Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers

OBJECTIVE

To assess the clinical and microbiological efficacy of maggot debridement therapy (MDT) in the management of diabetic foot ulcers unresponsive to conventional treatment and surgical intervention.

METHOD

Consecutive diabetic patients with foot wounds presenting at the vascular surgery unit and the diabetic foot unit of Alexandria Main University Hospital were selected for MDT. Lucilia sericata medicinal maggots were applied to the ulcers for three days per week. Changes in the percentage of necrotic tissue and ulcer surface area were recorded each week over the 12-week follow-up period. Semiquantitative swab technique was used to determine the bacterial load before and after MDT.

RESULTS

The sample comprised 10 patients with 13 diabetic foot ulcers. The mean baseline ulcer surface area was 23.5cm2 (range 1.3-63.1), and the mean percentage of necrotic tissue was 74.9% (range 29.9-100). Complete debridement was achieved in all ulcers in a mean of 1.9 weeks (range 1-4). Five ulcers (38.5%) were completely debrided with one three-day MDT cycle. The mean reduction in ulcer size was significant at 90.2%, and this occurred in a mean of 8.1 weeks (range 2-12). The mean weekly reduction in ulcer size was 16.1% (range 8.3-50). Full wound healing occurred in 11 ulcers (84.6%) within a mean of 7.3 weeks (range 2-10). The bacterial load of all ulcers reduced sharply after the first MDT cycle to below the 10(5) threshold, which facilitates healing.

CONCLUSION

The results highlight the potential benefits of MDT in diabetic wound care in developing countries. MDT was proved to be a rapid, simple and efficient method of treating these ulcers.

Ultrastructural observations on the elusive subtegumental cells of the viviparous gill monogenean, Macrogyrodactylus clarii

The ultrastructure of the tegument, including putative subtegumental cells, of the monogenean gill parasite Macrogyrodactylus clarii is described for the first time. The lateral cells are secretory in nature and can be classified into four types: T1 producing elongated, electron-dense, bodies (t1); T2 manufacturing electron-lucent vesicles (t2); T3 producing thin, dump-bell shaped, electron-dense bodies (t3); and T4 containing lyzosome-like inclusions. Morphologically, the T2 cells resemble those described as presumptive vitelline cells in other gyrodactylids whereas the T1, T3 and T4 cells are reported for the first time in gyrodactylids. The close similarity between the secretory inclusions of the outer syncytial layer of the tegument and those found in the T1, T2 and T3 cells suggests that these cells represent the enigmatic tegumental cell bodies rather than vitelline cells. The possible functions of the distinctive features of the tegument of M. clarii are discussed.

Neuromusculature of Macrogyrodactylus congolensis, a monogenean skin parasite of the Nile catfish Clarias gariepinus

Phalloidin fluorescence technique, enzyme cytochemistry and immunocytochemistry, in conjunction with confocal scanning laser microscopy, were used to describe the neuromusculature of the monogenean skin parasite Macrogyrodactylus congolensis from the Nile catfish Clarias gariepinus. The body wall muscles are composed of an outer layer of compactly arranged circular fibres, an intermediate layer of paired longitudinal fibres and an inner layer of well-spaced bands of diagonal fibres arranged in two crossed directions. The central nervous system consists of paired cerebral ganglia from which three pairs of longitudinal ventral, lateral and dorsal nerve cords arise. The nerve cords are connected at intervals by many transverse connectives. Both central and peripheral nervous systems are bilaterally symmetrical and better developed ventrally than laterally and dorsally. Structural and functional correlates of the neuromusculature of the pharynx, haptor and reproductive tracts were examined. Results implicate acetylcholine, FMRFamide-related peptides and serotonin in sensory and motor function. The results were compared with those of Macrogyrodactylus clarii, a gill parasite of the same host fish C. gariepinus.

