The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Complications and mortality after adult to adult living donor liver transplantation: A retrospective cohort study

BACKGROUND AND AIMS

Living donor liver transplantation (LDLT) is widely performed for patients to resolve the critical shortage of organs from cadavers. Despite rapid implementation of the procedure, both complications and mortality of LDLT are annoying problems. The aim of this study was to analyze complications and mortality of patients after adult to adult LDLT (A-ALDLT) in a single center.

METHODS

Between April 2003 and November 2013, 167 (A-ALDLT) recipients in National Liver Institute, Egypt were included. We retrospectively analyzed complications and mortality in them.

RESULTS

The overall incidence of complications was 86.2% (n = 144) and classified as biliary 43.7% (n = 73), vascular 21.6% (n = 36), Small for size syndrome (SFSS) 12.6% (n = 21), Gastrointestinal tract (GIT) 19.8% (n = 33), wound 12.6% (n = 21), chest 19.8% (n = 33), neurological 26.3% (n = 44), renal 21% (n = 35), intra abdominal collection 21.6% (n = 36), recurrent hepatitis C virus (HCV) 16.8% (n = 28), recurrent hepatocellular carcinoma (HCC) 2.4% (n = 4), acute rejection 19.2% (n = 32). 65 (45.1%) of 144 complicated patients died, while 10 (43.5%) of 23 non complicated died. The incidence of whole, in hospital and late mortalities were 44.9%, 28.7% and 16.2% respectively.

CONCLUSIONS

Mortality was higher among complicated cases where vascular complications and SFSS had significant effect on it so prevention and treatment of them is required for improving outcome.

Interleukin (IL)-4, IL-10, IL-18 and IFN-gamma cytokines pattern in patients with combined hepatitis C virus and Schistosoma mansoni infections

Schistosoma mansoni infection is characterized by a strong T-helper type 2 (Th2) cell-associated immune response, but in the case of viral infection, it is associated with interferon-gamma (IFN-gamma) increase and induction of Th1 immune response. Few data are available about the immune response of cases infected with combined hepatitis C virus (HCV) and schistosomiasis. Thus, the investigation of the cytokine pattern in patients coinfected with both HCV and Schistosoma mansoni was our rationale. This study included four patient groups: Group 1 included 20 patients infected with chronic HCV, Group 2 included 15 patients infected with schistosomiasis alone, Group 3 included 20 patients with chronic HCV and schistosomiasis and Group 4 included 15 healthy control individuals with matched age and sex. Serum levels of IFN-gamma, interleukin (IL)-4, IL-10 and IL-18 were measured in all groups by enzyme-linked immunosorbent assay. The results showed that the patients infected with HCV had significantly higher serum levels of IFN-gamma and IL-18 compared with the controls and with the patients with schistosomiasis and coinfection (P < 0.001). On the other hand, serum levels of IL-4 and IL-10 were significantly higher in patients with schistosomiasis and coinfection compared with the control group (P < 0.001 and 0.0001, respectively) and with the HCV patients (P < 0.05 and P < 0.001, respectively). A significant increase in serum levels of IL-4 and IL-10 was also found in HCV patients compared with the control (P < 0.05). Schistosomiasis appears to induce a Th2 cytokine profile, with increase in serum levels of IL-4 and IL-10, even in the presence of HCV coinfection. In conclusion, schistosomiasis may downregulate the stimulatory effect of HCV on Th1 cytokines and this may lead to the chronicity of HCV infection in coinfected patients.

Effect of intraoperative magnesium intravenous infusion on the hemodynamic changes associated with right lobe living donor hepatotomy under transesophageal Doppler monitoring-randomized controlled trial

BACKGROUND

Liver donors are subjected to specific postresection hemodynamic changes. The aim was to monitor these changes and to evaluate the effect of magnesium sulfate infusion (MgSO4) on these changes together with total anesthetic agents consumption.

