Influence of airborne particle abrasion on dentin bonding effectiveness of a 2-step universal adhesive

OBJECTIVE

To determine the effect of airborne particle abrasion (APA) on micro-tensile bond strength (µTBS) to dentin using different air-abrasion/polishing powders.

METHODS

The bonding effectiveness of G2 Bond Universal (G2B), used in etch-and-rinse (E&R) and self-etch mode (SE), was tested on bur-cut dentin and dentin air abraded/polished using six different powders (aluminum oxide 29 µm (AO29) and 53 µm (AO53), aluminum trihydroxide (AT), sodium bicarbonate (SB), sodium bicarbonate soft (SBsoft) and bioactive glass (BG); Velopex). Adhesive-composite resin specimens were immersed in distilled water at 37 °C for one week and cut into microspecimens. Half of the specimens were subjected to 50,000 thermocycles (aged). Immediate and aged μTBS to dentin were measured. Statistical analysis was performed using linear mixed-effects (LME) modeling (p < 0.05).

RESULTS

Comparing the aged bond strengths to air-abraded/polished dentin with bur-cut dentin, pretreatment with SB and SBsoft in combination with G2B used in E&R mode, and BG air polishing in combination with both application modes (E&R, SE), resulted in a significantly higher bond strength. Dentin bond strength was only significantly lower when air abraded with AO29 and using G2B in SE mode. Aging did not significantly influence bond strength for both application modes (E&R, SE), except for AO29 and AT-treated dentin, where bond strengths decrea sed significantly using G2B in SE mode. In general, G2B reached significantly higher bond strengths on air-abraded/polished dentin in E&R mode than in SE mode.

CONCLUSION

Air-abrasion/polishing did not impair dentin bond strength using G2B, except when dentin was air abraded with AO29 and using G2B in SE mode. Air polishing positively influenced the bond strength to dentin in specific groups.

CLINICAL SIGNIFICANCE

APA is safe concerning bonding to dentin. The E&R application mode is preferred using G2B as adhesive on air-abraded/polished dentin. Air polishing with BG positively influenced dentin bond strength for both application methods.

Bonding performance of experimental HEMA-free two-step universal adhesives to low C-factor flat dentin

OBJECTIVES

Experimental two-step universal adhesives (2-UAs) providing a particle-filled hydrophobic adhesive resin with a significant film thickness to hydrophobically seal the adhesive interface were designed and synthesized. This study aimed to characterize their interfacial interaction with dentin, to determine whether the 2-UA formulations achieve durable bonding to low C-factor flat dentin and to measure their water sorption.

METHODS

Bonding effectiveness of 2-UAs that combine a 10-MDP-based primer with hydrophobic adhesive resins differing only for filler (BZF-21, BZF-29, and BZF-29_hv) were comparatively investigated with the commercial adhesive Clearfil SE Bond 2 (C-SE2, Kuraray Noritake). Adhesive-dentin interfaces were characterized with TEM. Adhesive-resin disks were immersed in distilled water at 37 °C for 1 week, 6 months and 1 year to measure water sorption and solubility. 'Immediate' and 'aged' micro-tensile bond strength (μTBS) of the adhesives applied in etch-and-rinse (E&R) and self-etch (SE) bonding mode to low C-factor flat dentin were measured. Statistical analyses involved linear mixed-effects (LME) modelling and Kruskal-Wallis testing (p < 0.05).

RESULTS

TEM revealed that E&R hybrid layers were more sensitive to aging than SE hybrid layers. Lower water sorption was recorded for all UAs compared with C-SE2. The immediate μTBS of BZF-21 and BZF-29 was not significantly different from that of C-SE2. The 1-year aged μTBS of all 2-UAs was significantly lower than that of C-SE2, except for BZF-29 applied in E&R mode. A significant reduction in μTBS upon 1-year aging was recorded for BZF-21 and BZF-29 applied in E&R mode. A significant difference in μTBS between E&R and SE bonding modes was recorded for all adhesives except BZF-21.

SIGNIFICANCE

Experimental 2-UAs with a hydrophobic adhesive-resin design produced± 20-μm thick adhesive-resin layers, absorbed less water and resulted in bonding performance that was more aging-resistant when applied in SE than in E&R bonding mode. The silica-filled BZF-29 2-UA revealed the most comparable bonding performance with C-SE2 in a low C-factor condition (flat dentin).