Neuromusculature of Macrogyrodactylus clarii, a monogenean gill parasite of the Nile catfish Clarias gariepinus in Egypt

Phalloidin fluorescence technique, enzyme cytochemistry and immunocytochemistry in conjunction with confocal scanning laser microscopy have been used for the first time to describe the nervous and muscle systems of the viviparous monogenean gill parasite, Macrogyrodactylus clarii. The gross spatial arrangement of muscle and associated cholinergic, peptidergic and aminergic innervations has been examined. The central nervous system (CNS) consists of paired cerebral ganglia from which emanate three pairs of longitudinal ventral, lateral and dorsal nerve cords, connected at intervals by transverse connectives. The CNS is better developed ventrally than dorsally or laterally, and has the strongest reactivity for all neuroactive substances examined. Structural and functional correlates of the neuromusculature of the pharynx, haptor and reproductive tracts have been examined. Results implicate acetylcholine, FMRFamide-related peptides (FaRPs) and serotonin in sensory and motor function in this monogenean, although confirmatory physiological data are obviously required.

Amelioration of radiation-induced oxidative stress and biochemical alteration by SOD model compounds in pre-treated γ-irradiated rats

INTRODUCTION

The role of metalloelements in tissue maintenance, function and response to injury offer a new approach to decreasing and/or treating radiation injury. We investigated the roles of CuL(2)SO(4), [MnL(2)O](2)Cl(4)(H(2)O)(2) and [(VL(2)O)(VL(2)H(2)O)]Cl(6) complexes (L=2-methylaminopyridine) of SOD-mimetic activities, in ameliorating the radiation-induced oxidative stress and alterations in some biochemical parameters in liver, kidney, spleen and brain in pretreated female rats exposed to gamma-irradiation.

METHODS

Both untreated-rats and rats treated with the above complexes were subjected to whole-body gamma-irradiation (6 Gy). 5'-Nucleotidase (5'-NT), acetylcholinesterase (AChE), adenosne triphosphatase (ATPase), superoxide dismutase (SOD), catalase (CAT) and glutathione reductase (GSSG-R) were assessed as well as liver DNA and RNA contents and total protein concentration were estimated in tissue homogenates of the above organs. The same parameters were assessed in non-irradiated treated rats and normal control rats. Results were compared to irradiated non-treated and normal control rats.

RESULTS

Pretreatment of gamma-irradiated rats with Mn(IV) or V(IV) complex produced a significant decrease in liver 5'-NT activity compared to the corresponding value of the untreated irradiated rats. In contrast, liver DNA and RNA contents and brain AChE and ATPase activities were significantly increased in irradiated rat group pre-treated with these metal complexes. Cu II, Mn IV or V IV complex inoculation prior to irradiation of normal rats exhibited a significant increase in SOD, CAT, GSSG-R activities and protein content of liver, kidney, spleen and brain homogenates compared with that of the untreated irradiated rats. The treatment of non-irradiated rats with these complexes produced a highly significant increase in mean activities of SOD and CAT, with no changes in other parameters vs. controls.

CONCLUSIONS

Cu(II), Mn(IV) and V(IV) 2-methylaminopyridine complexes offer a physiological approach to ameliorate the radiation-induced biochemical alterations. In addition, they provide sufficient protection against radiation injury of radiosensitive tissues.

Prevention of biochemical changes in gamma-irradiated rats by some metal complexes