PATIENTS AND METHODS

A total of 50 donors scheduled for right hepatotomy were divided into two equal groups. Controls (C) received saline and magnesium group (Mg) received MgSO4 10% (30 mg/kg over 20 min) administered immediately after induction of anesthesia, followed by infusion (10 mg/kg/h) till the end of surgery. Hemodynamics, transesophageal Doppler (TED) data and anesthetic depth guided by Entropy were recorded.

RESULTS

Postresection both groups demonstrated an increase in heart rate (HR) and cardiac output (COP) in association with lowering of systemic vascular resistance (SVR). The increase in HR with Mg was lower when compared with C, P = 0.00. Increase in COP was lower with Mg compared to (C) (6.1 ± 1.3 vs. 7.5 ± 1.6 L/min, P = 0.00) and with less reduction in SVR compared to C (1145 ± 251 vs. 849.2 ± 215 dynes.s/cm(5), P < 0.01), respectively. Sevoflurane consumption was lower with Mg compared to C (157.1 ± 35.1 vs. 187.6 ± 25.6 ml, respectively, P = 0.001). Reduced fentanyl and rocuronium consumption in Mg group are compared to C (P = 0.00). Extubation time, postoperative patient-controlled fentanyl were lower in Mg than C (P = 0.001).

CONCLUSION

TED was able to detect significant hemodynamic changes associated with major hepatotomy. Prophylactic magnesium helped to reduce these changes with lower anesthetic and analgesics consumption and an improvement in postoperative pain relief.

Elevated serum level of interleukin (IL)-18, interferon (IFN)-gamma and soluble Fas in patients with pulmonary complications in tuberculosis

Mycobacterium tuberculosis can cause life-threatening complications in which the immune response plays an important role. This study was designed to evaluate the serum levels of interleukin-18 (IL-18), interferon-gamma (IFN-gamma) and soluble Fas (sFas) in cases with pulmonary tuberculosis due to confirmed M. tuberculosis infection. The study comprised 50 patients with M. tuberculosis classified to 13 complicated cases and 37 uncomplicated patients. A significant (P<0.05) increase was found in the serum levels of IL-18, IFN-gamma and sFas in patients compared to controls and also in complicated cases compared to uncomplicated ones. Moreover, a positive significant correlation was found between serum levels of sFas with IL-18 (r=0.532, P<0.001), and with IFN-gamma (r=0.37, P=0.008) and lastly between serum levels of IL-18 with IFN-gamma (r=-0.612, P<0.001). It is concluded from these results with the recent observations that IFN-gamma levels are elevated after successful MTB treatment, suggest the possibility of enhanced Fas expression and then stimulating the infected macrophages to show an increased FasL-induced apoptosis. Modulation of FasL system by M. tuberculosis might represent an escape mechanism to evade the effect of apoptosis. Moreover, the elevated serum levels of IL-18, IFN-gamma and sFas can be considered as pathognomonic markers suggesting pulmonary tuberculosis especially in complicated cases.

The effect of menopausal symptoms on the quality of life among postmenopausal Egyptian women

Objective: The current study aims to assess the prevalence of menopausal symptoms among postmenopausal Egyptian women and their effect on the quality of these women's lives.Study design: A cross-sectional study was carried out in a tertiary university hospital between January and December 2017. We enrolled 350 postmenopausal women aged 45-70 years. All women were interviewed using the Menopause-Specific Quality of Life (MENQOL) questionnaire after translation into the Arabic language by a certified translation expert. The Mann-Whitney test and the Kruskal-Wallis test were used to compare MENQOL item scores.Results: Low backache was the most common complaint among the study participants (86%). The sexual domain imposed the greatest impact on quality of life (mean = 3.12 ± 1.66), followed by physical (mean = 3.18 ± 0.92), psychological (mean = 3.08 ± 0.98), and vasomotor (mean = 3.01 ± 1.78) domains. Moreover, we found a significant positive moderate correlation between body mass index (BMI) and the total score (r = 0.689, p < 0.001). Multivariable linear regression analysis found that the best-fitting predictors for the MENQOL score were age (p < 0.001), BMI (p < 0.001), and exercise (p < 0.001).Conclusions: Physical symptoms were the most prevalent symptoms in this study. In general, older women, housewives, hand workers, less physically active women, and those of low socioeconomic status had poor quality of life.