Overcoming the blood brain barrier in glioblastoma: Status and future perspective

Glioblastoma is the most common primary brain malignancy in adults. Treatment of glioblastoma patients is based on neurosurgery, radiation therapy and chemotherapy. Despite this multimodal therapeutic regimen, the prognosis of glioblastoma patients is poor. Indeed, glioblastoma is very resistant to treatments due to multiple molecular and cellular mechanisms including the existence of the blood-brain barrier (BBB). The BBB consists of multiple layers surrounding brain vessels and limits drug penetration within the brain. Therefore, overcoming the BBB is a strategy to increase bioavailability and efficacy of therapeutic agents against glioblastoma cells. The development of two approaches is ongoing: i) enhancing the delivery of drugs to the brain and ii) improving the penetration of drugs into the brain. One way to enhance drug delivery to the brain is through high-dose intravenous chemotherapy, with or without bone marrow transplantation, or via intra-arterial chemotherapy, with or without disrupting the BBB through osmotic means. Conversely, improving drug penetration within the brain can be achieved through modifying either the drug itself or the BBB. Promising results in terms of safety and signals of efficacy were obtained with these approaches in early phase clinical trials. More advanced comparative clinical trials are needed to investigate the clinical benefit for glioblastoma patients.

Acrylamide monomers in universal adhesives

OBJECTIVES

The mono-functional monomer 2-hydroxyethyl methacrylate (HEMA) is often added to universal adhesives (UAs) to improve surface wetting and prevent phase separation. Nevertheless, HEMA promotes water sorption and hydrolysis at adhesive interfaces, hereby affecting long-term bonding to dentin. This study investigated if two acrylamide monomers could replace HEMA in an UA formulation applied in etch-and-rinse (2E&R) and self-etch (1SE) bonding mode.

METHODS

Four experimental UAs were bonded to bur-cut dentin. In addition to 12 wt% 10-MDP, 25 wt% Bis-GMA and 10 wt% TEGDMA as common monomer composition, 20 %wt ethanol and 15 %wt water as solvent, and 3 wt% polymerization-related additives, the four formulations solely differed for either the acrylamide cross-linker monomer 'FAM-201' as TEGDMA alternative and HEMA replacement, the hydroxyethyl acrylamide monomer 'HEAA' as HEMA alternative, HEMA ('HEMA+'), or extra TEGDMA in a HEMA-free control ('HEMA-'), all added in a 15 wt% concentration. The split-tooth study design involved application in 2E&R mode on one tooth half versus 1SE mode on the corresponding half. Micro-tensile bond strength of half of the micro-specimens was measured upon 1-week distilled water storage ('immediate' 1w μTBS), with the other half measured after additional 6-month storage ('aged' 6 m μTBS). Statistics involved linear mixed-effects (LME) modelling (p < .05). Additionally, interfacial TEM characterization, thin-film (TF) XRD surface analysis, LogP determination, and a cytotoxicity assay were carried out.

RESULTS

FAM-201 revealed significantly higher μTBS than HEMA+ at 1w and 6 m when applied both in E&R and SE bonding modes. HEAA's μTBS was significantly lower than that of HEMA+ at 1w when applied in SE mode. TF-XRD and TEM revealed similar chemical and ultrastructural interfacial characterization, including stable 10-MDP_Ca salt nano-layering. FAM-201 was least cytotoxic and presented with an intermediary LogP, while HEAA presented with the highest LogP, indicating high hydrophilicity and water-sorption sensitivity.

SIGNIFICANCE

The acrylamide co-monomer FAM-201 could replace HEMA in an UA formulation, while HEAA not.

P07.05.A Implantable electrophoretic devices for local treatment of inoperable brain tumours

Background

Glioblastoma (GBM) is the most malignant primary brain tumour in adults, with a median overall survival of fewer than 18 months after initial diagnosis. For over five decades, research has been focused on developing new anticancer therapies for GBM, including anti-neoplastic agents, molecular targeted drugs, immunotherapeutic approaches, and angiogenesis inhibiting compounds; however, the prognosis of patients has hardly improved and temozolomide remains the only chemotherapy shown to improve patient survival in randomized clinical trials. A fundamental limitation of the success of chemotherapy in brain cancer therapies is the blood-brain barrier which significantly reduces the concentration of chemotherapeutic agents delivered into a tumour.

Material and Methods

Therapeutic strategies that control drug release spatially and temporally represent a significant step forward in terms of reducing side effects and improving treatment efficacy and will thus have a significant clinical impact. Electrophoretic drug delivery devices, which use electric fields to enhance drug transport, represent one such strategy.

Results

Here, we present an implantable device that enables highly spatially selective delivery of charged drug molecules directly into brain tumours. Our device combines a microfluidic system for drug transport with embedded electrodes which enable electrophoretic transport of drug molecules into the target tissue. This allows delivery of chemotherapeutic agents without transport of bulk solvent preventing issues arising from intracranial pressure gradients. We have shown that the device can be implanted safely without any limitation. We have tested the device's capabilities to deliver a wide range of small, medium, and large chemotherapeutic agents without limitations. Currently, we are investigating the delivery of cisplatin in GBM-bearing mice.

