Women's mobility and transport in the peripheries of three African cities: Reflecting on early impacts of COVID-19

This paper reflects on the mobility experiences of women in African cities in COVID-19, based on research conducted both prior to and following entry into the COVID-19 'moment'. It draws on material collected during an ongoing action research study aimed at addressing the everyday transport and mobility challenges faced by young women living in poor peripheral communities of three African cities - Abuja, Cape Town and Tunis. The project has the specific objective of supporting young women's improved access to employment opportunities through trialling various mobility/transport-related skills interventions (based on prior in-depth analysis of mobility constraints). With the onset of COVID-19 some readjustments to the research focus and planned interventions became necessary. The research teams, together with an NGO partner, are now working to chart how young women's everyday experiences of mobility and transport - both as transport users and as transport sector workers - are changing as processes of lockdown and their relaxation evolve. The paper covers the period from early 2019 through to March 2021, and offers reflections regarding 'lived experiences' of mobility practice pre-pandemic, during the pandemic, and the potential longer-term mobility-related impacts for women resident in low-income neighbourhoods in a post-COVID-19 era. This leads to consideration of key policy lessons. There is potential for prioritisation of Non-Motorised Transport interventions towards a green restart that would benefit women (for instance through promoting women's cycling), and for growing women's participation as transport operators, even perhaps the usage of drones to aid women's safer pedestrian travel. But such interventions will require far greater representation of women in COVID-19 and wider transport decision-making entities than has hitherto been the case.

Identification of a novel nonsense variant in FYCO1 gene associated with infantile cataract and cortical atrophy

INTRODUCTION

Cataract is a major condition characterized by ocular lens opacification, resulting from alteration in the lens architecture, lens proteins or both. It is responsible for about one-third of infants' blindness worldwide. Variants in the FYCO1 gene have been associated with autosomal recessive infantile cataract.

MATERIAL AND METHODS

We conducted whole exome sequencing (WES) in a nine months old male patient who was referred for genetic investigation because of infantile cataract. WES analysis revealed the presence of a homozygous pathogenic variant (c.2365C>T) in exon 8 of the FYCO1 gene.

RESULTS AND DISCUSSION

This is the first report on a Lebanese infant with infantile cataract and cortical atrophy which was not previously reported, resulting from a novel homozygous FYCO1 variant; thus expanding the clinical phenotypic spectrum of FYCO1 involvement.

Results of survey on perception of patient safety culture among emergency nurses in Jordan: Influence of burnout, job satisfaction, turnover intention, and workload

BACKGROUND

Patient safety culture is an essential factor in the decreasing of medical errors and development of the institutions. This study was conducted to determine to what extent the selected variables, including age, weekly working hours, years of experience, burnout, turnover intention, workload, and job satisfaction, predict perceived patient safety culture among emergency nurses in Jordanian hospitals.

METHODS

A cross-sectional design with convenience sampling approach was used. A total of 157 emergency nurses from governmental and public hospitals were participated in the study and completed the study's survey: Hospital Survey on Patient Safety Culture (PSC), Copenhagen Burnout Inventory-Student Survey (CBI-SS), NASA Task Load Index (NASA-TLX), Nursing Workplace Satisfaction Questionnaire (NWSQ) and turnover intention scale (TIS).

RESULTS

The results showed that there was a negative relationship found between nurses' age and PSC perception (r=-.166, P=.039), personal burnout and PSC (r=-.160, P=.048), and there was also a negative relationship between turnover intentions and perceived PSC (r=-.334, P=.000). The results from the regression model indicated that turnover intentions, reporting patient safety events, and the number of events reported predicted PSC. The results showed that R²=.29, adjusted R²=.287, F(6,141)=9.45, P<0.01.

CONCLUSION

Our results suggests that nurses' managers may pay attention to decreasing burnout and analyze turnover intention among nurses in order to improve the culture of patient safety.