Distinct Serum Immunoglobulins Pattern in Egyptian Patients with Chronic HCV Infection Analyzed by Nephelometry

Hepatitis C has emerged as a major worldwide public health problem. The host immune response to HCV infection is composed of both a non-specific immune response, including interferon (IFN) production and natural killer (NK) cell activity, and a virus-specific immune response, including humoral and cellular components. Susceptibility to infection has been related to immunological disturbances. Several studies have provided experimental evidence of disorders of both cellular and humoral immunity. The present study was carried out to evaluate the serum immunoglobulins level (IgG, IgM, IgA) and IgG-subclasses (IgG1-4) in chronic hepatitis C patients in comparison with healthy control patients. This study included 50 patients with biochemical, serologic, virologic, and histologic evidence of chronic hepatitis C. Total IgG, IgA, and IgM were assayed by nephelometry. IgG subclasses were assayed using human IgG subclasses enzyme immunoassay. The results showed a significant increase of total serum IgG and IgM levels found in patients with chronic HCV compared with the healthy control patients (P < 0.001 for each). There was a statistically significant difference in the IgG subclasses (IgG1 to IgG4) between the patients and controls (P < 0.001 for each). On the other hand, no significant difference was found between patients and healthy controls in IgA level (P = 0.4). The normal total serum immunoglobulins pattern is apparently shifted in chronic hepatitis C infection in the Egyptian patients. This pattern may include an ethnic or biologic background and could be used in the differentiation of the patients with minimal liver disease.

The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Protective effect of gum acacia against the aspirin induced intestinal and pancreatic alterations

OBJECTIVES

The current study was carried out to examine the influence of aspirin (400 mg/kg of body weight) and gum acacia (one g/day) and their combination on pancreatic, intestinal mucosal enzymes, intestinal tissue iron and zinc after 21 days of treatment on experimental rats.

MATERIALS AND METHODS

The treated rats were sacrificed and the pancreatic and intestinal lipase and amylase were measured photometrically. Moreover, zinc and iron level were determined using atomic absorption spectrometry. Intestinal sections were stained with hematoxylin and eosin.

RESULTS

The results showed that treatment with aspirin caused a marked decrease in pancreatic lipase and amylase compared with that of the control group. This decrease in aspirin treated group was accompanied by significant increase in the intestinal amylase, lipase, alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) compared with the control group. On the other hand, gum combined with aspirin caused a significant increase in pancreatic and intestinal lipase, amylase accompanied with significant increase in intestinal ALP and LDH compared with that of the control group. Concentration of Zn in wet weight of intestine showed a significant decrease in aspirin and aspirin combined with gum groups but it was increased significantly in gum acacia treated group. Histological analysis revealed intestinal epithelial damage in aspirin treated rats, this damage was not noticed with gum acacia treatment. Co-administration of gum in combination with aspirin indicated some changes of denuded intestinal mucosal cells compared with that of the control.

CONCLUSIONS

Gum acacia exhibited a protective property that can ameliorate the alterations induced hazardous effect of aspirin treatment.

Prolactin level after prolonged lactation: contraceptive evaluation

A study was conducted to evaluate serum prolactin during lactation among 60 mothers with prolonged breastfeeding for 2 years. Patients were classified into 3 groups with 20 in each: lactating for less than 6 months, lactating for 6-12 months, and lactating for 12-24 months. There was hyperprolactinemia during lactation and serum prolactin levels decreased as lactation progressed. After long lactation (over a year), 10 of 20 women were amenorrheic and 10 were menstruating; 6 of the menstruating women were ovulating and 4 nonovulating. Prolonged lactation was found to be relatively successful for family spacing.