Conclusion

While electrophoretic drug delivery was first described in the early 20th century and has been used since primarily for transdermal drug delivery, we believe that our approach is one of the first times this has been demonstrated for brain cancer therapy.

Diagnosis of Viral Diseases in Sudan: Coronaviruses Unveil the Concealed Venues

Establishing the diagnosis of viral diseases often needs sophisticated settings, equipment, expertise, and strict laboratory methods.  In Sudan, as in most developing countries, viral diseases are mostly diagnosed by clinical presentation. As most viral infections are self-limiting and there is no specific treatment for most of them, laboratory diagnosis has not been a focus for improvement, particularly in public sector until the current pandemic of COVID-19. During this pandemic, the vital need for well-equipped clinical virology laboratories is urged. The aim of this work is to highlight the various diagnostic methods and to describe the current situation of clinical virology diagnostics in Sudan.

Multiparameter evaluation of acrylamide HEMA alternative monomers in 2-step adhesives

OBJECTIVE

As frequently added to adhesives, the mono-functional monomer 2-hydroxyethyl methacrylate (HEMA) acts as co-solvent and improves surface wetting. Nevertheless, HEMA promotes watersorption and hydrolysis at adhesive interfaces, affecting bond durability to dentin. This study investigated if two acrylamide co-monomer alternatives could replace HEMA in experimental adhesive-resin formulations as part of 3/2-step universal adhesives applied, respectively, in etch-and-rinse (E&R) and self-etch (SE) bonding modes.

METHODS

Upon priming dentin with the 10-MDP-based Clearfil SE Bond 2' primer ('C-SE2p'; Kuraray Noritake), three experimental adhesive resins, consisting of 50 wt.% Bis-GMA, 15 wt.% TEGDMA, and either 35 wt.% diethyl acrylamide ('DEAA'), hydroxyethyl acrylamide ('HEAA') or HEMA ('HEMA+'), were applied. The control HEMA-free adhesive resin contained 60 wt.% Bis-GMA and 40 wt.% TEGDMA ('HEMA-'). All adhesives were evaluated for 'immediate' and 'aged' micro-tensile bond strength (μTBS) to dentin upon, respectively, 1-week (1w) and 6-month (6m) water storage, TEM adhesive-dentin interfacial interaction, 24-h and 6m three-point bending, contact-angle wetting, viscosity and watersorption.

RESULTS

Linear mixed-effects model statistics revealed significantly better bonding performance of the adhesives applied in E&R than SE mode, except for DEAA_1w, with the highest μTBSs recorded for DEAA and HEMA- applied in SE mode. In E&R mode, aging did not significantly reduce DEAA's μTBS. Best wetting on primed dentin was recorded for HEMA+, significantly better than DEAA, further HEAA and HEMA-, these directly related to their viscosity. HEAA absorbed significantly more water than all other adhesive-resin formulations. HEMA->DEAA>HEAA>HEMA+ was the significant order for 6m bending strength.

CONCLUSIONS

The acrylamide co-monomer DEAA could replace HEMA, while HEAA not.

The Irrational Use of Antibiotics Among Doctors, Pharmacists and the Public in River Nile State, Sudan

Background: Inappropriate antibiotic prescription, dispensing and self-medication are alarmingly high worldwide. The problem is more so in developing countries, including Sudan, where resistance to life-saving drugs is emerging. Objective: to assess the prevalence of irrational use of antibiotics among doctors, pharmacists and the public in River Nile State (RNS), Sudan. Methodology: a descriptive cross-sectional study was conducted, in March 2014 through April 2014. The study population was 278 individuals, composed of 100 doctors, 78 pharmacists selected randomly from hospitals, pharmacies and health centers, besides 100 adults from the community. Three different interviewer-administered standardized pre-tested questionnaires were used for data collection. Results:antibiotic misuse is common practice among both medicals as well as the public in RNS. This was evidenced by the facts that 92% of doctors prescribed antibiotics without culture and sensitivity results, more than 93% of pharmacists dispensed antibiotics as over the counter medications and that 89% of participants used antibiotics without consulting a doctor. More than 90% of the misused antibiotics werebeta-lactams and macrolides and the most common indication for their use was cough and common cold. Conclusion: Irrational use of antibiotics is a widespread practice in RNS among all stakeholders. Therefore, health care policy makers and care providers should have antibiotic policy and clear to follow obligatory guidelines and to ensure that the public and every prescriber/dispenser conforms to that policy. Moreover, increasing awareness about the appropriate antibiotic use among all stakeholders is of paramount importance.