CT-derived left ventricular global strain: a head-to-head comparison with speckle tracking echocardiography

We assessed CT-derived left ventricular strain in a cohort of patients referred for transcatheter aortic valve implantation (TAVI) and validated it against 2 dimensional speckle tracking echocardiography as the gold standard. 65 consecutive patients with symptomatic aortic valve stenosis referred for CT imaging prior to TAVI were included in this analysis. For all patients, retrospectively ECG-gated multi-phase functional CT data sets acquired with identical reconstruction parameters were available. All data sets were acquired using a third generation dual source system. In all patients, multiphase reconstructions in increments of 10% of the cardiac cycle were rendered (slice thickness 0.75, increment 0.5 mm, medium smooth reconstruction kernel) and transferred to a dedicated workstation (Ziostation2, Ziosoft Inc., Tokyo, Japan). Additional functional reconstructions for dynamic assessment and quantification of strain were processed. Multiplanar reconstructions (MPR) of the left ventricle similar to standard echocardiographic 4, 2 and apical 3 chamber views were rendered in CT. Similar to echocardiographic longitudinal strain, the perimeter of the left ventricle was manually traced within the myocardium and peak maximal shortening as a parameter representing longitudinal strain was calculated for each view and averaged to obtain a marker for global longitudinal strain (CT perimeter-derived strain). Furthermore, for quantification of 3-dimensional strain, endocardial and epicardial borders of myocardium were marked in six short axis views and peak maximum 3- dimensional strain of the myocardium was calculated in standard six basal, six mid and four apical segments. 3-dimensional strain values of the 16 standard segments as well as perimeter-derived strain values in the three standard windows were averaged to obtain global strain. Echocardiography was performed in all patients before CT data acquisition. Digital loops were acquired from three apical views (four-, two-, and three chamber views). For assessment of 2 dimensional global longitudinal strain (GLS), recordings were processed with acoustic-tracking software allowing offline semiautomated speckle-based strain analyses. The mean age of all 65 patients was 81 ± 5 years. The mean echocardiographic ejection fraction and mean echocardiographic GLS were 50 ± 12% and -13.6 ± 4.5%, respectively. The mean CT-derived peak 3-dimensional global strain and mean peak strain derived by perimeter was 43.2 ± 13.5% and -11.2 ± 3.5%, respectively. Both CTderived global 3D-strain and perimeter derived strain showed a significant correlation to GLS derived by echocardiography (r = -0.8, p < 0.0001 for 3D strain and r = 0.71, p < 0.0001 for perimeter-derived strain). Bland-Altman analysis showed a systematic underestimation (i. e. worse strain values) of CT perimeter-derived strain compared to GLS by echocardiography (mean difference -2.4% with 95% limits of agreement between 4% to -9%). ROC Curve analysis assuming a normal GLS when less than -18% showed that a CT-derived peak 3-dimensional global strain cut-off-value of 45% has a sensitivity of 91% and a specificity of 60% for detecting normal left ventricular strain (AUC 0.81, p = 0.001). For CT perimeter-derived strain, a cut-off value of -12%-assuming a normal echocardiographic GLS when less than -18%-achieved a sensitivity of 82% and a specificity of 61% (AUC of 0.82, p = 0.001) for detecting abnormal left ventricular strain. Using dedicated software, assessment of CT-derived left ventricular strain is feasible and comparable to strain derived by echocardiographic 2 dimensional speckle tracking.

[Difficulty in diagnosis of a cardiogenic shock with thrombotic and sub-occluded LAD. A train can hide another one!]

The pheochromocytome is a localized tumor at the level of the medullosurrenale in 85% of the cases. The clinical presentation is very variable. Severe Heart failure presentation can be the mode of revelation in 2% of the cases. We present the case of a patient admitted for refractory cardiogenic shock correlated to pheochromocytome tumor. The difficulty of this rare clinical presentation was to confirm rapidly and in emergency this diagnosis in the same time when the patient presents a persistante and severe cardiogenic chock after finding a sub-occluded and thrombotic LAD coronary artery and which was treated by thrombectomy and coronary revascularization. The surgical treatment of this tumor is considered to be a quickly saving treatment. It allows a fast recovery of the cardiac function.

Seasonality and toxin production of Pyrodinium bahamense in a Red Sea lagoon

Harmful algal blooms of the dinoflagellate Pyrodinium bahamense have caused human and economic losses in the last decades. This study, for the first time, documents a bloom of P. bahamense in the Red Sea. The alga was recurrently present in a semi-enclosed lagoon throughout nearly 2 years of observations. The highest cell densities (10⁴-10⁵cellsL^-1) were recorded from September to beginning of December at temperatures and salinities of ∼26-32°C and ∼41, respectively. The peak of the bloom was recorded mid-November, before a sharp decrease in cell numbers at the end of December. Minimum concentrations in summer were at ∼10³cellsL^-1. A saxitoxin ELISA immunoassay of cultures and water samples confirmed the toxicity of the strain found in the Red Sea. Moreover, a gene expression analysis of the saxitoxin gene domain SxtA4 showed that transcript production peaked at the culmination of the bloom, suggesting a relation between transcript production, sudden cells increment-decline, and environmental factors.