The predictive value of circulating immune complexes (CIC) in patients with malignant salivary gland tumors

The present study included nine patients suffering from various types of malignant salivary gland neoplasms. The patients were monitored both pre and post operatively utilizing the circulating immune complex assay. The (CIC) levels decreased significantly after the surgical eradication of the neoplasms. This diagnostic parameter proved to be of great value in monitoring therapy in patients with various types of malignancies.

Complications and mortality after adult to adult living donor liver transplantation: A retrospective cohort study

BACKGROUND AND AIMS

Living donor liver transplantation (LDLT) is widely performed for patients to resolve the critical shortage of organs from cadavers. Despite rapid implementation of the procedure, both complications and mortality of LDLT are annoying problems. The aim of this study was to analyze complications and mortality of patients after adult to adult LDLT (A-ALDLT) in a single center.

METHODS

Between April 2003 and November 2013, 167 (A-ALDLT) recipients in National Liver Institute, Egypt were included. We retrospectively analyzed complications and mortality in them.

RESULTS

The overall incidence of complications was 86.2% (n = 144) and classified as biliary 43.7% (n = 73), vascular 21.6% (n = 36), Small for size syndrome (SFSS) 12.6% (n = 21), Gastrointestinal tract (GIT) 19.8% (n = 33), wound 12.6% (n = 21), chest 19.8% (n = 33), neurological 26.3% (n = 44), renal 21% (n = 35), intra abdominal collection 21.6% (n = 36), recurrent hepatitis C virus (HCV) 16.8% (n = 28), recurrent hepatocellular carcinoma (HCC) 2.4% (n = 4), acute rejection 19.2% (n = 32). 65 (45.1%) of 144 complicated patients died, while 10 (43.5%) of 23 non complicated died. The incidence of whole, in hospital and late mortalities were 44.9%, 28.7% and 16.2% respectively.

CONCLUSIONS

Mortality was higher among complicated cases where vascular complications and SFSS had significant effect on it so prevention and treatment of them is required for improving outcome.

Immunodiagnostic potential of mucin (MUC2) and Thomsen-Friedenreich (TF) antigens in Egyptian patients with colorectal cancer

OBJECTIVE

Colorectal cancer (CRC) is more common in developed countries and is the third most common cancer among both men and women. CRC provides an attractive model of tumour biology with normal mucosa to adenoma to carcinoma sequence. The TF-antigen (Thomsen-Friedenreich) can be identified by galactose oxidase-Schiff's (GOS) reaction either on tissues or on rectal mucus samples from patients with CRC. TF antigen is expressed in the neoplastic mucosa and not expressed in colonic mucosa of normal subjects. Apomucins play important role in cell signalling and their specific pattern of expression during the different steps of tumor progression toward adenocarcinoma suggests that they play significant roles in tumorigenesis. The family of secreted mucins including MUC2 is contributing in mucus formation to protect underlying epithelia against diverse injuries. The current study was investigated the expression of MUC2 and TF antigens in patients with adenoma and CRC.

MATERIALS AND METHODS

MUC2 and TF antigen expressions were detected immunohistochemically in CRC biopsies using specific monoclonal antibodies. Moreover, the TF antigen was invesigated using GOS reaction.

RESULTS

The results showed that in normal colonic specimens, MUC2 expression was detected in 20%, while TF antigen was completely negative in 100% of samples as detected by GOS and immunohistochemistry using anti-TF monoclone. Expressions of MUC2, and TF antigen as detected by GOS and anti-TF monoclone were positive in 96%, 80%, and 60% respectively in cases with adenoma. On the other hand, in cases with adenocarcinoma, the expression of MUC2 was seen in 92% of cases, while TF antigen was observed in 84% and 60% of cases as detected by GOS and immunohistochemically respectively.