Optimization unit for real-time applications in unbalanced smart distribution networks

This paper presents a new generic approach for developing a Jacobian matrix for use with the optimization unit in real-time energy management systems (EMS) for unbalanced smart distribution systems. The proposed formulation can replace approximated calculations for real-time optimal power flow in an optimization unit while providing greater accuracy and requiring less computational time, which is critical for real-time EMS. The effectiveness and robustness of the proposed approach have been tested through simulations with different distribution networks. The simulation results demonstrate a significant reduction in the computational time with the new proposed formulation. Moreover, the results demonstrate the scalability of the proposed approach as the reduction in the computational time is more significant for large practical systems. The proposed approach is characterized by evaluating the scalability and low computational time; thus, it can be used by grid operators in real-time energy management applications for large-scale practical distribution systems.

Prevalence of Hepatitis B surface antigen among biomedical students of African descent in Usmanu Danfodiyo University, Sokoto, Nigeria

BACKGROUND

Hepatitis B (HB) is a serious global public health problem that put health professionals particularly at risk.

OBJECTIVE

The aim of this study was to investigate the prevalence of Hepatitis B surface antigen (HBsAg) among Biomedical Students of African descent attending Usmanu Danfodiyo University Sokoto in North-Western Nigeria.

METHODS

The Onsite HBsAg (CTK Biotech, USA) was used to detect the presence of hepatitis B surface antigen.

RESULTS

We tested 186 consecutively-recruited students consisting of 147 males and 39 females aged 18-35 years (mean age 26 ± 2.0 years). Of the 186 students tested, 25 (13.4%) were positive for HBsAg. The prevalence of HBsAg was significantly higher among students in the 21-25 years age group. Hepatitis B vaccination uptake among students was 7%. Majority of subjects were single 173(93.1%) compared to married 13 (6.9%). Ethnic distribution of the subjects indicated that 104(55.9%) were Hausa compared to Yoruba 32 (17.2%), other ethnic groups 21(11.3%), Fulani 20(10.8%) and Igbo 9(4.8%).

CONCLUSIONS

This study indicates a high prevalence of hepatitis B virus infection among Biomedical students in Sokoto, North Western, Nigeria. Finding from this study is enough justification for the implementation of a policy to routinely test students entering into the biomedical professions for Hepatitis B virus infection. There is the need to provide hepatitis B vaccination universally to all those who are found negative prior to commencement of their biomedical training. There is also need to educate students entering biomedical professions and healthcare workers on the modes of transmission and prevention, importance of being compliant with protective vaccination as well as the need to observe universal precaution and infection control guidelines during their training and future professional practice.

Epidemiology of tuberculosis and evaluation of treatment outcomes in the national tuberculosis control programme, River Nile state, Sudan, 2011-2013

Tuberculosis is a major health problem in Sudan, a country that carries 11-15% of the tuberculosis burden in the Eastern Mediterranean Region. This study aimed to describe the epidemiology of tuberculosis in River Nile State and to compare treatment outcomes with WHO recommended indicators. A descriptive study was conducted on data collected from records of 1221 patients registered at tuberculosis management units over the 3 years 2011-2013. The mean age of cases was 37.7 (SD 21.5) years and 65.9% were males; 76.3% were pulmonary tuberculosis and 36.9% were sputum smear-positive cases. Average values for all outcome indicators were suboptimal, notably rates of case notification (30.8 per 100 000), case detection (10.3%), treatment success (79.6%), treatment failure (3.0%), default (8.1%) and death (8.0%). Of the 264 patients tested for HIV, 3.8% were positive. Outcome indicators for the national tuberculosis control programme are lagging behind the required targets.

Undiagnosed diabetes mellitus in rural communities in Sudan: prevalence and risk factors

Undiagnosed diabetes constitutes a challenge for health providers, especially in rural areas. The aim of this study was to determine the prevalence of undiagnosed diabetes mellitus and glucose intolerance among adults in rural communities in River Nile State, north Sudan. In a cross-sectional community-based study, blood glucose, anthropometric, demographic and clinical history data were obtained from 1111 individuals from 35 villages. The prevalence of undiagnosed diabetes was 2.6% (29 individuals); glucose intolerance was detected in 1.3% (14 individuals). Classic symptoms (polydipsia, polyuria and weight loss) were present in around half of the participants but were not more prevalent in those with diabetes. Lower educational level, increasing age, hypertension and unexplained weight loss were significant risk factors for diabetes. Other variables (obesity, sex, occupation, alcohol consumption and cigarette smoking) were not significant risk factors. There is a low prevalence of undiagnosed diabetes and glucose intolerance in the rural population of River Nile State.