Investigating the informed consent process, therapeutic misconception and motivations of Egyptian research participants: a qualitative pilot study

Few studies have explored the informed consent process among research participants in developing countries. This study aimed to evaluate the informed consent process, therapeutic misconception and motivation for participation among Egyptians participating in clinical trials. In a cross-sectional qualitative pilot study 103 participants in 10 clinical trials responded to a questionnaire. Over 90% agreed they had time to ask questions and received adequate information about the risks prior to consenting. All participants thought the research and the drug would improve their condition; only 46.1% were aware of receiving a non-approved experimental drug and 21.3% of being randomized. Reasons for participation included: better treatment (100%), to benefit society & advance science (85.4%), to receive free drugs (42.6%) and medical care (43.6%), to get hospitalized (15.8%) and to receive money or gifts (4.9%). Investigators need to emphasize the distinction between research and clinical care to address the high rate of therapeutic misconception.

Management of acute chest pain: A major role for coronary CT angiography

Most patients presenting with acute chest pain (ACP) at the emergency unit do not have any marked electrocardiogram abnormalities or known history of heart disease. Identifying the few patients who have, or will actually develop acute coronary syndrome in this group that is considered to be at low risk, is an actual clinical challenge for emergency department physicians. In these patients, the goal of complementary non-invasive morphological or functional imaging tests is to exclude heart disease. The diagnostic values of coronary CT angiography include a sensitivity of 96% and a negative likelihood ratio of 0.09, which are highly contributory to the diagnosis, and the integration of this imaging test into a decision tree algorithm appears to be the least expensive strategy with the best cost/effective ratio. Coronary CT angiography is indicated in the presence of ACP associated with an inconclusive electrocardiogram, in the absence of any other obvious diagnoses, when the ultrasensitive troponin assay is negative or the dynamic changes are modest, slow and/or inconclusive. Ideally, coronary CT angiography should be performed within 3 to 48hours after the initial consultation.

Neutronic and burn-up calculations of heterogeneous Thorium/Uranium fuel in pressurized water reactors

The purpose of this work is to study the feasibility of the Thorium/Uranium fuel cycle in heterogeneous Pressurized Water Reactors (PWR) core design. This paper focuses on the neutronic and burn-up analysis of the Thorium/Uranium fuel using the computer codes MCNPX and WIMS. The design is based on the Whole Assembly Seed and Blanket (WASB) concept, in which the individual seed (Uranium) and blanket (Thorium-Uranium) units occupy one full-size PWR assembly in a checkerboard core configuration. The results of the present models were compared with the solution of benchmark problems and satisfactory agreement was found.

A Study on Physical Aging of Semicrystalline Polyethylene Terephthalate below the Glass Transition Point

Physical aging of semicrystalline polyethylene terephthalate was studied using differential scanning calorimetry(DSC). PET samples with crystallinity content of 0.28 were aged at two different temperatures, 25 and 45°C. Thesamples were stored for several days and periodically tested using DSC method. The glass transition temperature forthe samples aged at 25°C was about 73-74°C, and the position and intensity of endothermic peaks wereapproximately constant. Higher glass transition of the samples aged at 45°C, 73-86°C, was attributed to the enthalpyrelaxation process of amorphous regions of semicrystalline PET. For the samples aged at 45°C, the endothermicpeaks shifted to higher temperatures with increasing aging time. The position of the endothermic peaks determined bythe temperature of the maximum, Tmax, tended to increase with aging time for samples aged at 45°C, and theintensity of the peaks continuously increased with time; however, the results showed that the aging of PET samples at45°C even after 120 days continued the enthalpic relaxation of semicrystalline PET and that the process could bestudied by DSC method. The results also showed that the aging process could affect the final degree of crystallinity ofc-PET samples and the samples stored at 45°C showed higher degree of crystallinity than the samples aged at 25°C.

