this context versus electrocoagulation.

Clinical and laboratory studies in patients with leprosy and enthesitis

In a combined clinical, radiological, and laboratory study of 77 patients throughout the leprosy spectrum, 10 patients had an enthesitis which has not been described previously as far as is known and which was not associated with the characteristics of erythema nodosum leprosum reactions. C reactive protein and alpha 1 acid glycoprotein values were significantly lowered only in those patients with leprosy and enthesitis. No radiological abnormalities were found.

The combined use of cytological imprint and frozen section in the intraoperative diagnosis of ovarian tumors

Intra-operative diagnosis by cytological imprint and frozen sectioning supplemented by paraffin impregnation were carried out on 50 suspected ovarian tumors. The combined cytologic and cryostat methods gave an accuracy rate of 90% compared to 84% and 74% of either method used separately, and in a short time.

Changes in menstrual blood loss after four methods of female tubal sterilization

One-hundred females requesting tubal sterilization were included in this study. They were enrolled into 4 groups, each n = 25. They were allocated to a particular method of sterilization on a randomized basis. The four modalities used were: laparoscopic Falope ring application, bipolar electrocoagulation, Hulka clip application and Pomeroy tubal ligation via minilaparotomy. The menstrual blood loss (MBL) was quantitatively estimated, using the alkaline hematin method, prior to sterilization and after 3, 6 and 12 months. No significant changes in MBL were observed after the four sterilization techniques. Moreover, they did not differ significantly in this context.

Avascular necrosis of temporomandibular joint in sickle cell disease

Avascular necrosis of temporomandibular joint (TMJ) in sickle cell disease was not reported in patients suffering from this disease. In this report, we present a case of a young Saudi female with avascular necrosis of the left temporomandibular joint associated with avascular necrosis of head of left femur, and early changes of infarction of the humeral head of the left shoulder. Clinical examination, laboratory investigations, tomography and computerized tomography scanning, confirmed the diagnosis of sickle cell disease, and the development of avascular necrosis of the left temporomandibular joint.

Clinical and laboratory studies of arthritis in leprosy

Arthritis associated with leprosy is underreported. In Egypt 66 patients from a leprosy colony were studied, 20 of whom had arthropathy. This was characterised by an inflammatory symmetrical peripheral polyarthritis. The wrist, metacarpal and proximal interphalangeal joints of the hands, the knees, and the metatarsophalangeal joints of the feet were affected with associated morning stiffness. The arthritis was erosive in 11 out of 20 patients, had no features of the arthritis associated with erythema nodosum leprosum reactions, but symptomatically responded to antileprosy treatment. This arthritis would seem to be a previously unrecognised feature of leprosy.

Incidence of coliphage in potable water supplies

Samples of drinking water from different sources in greater Cairo, Egypt, and bottled drinking water were tested for total coliform, fecal coliform, and coliphage populations. Of the 147 samples tested, 4 samples were positive for both total coliforms and coliphage, 65 samples were negative for total coliforms, fecal coliforms, and coliphage, and 78 samples were positive for coliphage and negative for total coliforms and fecal coliforms. The incidence of coliphage in these potable water supplies reflects the probability of human pathogenic virus survival in these waters also.

Hepatic macrophage function in schistosomal glomerulopathy

Hepatic fibrosis in the pathogenesis of schistosomal glomerulopathy cannot be explained by any positive influence of hepatocellular injury. In order to examine the potential role of impairment of hepatic macrophage function, the t1/2 plasma clearance of 99mTc-sulphur colloid was studied in 30 patients with schistosomal glomerulopathy, ten normal volunteers, ten cases of uncomplicated intestinal schistosomiasis, ten non-schistosomal cirrhotic patients and ten non-schistosomal nephrotic patients. Liver and renal biopsies were obtained from appropriate groups and examined by light microscopy and glomerular immunofluorescence. There was a significant correlation between t1/2 of sulphur colloid clearance and proteinuria, mesangial hypercellularity, and predominance of IgA glomerular deposits. These data indicate that hepatic macrophage dysfunction is an important factor in the pathogenesis of schistosomal glomerulopathy, and that IgA plays a major role in advanced glomerular lesions. The degree of impairment of hepatic macrophage function may influence the pattern and severity of glomerular lesions depending upon the affection of IgA clearance mechanisms.

Prostaglandins and cellular reaction in uterine flushings. I. Effect of IUD insertion

Uterine prostaglandin (PG) levels and cellular reaction in response to IUDs were elevated in sixty women. Short-term users (n = 30) were studied in a control cycle and 3 months after IUD insertion, and long-term users (n = 30) were studied at least 2 years after device insertion. A uterine wash was performed in the proliferative and luteal phase of each investigated menstrual cycle; the cellular components were counted and levels of PGE2, PGF2 alpha and their 13,14-dihydro-15-keto metabolites measured. A significant rise in PG levels was observed in the uterine wash shortly after IUD insertion, particularly in the luteal phase. However, there was a significant reduction in PG levels among long-term users, though the cellular reaction showed a continued increment. The absence of correlation between the biochemical and biological responses indicated that neither of them was totally dependent on the other. The decreased PG levels among long-term users does not support the concept of a key role for these substances in the mechanism of action of IUDs. The temporary post-insertion rise in PG levels coincides with the phase of increased bleeding and pain.

Prostaglandins and cellular reaction in uterine flushings. II. Effect of PG synthesis inhibition in IUD users

The effect of oral administration of indomethacin (100 mg/day), a potent inhibitor of prostaglandin (PG) biosynthesis, on the PG levels and cellular profile in the uterine flushings in response to the use of an IUD (Lippes Loop size C) was studied in sixty women. Indomethacin reduced the cell counts in both follicular and luteal phases of menstrual cycles before and after IUD insertion. The anti-inflammatory drug decreased PGE2 and PGF2 alpha levels in both phases of the cycle before IUD insertion. After insertion, it inhibited only the formation of PGF2 alpha and its 13,14-dihydro-15-keto metabolite in the luteal phase but not in the follicular phase. In long-term users, however, the drugs reduced the levels of all PGs studied in the luteal phase and only PGF2 alpha and its metabolite in the follicular phase. The implications of these findings in the mechanisms of contraceptive action of IUDs and their side effects are discussed.

[Salivary glands of Myzus persicae (Homoptera, Aphididae): structure and secretory rhythm]

The salivary glands of Myzus persicae (Homoptera, Aphididae): structure and secretory rythm. Studying the structure of the salivary glands of Myzus persicae, a particular mode of working of these organs were observed. The glands seem to function in an alternative manner. This aspect is discussed with regards to the nutritional biting of the bug.