Registry of the clinical characteristics of spondyloarthritis in a cohort of Egyptian population

The aim of this study was to characterize the socioeconomic features, as well as disease activity and functional status, treatment use, and quality of life in a cohort of Egyptian population. All are measured by standard instruments. This is a descriptive multicenter; cross-sectional study included consecutive patients with spondyloarthritis (SpAs) diagnosed according to the European spondyloarthritis study group criteria. Four Egyptian centers participated (one from the Upper Egypt, one from the Delta, and two from the West Coast), all adopted the same criteria for patient assessment, and data were collected in the same data base over a 12-month duration. A total of 75 patients were included in the study. The series consisted of 34 ankylosing spondylitis (AS) patients (64%), 23 patients with psoriatic arthritis (45.3%), 15 patients with Juvenile onset AS (18.7%), 2 patients with reactive arthritis (2.7%), and one with inflammatory bowel disease-related arthritis (1.3%). There was predominance of male patients (84%). All were Caucasians; 13% from the Upper Egypt, and 87% from the Delta and West coast Egypt. Their mean age was 37.44 ± 12.8 years; mean disease duration was 11.85 ± 9.27 years. Pure axial disease was reported by 24% of the patients, and pure peripheral involvement was observed in 4%, while the mixed pattern (axial, peripheral, and entheseal) was observed in 34%. Dactylitis was detected in 9.3%, tarsitis in 8%, and enthesitis in 29.3%. The most common extra-articular manifestation was anterior uveitis, reported by 5.3% of patients. Human leukocytic antigen B27 (HLA-B27) was positive in 58.7% of the tested patients (n = 29). Mean Bath Ankylosing Spondylitis Disease activity Index (BASDAI) score was 4.16 ± 2.12, of which 22 patients had a score more than 4; mean Bath Ankylosing Spondylitis Functional Index 5.12 ± 2.40, mean BASMI 4.17 ± 2.95, mean BAS-GI 5.92 ± 2.00, and mean Health assessment questionnaire 1.10 ± 0.65. In addition, patients with AS showed a higher incapacity for work, felt more pain and presented more axial affection than others. The most utilized treatments were the conventional drugs including non-steroidal anti-inflammatory drugs, followed by sulfasalazine (50%), methotrexate (14%), and steroids (6%). Tumor necrosis factor-alpha inhibitors were received by 7 patients (14%), mostly in the form of Infliximab (85.7%) and were used by only 38.7% of patients with BASDAI of 4 or more. This registry provides the first clinical and demographic data of SpA patients in Egypt upon which a large-scale database registration can be initiated. The most frequently diagnosed SpA in Egyptian patients was AS, with mainly combined axial and peripheral involvement. The clinical spectrum of SpAs seen among Egyptians is similar to most other registries; however, Egyptian AS patients showed some differences in the clinical manifestations. The low frequency of HLA-B27 and the clinical variations in AS may be due to different genetic and/or environmental factors in Egypt.

Potential therapeutic uses for ezetimibe beyond lowering LDL-c to decrease cardiovascular events

Ezetimibe is a relatively new drug that inhibits the absorption of dietary cholesterol in the small intestine. It is a low density lipoprotein-cholesterol (LDL-C) lowering medication that acts directly on the intestine by inhibiting Niemann-Pick C1 Like1 (NPC1L1). Recently, results of the ARBITER 6-HALTS trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies) and the ENHANCE trial (Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression) showed that ezetimibe had no effect on atherosclerosis despite producing a marked decrease in LDL-C. Recent studies show a potential benefit of ezetimibe in treating insulin resistance, non-alcoholic fatty liver disease (NAFLD), gallstones and dyslipidaemia associated with chronic renal failure and organ transplantation. All of these conditions are known to be associated with an increase in risk of cardiovascular disease (CVD) and further studies are needed to assess the potential benefits of ezetimibe in these therapeutics areas.

Frequency of inhibitor development in severe haemophilia A children treated with cryoprecipitate and low-dose immune tolerance induction