Gender moderates the relationship between mania spectrum and serotonin transporter polymorphisms in depression

The short (s) variant of the serotonin transporter gene linked functional polymorphic region (5-HTTLPR) is associated with depression. Stressful life events, gender, and race have been shown to moderate this association. Because features of mania/hypomania seem to constitute an indicator of higher severity of depression, we examined the relationship between 5-HTTLPR genotype and symptoms of mania-hypomania spectrum occurring over the lifetime in patients with major depression. The possible moderating role of gender in this relationship was taken into account. Two hundred twenty-two patients with unipolar major depression were genotyped for 5-HTTLPR and nine other representative polymorphisms, and were administered the Mood Spectrum Questionnaire, Lifetime Version (MOODS-SR). The manic-hypomanic (MH) component score was used for analysis. Using a linear model of the MH score as a function of genotypes and gender, controlling for age, severity of depression, and site, we found significant effects of gender (F = 8.003, df = 1, P = 0.005), of the interaction gender x genotype (F = 4.505, df = 2, P = 0.012), and of the baseline Hamilton score (F = 5.404, df = 1, P = 0.021), non-significant effects of genotype (F = 1.298, df = 2, P = 0.275), age (F = 0.310, df = 1, P = 0.578) site (F = 0.504, df = 1, P = 0.479). Significant associations were also detected at three other SNPs. The association between the manic/hypomanic component of the MOODS-SR and the polymorphisms of the 5-HTTLPR is moderated by gender. This finding is intriguing from a clinical point of view because women with unipolar disorder and the "ss" genotype seem to constitute a sub-group with higher severity of depression. These results should be considered tentative pending replication in other samples.

Predominant Th1 and cytotoxic phenotype in biopsies from renal transplant recipients with transplant glomerulopathy

Transplant glomerulopathy (TGP) appears to be a pathogenic feature of chronic antibody-mediated rejection, but the pathogenesis of this histologic entity is still poorly understood. Previous studies suggest the involvement of lymphocytes but the phenotypes of these cells have never been analyzed. Here, we report the first study of mRNAs for specific markers of CD4+ T cells including Th1 (T-bet and INFgamma), Th2 (IL4 and GATA3), Treg (Foxp3) and Th17 (IL-17 and RORgammat) subsets, cytotoxic CD8 T cells (Granzyme B) and B-cell markers (CD20) in renal biopsies from renal transplant recipients suffering interstitial fibrosis and tubular atrophy (IF/TA) with or without TGP but with a similar inflammatory score and controls including transplant recipients with normal renal function. Only INFgamma, T-bet (both functionally defined markers of Th1 CD4 T cells) and granzyme B (a CD8 cytotoxic marker) were significantly more strongly expressed in patients with TGP than in patients without TGP and normal controls. These results indicate a role of an active T-mediated inflammatory and cytotoxic process in the pathogenesis of TGP.

High prevalence of Foxp3 and IL17 in MMR-proficient colorectal carcinomas

BACKGROUND AND AIMS

Colorectal cancer (CRC) harbours different types of DNA alterations, including microsatellite instability (MSI). Cancers with high levels of MSI (MSI-H) are considered to have a good prognosis, probably related to lymphocyte infiltration within tumours. The aim of the present study was to characterise the intratumoural expression of markers associated with the antitumour immune response in mismatch repair (MMR)-proficient (MSS) colon cancers.

METHODS

Ninety human colon cancers (T) and autologous normal colon mucosa (NT) were quantified for the expression of 15 markers of the immune response with quantitiative reverse transcription-PCR (qRT-PCR). mRNA expression levels were correlated with MMR status. Immunohistochemistry (IHC) was performed using both interleukin 17 (IL17) and CD3 antibodies.

RESULTS

Expression of cytotoxic markers (FasL, granzyme B and perforin), inflammatory cytokines (IL1beta, IL6, IL8, IL17 and transforming growth factor beta (TGFbeta)) and a marker of regulatory T cells (forkhead box P3 (Foxp3)) was significantly higher in tumours than in autologous normal tissues. Adjusting for MMR status, higher tumoural expression of both granzyme B and perforin was associated with the MSI-H phenotype, and the perforin T/NT ratio was higher in MSI-H tissues than in MSS tissues. Higher tumoural expression of Foxp3, IL17, IL1beta, IL6 and TGFbeta was associated with the MSS phenotype, and the IL17 T/NT ratio was higher in MSS tissues than in MSI-H tissues as assessed by both qRT-PCR and IHC.