The formation of superoxide partially accounts for the well-known oxygen enhancement of radiation-induced biochemical changes and cell damage. Radioprotective effects of copper (II), manganese (IV) or vanadium (IV) complexes, of superoxide dismutase-mimetic activity, on body weight, survival rate and some biochemical parameters in pre-treated irradiated, untreated irradiated and treated non-irradiated female albino rats have been studied 24 h after whole body gamma-irradiation at a dose level of 6 Gy. Survival time, body weight, red blood cell (RBC) and white blood cell (WBC) counts, hemoglobin (Hb) concentration, percentage of hematocrit (Hct%), reduced glutathione (GSH), serum total protein, albumin, globulin (G), blood urea, creatinine and cholesterol were estimated, as well as the activities of blood superoxide dismutase (SOD), glutamate-oxaloacetic (GOT) and glutamate-pyruvic (GPT) transaminases, and alkaline phosphatase were assessed. A significant decline was shown in body weight, survival rate, the mean values of RBC and WBC counts, Hb and Hct percentages, and GSH concentration, as well as blood SOD activity, in whole body gamma-irradiated rats compared with the control non-irradiated rat group. The mean activity values of alkaline phosphatase, GOT and GPT, as well as the average values of blood urea, creatinine, total cholesterol, total protein and globulin were significantly elevated, while the average values of albumin and the albumin/globulin ratio were decreased in gamma-irradiated rats compared with the corresponding values of the normal control rat group. Pretreatment of rats with either manganese or vanadium complexes resulted in a significant increase in survival rate and body weight over that of the non-treated irradiated rat group. Pretreatment of rats with copper (II), manganese (IV) or vanadium (IV) complexes caused a significant increase in RBC and WBC counts, Hb concentration, HCt (%), GSH content and SOD activity in blood when compared to the irradiated rat group without treatment. The administration of copper (II), manganese (IV) or vanadium (IV) complexes prior to irradiation exposure resulted in a significant decrease in GOT and GPT activities in addition to blood urea, creatinine, cholesterol, globulin and total protein contents, while each complex exhibited a significant increase in plasma alkaline phosphatase, albumin, and the albumin/globulin ratio compared to the untreated irradiated rat group. Administration of vanadium (IV), manganese (IV) or copper (II) complexes in non-irradiated rats caused a significant increase in SOD activity without changing other biochemical parameters compared with the corresponding values of the normal control rat group. We conclude that these metallo-elements, particularly manganese (IV) and vanadium (IV) complexes of 2-methylaminopyridine, have radiation protection and radiation recovery. Furthermore, these metal complexes offer a new approach to overcome the pathological effects of ionizing radiation and suggest their use as a physiological approach to preventing or perhaps predominantly facilitating recovery from radiation injury.

Identification of 100 KDa protein in sera of mice-treated with Cu(II) complex with superoxide dismutase-mimetic activity

The protein profile of sera isolated from mice pre-treated with Cu(II) complex of Girard T with superoxide dismutase (SOD)-mimetic activity was analyzed using SDS-PAGE. This complex was intraperitoneally administered (10 mg/Kg body weight) to Swiss albino mice. The resolved polypeptides showed a new sharp band at 100 KDa against which a polyclonal antibody was raised in rabbit. Sera of rabbit anti-100 KDa protein was used as a powerful probe for the detection of 100 KDa protein isolated from sera of treated mice. Western blot assays revealed a strong reactive polypeptide band at 100 KDa in sera of the mice, but no cross reaction was observed with sera of normal mice. The identification of purified polypeptide was confirmed by different characterization experiments.

Chaetotaxy of the monogeneans Macrogyrodactylus clarii and m. congolensis from the gills and skin of the catfish clarias gariepinus in Egypt, with a note on argentophilic elements in the nervous system

A comparison has been made between the chaetotaxy of the gyrodactylid monogeneans Macrogyrodactylus clarii Gussev, 1961 and M. congolensis (Prudhoe, 1957) Yamaguti, 1963 from the gills and skin, respectively, of the catfish Clarias gariepinus (Burchell) from the river Nile in Egypt. Bilaterally arranged argentophilic structures on the surface of these parasites are presumed to be sensilla and are more abundant in M. clarii than in M. congolensis especially on the ventral surface (124 vs. 66). In both species these sensilla are concentrated on the head lobes and in the pharyngeal region, but there are features of the sensilla patterns that can be used to distinguish the two species. Comparison is made with sensilla patterns of other gyrodactylids. A system of cells and dendritic processes, most probably part of the nervous system, also has an affinity for silver in the two species. There are no previous records of extensive argentophilic elements in the nervous systems of monogeneans.