The frequency of factor VIII inhibitor development was evaluated in a hundred severe haemophilia A patients < 18 years of age (mean 10.4 +/- 5.1 years); 25 were previously untreated patients (PUPs), with a mean age of 11.2 +/- 2.9 months. All were followed up for 3 years from December 1996. Immune tolerance (IT) was induced with low-dose factor VIII (FVIII); 25-50 IU kg(-1) every other day for the 10 haemophiliacs who developed persistent inhibitors. The incidence of inhibitors for PUPs was 3/25 (12%; 95% confidence interval [CI], 0. 7-24.7%) and were detected after 4, 15 and 20 exposure days (mean 13 +/- 8.2 days; 95% CI, 3.7-22.2%). Children with maximum inhibitor levels of > 40 Bethesda units (BU) per mL (n=4) received IT therapy as 25 U kg(-1) FVIII in the form of cryoprecipitate every other day for 1-4 months (mean 2.4 +/- 1.6 months; 95% CI, 0.8-3.9%), which was successful in all of them. FVIII (50 U kg(-1)) was given every other day for six patients with maximum inhibitor level > 40 BU mL(-1) for 3-9 months (mean 5.4 +/- 3.2 months; 95% CI, 2.9 -7.9%) with success in 4/6 (66.6%; 95% CI, 28.8-104.3%). Patients who showed a good IT response had an inhibitor level < or = 30 BU mL(-1), were < or = 9 years of age at inhibitor development with few exposure days to FVIII and had an early immune tolerance. In conclusion, inhibitor development in severe haemophilia A children exclusively treated with cryoprecipitate is low. Early low-dose IT induction for high responders may be achieved successfully if inhibitor level is < or = 50 BU mL(-1).

Quality of care of children with chronic diseases in Alexandria, Egypt: the models of asthma, type I diabetes, epilepsy, and rheumatic heart disease. Egyptian-Italian Collaborative Group on Pediatric Chronic Diseases

OBJECTIVES

To evaluate the quality of care delivered to children suffering from index chronic diseases using specific indicators of health care delivery and to study the predictors of suboptimal quality of care (SQC) and its outcome on children.

DESIGN

Over a 9-month period, guidelines for optimal care were formulated. A specific questionnaire for every studied chronic disease was prepared in collaboration with the clinicians in charge of the diseased children (66% pediatricians and pediatric specialists and 34% adult specialists). The clinicians were asked to write the details of daily practice, ie, how these children were managed on a routine basis as well as in an emergency situation. A cross-sectional study was conducted over a 4-month period and included 953 children suffering from bronchial asthma (BA), childhood epilepsy (CE), type I diabetes mellitus (IDDM), and rheumatic heart disease (RHD). A systematic random sample of children was selected from children visiting the ambulatory settings of all children's hospitals. Every fourth child was selected on 2 randomly chosen days each week, while all diseased children admitted in the hospital settings of the children's hospitals during the study were included. A general form describing the impact of the diseases on the child was prepared. A network of clinicians was created in all children's hospitals; seminars were held during which the content validity of the questionnaire was tested. Items were evaluated for their internal consistency using the Cronbach alpha. According to the degree of adherence to the recent therapeutic guidelines concerning selected indicators of the quality of care specific to every disease, children were categorized as receiving optimal quality of care or SQC. These indicators were: the use of inhaled bronchodilators in acute asthmatic attacks in mild asthma and the use of the prophylactic drugs (inhaled sodium cromoglycate or inhaled beclomethasone) in moderate to severe chronic BA in between acute asthmatic attacks; compliance with antiepileptic drugs in epileptic children; regular performance of self-monitoring of blood glucose and/or urine testing in diabetic children; and compliance with prophylactic antibiotics in children suffering from RHD. The records of the outpatient clinics for ambulatory and hospitalized cases were reviewed to assess the degree of compliance with the prescribed management before the index visit. Sociodemographic characteristics and health care system-related predictors of SQC were analyzed via stepwise logistic regression analysis. The impact of illness on the child was assessed by 7 items which were: dependence on parents in domestic activities, level of activity compared with peers, mood compared with peers, level of socializing, degree of discomfort attributable to illness, level of physical disadvantage, and urinary incontinence. Factor analysis with Varimax rotation was performed on items related to the impact of illness. Parental satisfaction with care was rated as excellent, very good, fair, or poor. Information on school outcome was obtained by asking the caretakers whether the child was able to attend school regularly despite his sickness. Scholastic achievement was also rated as excellent, very good, good, and acceptable. Parents were asked whether the child had ever repeated a grade because of his sickness.

SETTING

Ambulatory and hospital settings of all children's hospitals in Alexandria, Egypt.

RESULTS

Only 52% of mild asthmatics were given inhaled bronchodilators during acute attacks and 6.84% of moderate to severe asthmatics were taking prophylactic drugs (inhaled sodium cromoglycate and/or inhaled beclomethasone) between acute attacks. Similarly, only 53 of 134 (39.6%) of diabetic children were regularly performing self-monitoring of blood glucose and/or urine testing. In contrast, in epileptic children, 121 of 173 (69.9%) were judged as being compliant by their managing clinicians and more than two

The translation into arabic and revalidation of a fatigue questionnaire

The aim of this study was to translate a fatigue questionnaire, which had been developed in England for use in epidemiological studies and in community settings, into Arabic. It was intended that the translated questionnaire could be used in any setting where Arabic is the first language of the patient. The process of translating the questionnaire and the revalidation method are described. The Arabic translation was shown to be both reliable and valid in the United Arab Emirates setting.