CONCLUSIONS

Immune gene expression profiling in CRC displayed different patterns according to MMR status. Higher Foxp3, IL6, TGFbeta and IL17 expression is a particular determinant in MMR-proficient CRC. These may be potential biomarkers for a new prognostic "test set" in sporadic CRCs.

Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998–2004)

Laboratory-based surveillance for bacterial meningitis was conducted in a network of infectious disease hospitals in Egypt to better understand the epidemiology of this infection. Healthcare and laboratory personnel were trained in basic surveillance and microbiologic processing of cerebrospinal fluid (CSF) specimens. All bacterial isolates from CSF were confirmed and tested for antimicrobial susceptibility. PCR testing was performed on a random subset of purulent, culture-negative CSF specimens. Of 11,070 patients who met criteria for the case definition, 843 (8%) were culture positive (42% positive for Streptococcus pneumoniae, 20% for Haemophilus influenzae serotype b, 17% for each of Neisseria meningitidis and Mycobacterium tuberculosis, and 6% for other bacteria). Of 1,784 (46%) CSF specimens tested by PCR, 232 (13%) were positive for the first three major pathogens. Of N. meningitidis isolates, 52% belonged to serogroup A, 35% to serogroup B, and 4% to serogroup W135. S. pneumoniae isolates comprised 46 different serotypes, of which 6B, 1, 19A, 23F, and 6A were the most predominant. The overall case-fatality rate for culture-positive cases was 26% and was highest among patients with M. tuberculosis (47%). Factors significantly associated with death (p < 0.05) included admission to rural hospitals, long prodromal period, referral from other hospitals, antibiotic treatment prior to admission, and clear CSF (<100 cells/mm3). Susceptibility to ampicillin and ceftriaxone was observed in 44 and 100% of H. influenzae serotype b isolates and in 52 and 94% of S. pneumoniae isolates, respectively. This surveillance highlights the significant mortality and morbidity associated with bacterial meningitis in Egypt. Decision makers need to review current treatment guidelines and introduce appropriate vaccines for prevention and control of the disease.

Renal allograft biopsies with borderline changes: predictive factors of clinical outcome

The clinical outcome and appropriate management for patients showing 'borderline changes' on allograft biopsy after renal transplantation is still controversial. In an attempt to identify predictive factors of clinical outcome of patients with such lesions, we reviewed the clinical course of 91 patients with borderline changes. Multivariate analysis revealed significant and independent effects of histological stage (i + t < or = or > 2) and time to borderline changes (< or = or > 3 months after transplant) on serum creatinine levels at 1 year from borderline changes episodes (respectively, p = 0.04 and p = 0.02) and only a significant effect of time to borderline changes on serum creatinine levels at 2 years (p = 0.005). Renal function at 1 year and 2 years as 5- and 8-year graft survival were not significantly different in the group of patients treated with antirejection therapy (T group, n = 49) compared with the untreated group (UT group, n = 42). This study strongly suggests that borderline changes with histological score (i + t) > 2 and late episodes of borderline changes should be considered to be of poor prognosis.

Acute hepatitis C without and with schistosomiasis: correlation with hepatitis C-specific CD4(+) T-cell and cytokine response

BACKGROUND & AIMS

Immune responses during the first few months of acute hepatitis C virus (HCV) infection seem crucial for viral control, but the relationship of these responses to natural history is poorly characterized.

METHODS

This prospective study investigated the HCV-specific CD4(+) and cytokine responses in patients with acute HCV hepatitis with or without Schistosoma mansoni coinfection, a parasitic infection with T helper (Th) 2 immune bias. HCV-specific CD4(+) proliferative responses and cytokine production in peripheral blood mononuclear cells were correlated with liver biopsy results at 6 months and at the end of follow-up.

RESULTS

Whereas 5 of 15 patients with HCV alone recovered from acute HCV, all (17 of 17) patients with S. mansoni coinfection progressed to histologically proven chronic hepatitis. Coinfected patients had either absent or transient weak HCV-specific CD4(+) responses with Th0/Th2 cytokine production. The magnitude of the HCV-specific CD4(+) response at week 12 was inversely correlated with the fibrosis progression rate in chronically infected patients.

CONCLUSIONS

Patients with acute hepatitis C and schistosomiasis coinfection cannot clear viremia and show rapid progression once chronic infection is established. This rapid progression is associated with a strong Th2 response in peripheral immune responses, suggesting that early development of vigorous Th1 responses not only facilitates clearance but delays disease progression.