CONCLUSIONS

Thus, it is concluded that the expression of MUC2 and TF antigens are altered during CRC carcinogenesis. Furthermore, MUC2 and TF antigens may have a diagnostic and or prognostic potential in CRC.

Condition-based monitoring of a small centrifugal pump by vibration analysis

Rotating machinery vibration problem is the most significant restriction which control the life time and may cause disastrous failure of the entire system. The vibration monitoring is the main element for any customized maintenance program to guarantee power plant availability and minimize danger of predictable failures. The present work is an experimental study on a small centrifugal pump running in healthy and intentionally defected to show the difference in the vibration spectral and time domain. Triaxial acceleration measurements were made at the shaft of the pump. The most dangerous case of vibration denoted by the highest amplitude as determined as well as its corresponding frequency. The most serious case was the pedestal looseness with full flow rate which cause a vibration of amplitude of (0.104g) at frequency (47Hz). The unacceptable vibration, as classified according to ISO 10816 to have amplitude of (0.5g) for small machines within this rang of acceptable vibration it was not difficult to predict the artificial defects mode in the pump and demonstrated the capability of condition monitoring.

Localization of leucine aminopeptidase in the Schistosoma mansoni eggs and in liver tissue from infected mice

Infection with Schistosoma mansoni causes hepatic granuloma formation and fibrosis in response to parasite eggs. The present work localized the leucine aminopeptidase (LAP) in S. mansoni eggs and in liver tissue sections from infected mice. Fresh eggs and livers obtained from infected hamsters were processed and stained with the L-leucine-7-amino-trifluoromethyl-coumarin specific substrate. The L-argnine-7-amino-trifluoro-methylcoumarin and Bestatin (leucine aminopeptidase inhibitor) were used to test the LAP substrate specificity and reactivity. The staining pattern for that enzyme in the egg and liver tissue reflects that the leucine aminopeptidase is a major egg constituent distributed in nearly all the egg except the spine. The control substrates confirmed the substrate broad specificity of LAP. In conclusion, the LAP enzyme is a major egg antigen and the target antigen for the antipathology vaccine development studies.

Diclofenac potassium in the management of dental pain: a multicenter double-blind comparison with glafenine

The analgesic efficacy and tolerability of diclofenac-potassium 50 mg were compared with those of glafenine 200 mg in 109 outpatients suffering from moderate to severe dental pain. Throughout the four-day trial period, patients (Diclofenac-potassium: n = 58, mean age = 32.84 +/- 12.0 yrs. Glafenine n = 51, mean age = 34.12 +/- 14.0 yrs.) were randomised, in a double-blind fashion, to receive one tablet of either medications three times daily, together with an antibiotic, ampicillin, 500 mg, 8 hourly. Half an hour following the administration of the first analgesic dose, both treatment groups showed highly statistically significant (P < 0.001) reductions in the mean pain level when compared with their baseline values. The mean decrease of pain level in diclofenac-potassium group after 1/2 hour was significantly (P < 0.01) greater than that in the glafenine group. Moreover, the percent of pain free patients after 1/2 hour in the diclofenac-potassium group was significantly higher (P = 0.05) compared with those in the glafenine group. The mean decreases in pain and tenderness on the second and fourth days, in relation to their initial values, were greater in the diclofenac-potassium treated patients than the glafenine treated ones. The overall evaluation of therapeutic effect was considered excellent in 72% of the diclofenac- potassium patients compared with 57% of the glafenine patients. Furthermore, 95% of the diclofenac-potassium patients, compared with 90% of the glafenine ones, expressed their willingness to use the trial medication again in similar conditions. None of the patients in both treatment groups discontinued the trial due to unwanted effects. Both therapies were well tolerated. Only one patient (1.72%) in the diclofenac-potassium treatment group experienced slight diarrhoea. It can be concluded from this study that both medications are effective and well tolerated in the management of dental pain. However, diclofenac-potassium with its fast onset of effect is particularly suitable in the management of acute painful conditions.