The translation into Arabic and revalidation of a fatigue questionnaire

The aim of this study was to translate a fatigue questionnaire, which had been developed in England for use in epidemiological studies and in community settings, into Arabic. It was intended that the translated questionnaire could be used in any setting where Arabic is the first language of the patient. The process of translating the questionnaire and the revalidation method are described. The Arabic translation was shown to be both reliable and valid in the United Arab Emirates setting.

Parasitological profile of the surveyed population for malaria in an endemic area in Faiyoum Governorate, Egypt

Egypt represents the only focus in the Mediterranean region where Plasmodium falciparum transmission still occurs. A longitudinal parasitological study has been implemented (September 1995 to December 1996) in Faiyoum, Egypt. A total of 9065 blood slides for malaria parasites were taken from all people in the study area as mass blood examination (MBE); those attending the malaria unit as passive case detection (PCD) as well as from neighborhood of the detected cases (NOD). They were stained by Giemsa stain and examined under standard conditions for positivity, parasite species and parasite density. Our results show that MBE detected 61.5% of malaria cases while 23.1% and 15.4% of the confirmed cases were detected through PCD and NOD respectively. The overall parasite rate was 5.7/1000 examined population. P. falciparum was the most predominant species (96.1%), followed by P. vivax (3.9%). The epidemiological factors causing the persistence of malaria transmission in the study area are discussed.

Developing and testing of an Egyptian version of Children's Health Locus of Control scale

The purpose of this study is to develop and test the reliability and validity of an Egyptian version of the Children's Health Locus of Control scale. A cross sectional study design was applied using a stratified random sample of 930 students from the final two grades of primary and all grades of the preparatory schools. A further convenience sample of 120 students was selected to examine test-retest reliability of the scale. A preliminary instrument was developed and consisted of 40 statements having one of two response forms; a Yes/No format and a 4-point Likert scale format From data analysis the later format showed higher validity and reliability than the former one. Construct validity of the scale is evidenced by the factor analysis which revealed five factors (Internal, Chance, Powerful Others, Fate and Self blame) consistent with the previous theoretical model of HLC. As indicated by eta coefficient the scale and the subscales showed strong discriminating power between subjects. The known group comparison indicated a good criterion validity of the scale and the subscales. The scale showed a considerable reliability as alpha coefficient was 0.73 with test-retest reliability of 0.65. Comparison of different groups of students indicated that the scale could be used with confidence for all age groups, though it was more reliable for the preparatory phase, for private and governmental schools for males and females and for different social strata. Further testing of the developed scale is indicated among Egyptian children in different cultures.

Bionomics of the anopheline vectors in an endemic area in Fayoum Governorate, Egypt

A one-year longitudinal entomological study was carried out at Kafr Fazara village, Sinnuris District, Faiyoum Governorate from January to December 1996. The results revealed that three species of anophelines were found. A. sergenti was the most prevalent species followed by A. multicolor and the least prevalent one was A. pharoensis. The influence of climatic conditions on anopheline abundance was also studied. The mean monthly temperature has a significant effect on larvae abundance, while no significant correlation was found concerning relative humidity or wind speed for both larvae and adult anophelines. The transmission season of P. falciparum in Faiyoum Governorate extended to more than eight months a year which could explain the persistence of malaria up there. The bionomics of the recorded vectors were discussed.

Regression of metastatic liver tumors in rats treated with angiogenesis inhibitor TNP-470: occurrence of apoptosis and necrosis

To clarify the mechanism of the reduction of metastatic liver tumors in rats treated with angiogenesis inhibitor TNP-470, the death of tumor cells was examined pathologically and ultrastructurally. Liver metastases were developed by intravenous injection of AH-130 cells. TNP-470 was given subcutaneously after tumor cell injection. Alterations in the size and number of metastatic tumors were examined at various time points, in association with the analysis of cell death pattern. The metastatic nodules were divided into 4 groups according to the morphological patterns of cell death; no cell death, scattered apoptosis, central necrosis, and diffuse necrosis. The number and size of the metastatic tumors at 2 weeks in untreated rats were larger than those in treated rats. The number of tumors in untreated rats decreased, but the tumor size increased. All rats treated with TNP-470 were alive and free from tumors after 4 weeks, whereas all the untreated rats died of liver metastases. The percentages of the tumors with necrosis in untreated rats (61.2% at 2 weeks and 100% at 4 weeks) were significantly higher than that (31.8% at 2 weeks) in treated rats (P < 0.01). The percentage of the tumors containing apoptotic cells in treated rats was significantly higher than that in untreated rats (54.5% vs. 30.6%; P < 0.05). The growth of metastatic tumors without treatment might be faster than the growth of vessels in untreated tumors, resulting in central necrosis due to ischemia. On the other hand, the reduction of metastatic liver tumors treated with TNP-470 might be caused by inhibition of angiogenesis, providing a weak ischemic stimulus which triggers apoptosis, rather than by a direct cytotoxic effect on tumor cells, because previous in vivo experiments demonstrated that TNP-470 affected endothelial cells but not tumor cells.