Two bellies of the coracobrachialis muscle associated with a third head of the biceps brachii muscle

Reports that describe the abnormalities and complexities of the anatomy of the arm are important with regard to surgical approaches. This case study reports a combined abnormal form of the coracobrachialis and biceps brachii muscles of the left arm of an adult male cadaver that was detected during the educational gross anatomy dissections of embalmed cadavers. The coracobrachialis muscle demonstrated two bellies which formed shortly inferior to its origin from the coracoid process of the scapula. One belly inserted into the middle of the antero-medial surface of the humerus, whereas the other belly inserted into the medial head of the triceps brachii muscle. The musculocutaneous nerve passed between the two bellies, giving a separate branch to each. We suggest that the two bellies of the coracobrachialis muscle may represent the incompletely fused short heads of the ancestral muscle. The biceps brachii muscle showed a third head, which originated mainly from the antero-medial surface of the humerus and partially from an aponeurosis belonging to the medial head of the triceps brachii muscle. These observations were confined to the left upper limb and were not accompanied by any other abnormality.

Effect of allergen-specific immunotherapy on interleukin-4, interleukin-5 and interferon-gamma mRNA expression in the nasal mucosa of rats with allergic rhinitis

To elucidate the mechanism of immunotherapy, we tested the effect of ovalbumin and ovalbumin-pullulan conjugate immunotherapy on the expression of interleukin (IL)-4, IL-5 and interferon-gamma (IFN-gamma) mRNA in the nasal mucosa of sensitized rats. Forty-five rats were injected with ovalbumin intraperitoneally on three consecutive days and later were exposed to ovalbumin aerosol. The rats were injected intradermally, on six consecutive days, with saline, ovalbumin or ovalbumin-pullulan conjugate. Later, nasal mucosa was obtained and reverse transcription-polymerase chain reaction (RT-PCR) was performed. Nasal responses and specific immunoglobulin E (IgE) were measured. Although the immunotherapy significantly decreased nasal airway resistance, dye leakage and histamine content in nasal irrigation after allergen challenge, no significant difference was found in IL-4 and IL-5 mRNA expression or in specific IgE level among the three groups. We conclude that in this allergic model, the improvement of nasal responses after immunotherapy was the result of a mechanism other than decrease of T-helper 2 (Th2) cytokines.

Antitumor activities of vanadium(IV), manganese(IV), iron(III), cobalt(II) and copper(II) complexes of 2-methylaminopyridine

The effect of Cu(II), Mn(IV), Fe(III), V(IV) and Co(II) complexes of 2-methylaminopyridine (L) having superoxide dismutase (SOD)-like activities on Ehrlich ascites carcinoma (EAC) cells was studied. Each of these complexes was intraperitoneally administered (10 mg/kg body weight for 9 days) to Swiss albino mice implanted intraperitoneally with 1 x 10(6) EAC cells. Six days after the last treatment the EAC cells were harvested using a heparinized syringe. The volume of EAC cells and EAC cell viability as well as changes in the levels of tumor cell enzyme activities of SOD, catalase, glutathione peroxidase (GSH-Px), glutathione reductase (GSH-R) and glucose-6-phosphate dehydrogenase (G6PD) were tested to examine the antitumor effects of these complexes. Both tumor volume and tumor cell viability were significantly lowered in complex-treated mice. After tumor transplantation and treatment with the complexes, the activities of GSH-Px and GSH-R were significantly lowered while SOD and G6PD activities were increased in EAC cells compared to their levels in EAC cells harvested from saline-treated mice.