Predictive factors of ventricular fibrillation triggered by pause-dependent torsades de pointes associated with acquired long QT interval: role of QT dispersion and left ventricular function

INTRODUCTION

Death due to acquired torsades de pointes usually is caused by ventricular fibrillation (VF), but the contributing factors to VF triggered by pause-dependent torsades de pointes are not understood.

METHODS AND RESULTS

We evaluated 91 patients who fulfilled four criteria: (1) pause-dependent torsades de pointes; (2) prolonged QT interval and/or corrected QT (QTc) (>0.44 sec); (3) long-short initiation sequence; and (4) conditions known to induce pause-dependent torsades de pointes. There were 38 patients with a documented VF (group I) and 53 without VF (group II). Absolute and relative dispersions of QT and QTc were calculated based on the 12-lead standard ECG. Group I differed from group II with regard to myocardial infarction history (32% vs 13%; P = 0.035), left ventricular ejection fraction (44% +/- 14% vs 65% +/- 9%; P < 0.0001), presence of structural heart disease (100% vs 20.8%; P < 0.0001), QT mean (591 +/- 73 msec vs 514 +/- 78 msec; P < 0.0001), QTc mean (563 +/- 76 msec vs 508 +/- 90 msec; P = 0.002), absolute QT dispersion (166 +/- 56 msec vs 84 +/- 49 msec; P < 0.0001), relative QT dispersion (9.9% +/- 3.5% vs 6.3% +/- 3.2%; P < 0.0001), absolute QTc dispersion (158 +/- 57 msec vs 81 +/- 44 msec; P < 0.0001), and relative QTc dispersion (9.9% +/- 3.6% vs 6.2% +/- 3%; P < 0.0001). Multiple regression analysis showed that ejection fraction (P = 0.0001), presence of structural heart disease (P < 0.0001), and relative QTc dispersion (P = 0.038) were the only independent predictors of VF.

CONCLUSION

Left ventricular function, presence of structural heart disease, and QTc relative dispersion should be evaluated carefully in patients with conditions susceptible to inducing torsades de pointes.

Junctional rhythm during slow pathway radiofrequency ablation in patients with atrioventricular nodal reentrant tachycardia: beat-to-beat analysis and its prognostic value in relation to electrophysiologic and anatomic parameters

INTRODUCTION

Junctional rhythm usually is considered a sensitive but nonspecific marker of successful ablation of the slow pathway in AV nodal reentrant tachycardia. Nevertheless, this junctional rhythm has been little studied, and its relations to recognized predictors of successful radiofrequency (RF) application were never established in any study.

METHODS AND RESULTS

Thirty-nine patients underwent RF ablation of the slow pathway for AV nodal reentrant tachycardia. Ninety RF applications were delivered, and each ablation site was determined using three different fluoroscopic projections. Six anatomic zones were defined from low posterior septum to the site of distal His-bundle recording (P1, P2, M1, M2, A1, and A2). Characteristics of junctional rhythm during RF applications were analyzed. Atrial electrogram characteristics at the ablation sites also were studied. All patients had successful slow pathway ablation, without any complication. The ablation sites were located as follows: 41 at P1, 26 at P2, 20 at M1, and 3 in M2. Forty RF applications were successful: 14 of 41 attempts at P1, 7 of 26 at P2, 16 of 20 at M1, and 3 of 3 at M2. Mid-septal ablation site (M1 and M2) was associated with higher occurrence of junctional rhythm (P < 0.0001), earlier first junctional beat (P = 0.008), and earlier occurrence of the longest junctional burst (P = 0.03) compared with posterior ablation site (P1 and P2). The combination of a mid-septal ablation site and a first junctional beat occurring < or = 3 seconds after onset of RF application identified successful RF application with 100% accuracy. Using multivariate analysis, the ablation site, duration of atrial electrogram (including slow pathway potential when present), and occurrence of junctional rhythm were independent predictors of success.

CONCLUSION

Successful slow pathway ablation depends on many factors. Junctional rhythm characteristics are related to the site of RF delivery and can be helpful in assessing successful slow pathway ablation.