Expression of interferon-gamma, interleukin-4 and interleukin-5 mRNA in the nasal mucosal membrane of rats with allergic rhinitis

The production of immunoglobulin E (IgE) antibody is largely dependent on the ratio between interleukin-4 (IL-4) (a T helper 2 (Th2)-type cytokine) and interferon-gamma (IFN-gamma) (a T helper 1 (Th1)-type cytokine). Interleukin-5 (IL-5) (also a Th2-type cytokine) is an important eosinophil differentiation factor and also co-stimulates B-cell growth and differentiation. The present study was designed to evaluate and compare the expression of IFN-gamma, IL-4 and IL-5 mRNA in the nasal mucosal membrane of sensitized Brown-Norway (BN) rats. Fourteen BN rats were divided into two groups: non-sensitized (control) and sensitized. The sensitized group was injected with ovalbumin (OA) intraperitoneally on three consecutive days. Twenty-one days later, rats were exposed to 1% OA aerosol. Twenty-four hours after exposure to aerosol, nasal mucosa was extracted from both groups and reverse transcriptase-polymerase chain reaction (RT-PCR) was performed. The densities of the bands of IL-4, IL-5 and IFN-gamma mRNA were expressed as percentages against beta-actin mRNA. Our results showed that the mean values for IL-4 and IL-5 mRNA were increased significantly in sensitized rats compared with control rats. In contrast, the mean value for IFN-gamma mRNA was significantly lower in sensitized rats compared with those of the control group. Our data therefore suggest that sensitization of rat nasal mucous membranes results in the predominant expression of Th2-type cytokines.

Superoxide dismutase activities in serum and white blood cells of patients with some malignancies

Superoxide dismutase (SOD) activity has been estimated in serum and leukocytes isolated from adults and children with acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL), Hodgkin's disease (HD) and neuroblastoma. Superoxide dismutase levels in leukocytes isolated from adult patients with HD, ALL and NHL were significantly higher than the corresponding control values. Serum SOD activity of adult patients with ALL and NHL was significantly decreased compared to the normal value, while its activity was not significantly changed in patients with HD. Marked deficiencies of leukocyte SOD levels in children with ALL, NHL, HD and neuroblastoma were found. There were no apparent differences in serum SOD activity in children suffering from ALL, NHL, HD and neuroblastoma. It is concluded that the assay of leukocyte SOD can be used to differentiate between HD and NHL in both adults and children.

The development of the human phreno-oesophageal membrane

23 human fetal diaphragms were used to study the structural changes of the phreno-oesophageal membrane at the different prenatal ages. 2 human adult diaphragms were used for comparison. This membrane was found to be formed by both the superior and inferior diaphragmatic fasciae. The phreno-oesophageal membrane was mainly formed by the superior fascia at early stages of development and by the inferior at later ages. The collagenous and elastic components of this membrane increased gradually with age. The crural muscle fibres forming the boundary of the oesophageal hiatus at 10 weeks showed gradual regression and was replaced by tendinous fibres. The latter formed secondary insertion in addition to the primary one in the central tendon. The strip of striated muscle, which was occasionally present at the lower end of the oesophagus, could be attributed to failure of recession of the crural muscle bordering the hiatus. The functional significance of the phreno-oesophageal membrane in the process of deglutition and vomiting and for prevention of hiatus hernia is discussed.

Ultrastructural observations on the anterior adhesive apparatus in the monogeneans Dactylogyrus amphibothrium Wagener, 1857 and D. hemiamphibothrium Ergens, 1956

The light microscope and the transmission electron microscope have revealed that the anterior adhesive apparatus of Dactylogyrus amphibothrium and that of D. hemiamphibothrium are similar and composed of three kinds of gland cell, one producing rod-shaped bodies (secretion S1), one producing spherical bodies (S2), and the third producing electronlucent vesicles (S3). In the cytoplasm of G1 gland cells each rod-shaped body is enclosed by a single layer of microtubules but no microtubules are associated with S2 and S3 bodies. The possible functions of these microtubules are discussed. The ducts which extend anteriorly from all three kinds of gland cell converge on and open into six adhesive sacs, situated ventrally on the distal extremities of the head lobes. Each adhesive sac is supplied with at least one gland duct from each type of gland cell and is lined by a special tegument bearing dense microvilli and a few cilia which may have a sensory function. It has been shown that during the attachment of the head region, these sacs are everted to expose the enclosed microvilli and duct openings and secretions S1 and S2 are extruded.