Evaluation of Egyptian sheep production systems: I. Breed crosses and management systems

Our objective was to evaluate life-cycle performance of flocks of two Egyptian breeds, Rahmani (R) and Ossimi (O), and their crosses with Finnish Landrace (F) in two management systems. Management systems were one mating season per year (1M) and three mating seasons per 2 yr (3M). Breeds and crosses studied included purebred R and O, F1 crosses 1/2F-1/2R (FR) and 1/2F-1/2O (FO), and inter se matings of 1/4 F-3/4 R (RFR) and 1/4 F-3/4 O (OFO). A dynamic computer model was used to simulate animal performance and enterprise efficiency and profit. Two measures of lifecycle feed conversion (biological efficiency) were computed: kilograms of TDN input per kilograms of empty body weight output (TDN/EBW) and kilograms of TDN input per kilogram of carcass lean output (TDN/CLN). Profit was measured as gross margin (income minus variable costs per ewe per year, GM/EWE). Input parameters for the model were obtained from published results and analyses of data collected from experimental flocks of the same genetic stocks in Egypt. Profit for FR and RFR was 42 and 6% higher in 1M than in 3M. However, profit for all other genetic types was 4 to 8% greater in 3M than in 1M. Breed rankings changed depending on the measure of evaluation (i.e., biological efficiency or profit). Maximization of system output did not necessarily improve efficiency. Under accelerated lambing systems, greater overhead costs associated with labor and feed offset gains in ewe productivity. Genetic stocks should be matched to resources and management systems.

Evaluation of Egyptian sheep production systems: II. Breeding objectives for purebred and composite breeds

Objectives for this study were to estimate relative economic weights for performance traits for two native and two composite sheep breeds under two management systems in Egypt. Breeds studied were Rahmani (R), Ossimi (O), 3/4R-1/4Finnish Landrace (RFR), and 3/4O-1/4Finn (OFO); OFO and RFR were composite breeds. Management systems were one mating season per year (1M) and three mating seasons per 2 yr (3M). A dynamic computer model was used to simulate animal performance and enterprise efficiency and profit. Input parameters for the model were obtained from published results and analyses of data collected from experimental flocks of the same genetic stocks in Egypt. Responses for two measures of life-cycle feed conversion and one measure of enterprise profit were evaluated. Life-cycle feed conversion was calculated as kilograms of TDN input per kilogram of empty body weight output (TDN/EBW) and kilograms of TDN input per kilogram of carcass lean output (TDN/CLN). Profit was measured as annual gross margin/ewe (GM/EWE). Traits evaluated were conception rate (CR), lambing rate (LR), mortality rate (MR), mature weight (MW), and milk production (MK). Based on responses to percentage changes in trait means, CR was most important for TDN/EBW, followed by LR and MR. For TDN/CLN, LR, MR, and CR were most important. For GM/EWE, CR was most important, followed by LR, MW, and MR. In the systems studied, there was little response to changes in MK. Based on changes in GM/EWE per genetic standard deviation change, LR was most important, followed by CR, MR, MW, and MK in all systems. Relative economic weights for O and OFO were similar, as were weights for R and RFR. Differences in economic weights between management systems for the same breed were not large enough to justify separate selection lines within breeds.

Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure

Biventricular pacing has recently been proposed for treating patients with drug refractory heart failure and intraventricular conduction delay. The purpose is to restore ventricular relaxation and contraction sequences as homogeneously as possible. The aim of this study was to determine if some factors could predict the long-term clinical effectiveness of that new treatment. This study included 26 patients, aged 66 +/- 7 years, with drug refractory heart failure and wide QRS. Patients were implanted with a biventricular pacemaker. The left ventricle was paced through a coronary sinus tributary. New York Heart Association functional class, exercise tolerance, and left ventricular (LV) ejection fraction were collected at baseline and after pacemaker implantation. Patients were divided into 2 groups: group I = responders; group II = nonresponders. QRS duration and axis at baseline and during biventricular pacing, interventricular conduction time, and LV and right ventricular lead positions were compared between the 2 groups. Group I patients (n = 19) had a mean reduction of 1.3 in functional class and an increase in peak oxygen consumption rate by a mean of 50%. The only parameter that differed between the 2 groups was the QRS duration during biventricular pacing, with a significantly shorter value in group I than in group II (154 +/- 17 vs 177 +/- 26 ms; p = 0.016). Thus, a positive response to biventricular pacing is correlated with the quality of electrical resynchronization. The optimal positions of the right and LV leads would be those that could induce the greatest shortening of QRS duration.

Echocardiographic and Doppler study of patients with heatstroke and heat exhaustion

This is a two-dimensional and Doppler echocardiographic study of the hemodynamic changes in patients with heatstroke and heat exhaustion. It demonstrates that the hemodynamic changes in severe heat exposure reflect a hyperdynamic circulation with tachycardia and high cardiac output states. Relative hypovolemia was more pronounced in patients with heatstroke compared to patients with heat exhaustion. Signs of peripheral vasoconstriction were more often present in patients with heatstroke, while patients with heat exhaustion more often demonstrated peripheral vasodilatation.

[Contraception with levonorgestrel subdermal implants. A Tunisian study]

OBJECTIVES

We report our experience in Tunisia with contraception by subdermal levonogestrel implants.

METHODS

From January 1, 1990 through June 30, 1994 we inserted 1021 implants at our family planning center in Ariana.

RESULTS

Our experience with this pure progesterone implant showed that this method provides effective long-duration contraception. There was only one case of ectopic pregnancy among our 1021 patients. The most frequent undesirable effect and the first cause of discontinuing treatment was disturbed menstrual cycle with irregular discharge.

CONCLUSION

Our results underline the importance of counselling before implant insertion. A 10-day estrogen regimen may provide a solution for menstrual disorders.

Hemophilus influenzae and Streptococcus pneumoniae as causative agents of pneumonia in Egyptian preschool children: analysis and serotyping of Hemophilus isolates from hospital patients in Cairo, 1991-93

The Hemophilus influenzae blood culture and nasopharyngeal isolates, collected during a limited Surveillance of Antimicrobial Resistance in 1991-1993 from 1,635 Egyptian children under 5 years of age, presenting with pneumonia to Embaba and Abbassia Fever Hospitals, were serotyped. The 8 blood culture isolates confirmed H. influenzae to be responsible for 0.5% of the cases of pneumonia, versus 50 Streptococcus pneumoniae blood culture isolates from the same population that confirmed it responsible for 3.1% of the cases. The invasive Hemophilus strains were exclusively isolated from infants below 1 year, from one hospital (Embaba), on one winter season (January to March, 1992). On serotyping, 50% of the blood culture isolates were found to be non-b by latex agglutination. Some 297 nasopharyngeal isolates from cases of pneumonia were also serotyped and 45% were found to be non-b, thus confirming the invasive strains findings. Furthermore, the typing results from ARI-free controls nasopharyngeal isolates--though limited--were consistent with the findings and showed a 43% proportion of non-b. These findings put a question mark on the benefit of a large scale use of the available H. influenzae type b polysaccharide and conjugated vaccines in Egypt. But before interpreting out data in terms of vaccine needs, more specifically designed epidemiological studies need to be conducted to assess the role of H. influenzae as a pathogen in Egypt.

Activities of lung NADPH-cytochrome C-reductase and of cytochrome P-450 peroxidase during the protection of rat from hyperoxic injury by polyriboinosinic acid-polyribocytidilic acid

Rats exposed to normobaric oxygen received a single i.p. injection of 2.5 mg/kg of poly I: poly C at various times (-120 to +36 h) before and after the beginning of oxygen exposure. Hyperoxic lung damage and modifications in cytochrome P-450 system components were evaluated. Our results confirmed the protective effect of poly I: poly C on rats exposed to oxygen, reducing the lung edema and the mortality. This effect was only observed when poly I: poly C was injected 48 or 36 h before the beginning of oxygen exposure. Although oxygen exposure per se decreased the total level of lung cytochrome P-450, poly I: poly C per se induced a deeper decrease to levels similar in air- or oxygen-exposed rats. Poly I: poly C did not modify the NADPH-cytochrome c reductase level nor the cytochrome P-450 peroxidase activity in air-exposed rats. The oxygen exposure induced a decrease of these two enzymes, either in the absence or in the presence of poly I: poly C, except when poly I: poly C was injected 48 or 36 h before the beginning of oxygen exposure, times at which poly I: poly C restored the enzymatic values measured in rats exposed to air. Because the times of injection of poly I: poly C were those at which the protective effect was observed, it suggested that the protective effect of poly I: poly C against oxygen toxicity was associated with a lack of oxygen-induced decrease of both the lung NADPH-cytochrome c reductase level and the lung cytochrome P-450 peroxidase activity.