The angiogenesis inhibitor TNP-470 (AGM-1470) improves long-term survival of rats with liver metastasis

An excellent therapeutic effect of angiogenesis inhibitors on tumor growth or metastasis has been reported, but the sustained antimetastatic effect of these agents has not been studied. We investigated the sustained effect of TNP-470, an angiogenesis inhibitor, in rats with hepatic metastasis following intraportal implantation of rat ascites hepatoma AH-130 cells. TNP-470 was administered subcutaneously at 15 mg/kg (L-TNP) or 30 mg/kg (H-TNP) on alternate days for 2 weeks. The number of liver metastases was significantly reduced in both the L-TNP (85.1 +/- 77.6) and H-TNP (31.7 +/- 49.6) groups compared to the control group (300.7 +/- 100.7) (P < 0.01) at 14 days after the start of treatment. Although all rats in the control group died within 1 month of massive liver metastasis, the L-TNP and H-TNP, respectively, had a survival rate of 82 and 60%, at 4 months (P < 0.001). Absence of toxicity of TNP-470 at the lower dose, as evidenced by the absence of intraperitoneal or intrapleural bleeding, contributed to a better prognosis in the L-TNP group. Interestingly, a small dormant metastatic focus was found in only 1 of 15 rats surviving for 4 months, whereas metastatic foci were observed in all rats at the end of treatment. These results suggest that the sustained cytostatic effect of TNP-470 on vascular endothelial cells may help to improve long-term survival by reducing the metastatic burden.

Plasma serotonin and platelet aggregation during ischemia-reperfusion in dogs: effect of dipyridamole and coenzyme Q10

Platelet aggregation and plasma serotonin were studied during ischemia-reperfusion of the small intestine in dogs. Blood was withdrawn from the superior mesenteric vein before and 1 h after ischemia, then 5, 30 and 60 min after reperfusion. Dipyridamole (5 mg/kg body weight) and coenzyme Q10 (CoQ10; 10 mg/kg body weight) were administered intravenously 5 min before reperfusion, following 1 h ischemia, in order to investigate their effects on platelet function and free serotonin. Ischemia-reperfusion resulted in an increased local free serotonin concentration together with an enhanced platelet response to ADP, collagen and arachidonic acid. Administration of dipyridamole and CoQ10 prior to reperfusion prevented, at least in part, augmented platelet activation and serotonin release. It appeared that dipyridamole was more potent than CoQ10. Our results may indicate a possible protective effect of dipyridamole on enhanced platelet activation during ischemia-reperfusion in dogs.

Psychosocial aspects of murder in Nigeria

This study is a review of cases of murder reported to Police in Kaduna State from 1983 to 1987 and a survey of the psychosocial profile of the murderers. Most of the murderers, 91.7%, were between the ages of 20 and 40 while 93.6% were male. Of them 56.5% were single while Moslems (51.2%) formed the highest group. Unemployed and ex-service men predominated in the cohort interviewed. Sharp tools such as matchets, knives and axes were used by 66.7%, 83.3% of the murderers are acquitances (friends and family members) of their victims. Socially acceptable reasons were given for 79.1% of the murder while 5.3% were referred for psychiatric assessment. Implications of this study in formulating policy on murder are briefly mentioned.

A two year prospective study of maniac disorder and its symptomatology in northern Nigeria

A prospective study of 38 manic patients (22 males and 16 females) was carried out. The average age of males and females were 31.2 and 29.4 years respectively. About 66% were Moslems while 33% were Christians. Fifteen patients were Hausa/Fulani, the largest ethnic group in Northern Nigeria. 17 patients were illiterates and were mainly Hausa-Fulani housewives. 35 out of the 38 patients were treated as in-patients and the duration of stay ranged from 14-42 days. 32 patients were followed-up for between 6 months to about 2 years. Only 3 cases relapsed during follow-up. Hypomanic affect, the commonest symptom was found in only 71% of the cases, a finding which compares favourably with a previous study. 15 cases (8 males and 7 females) had previous histories of mainly manic illness. 8 cases had associated drug abuse mainly alcohol and hemp. There was no positive family history of mental illness. 16 cases consulted traditional or religious healers before seeking orthodox psychiatric treatment. The main neuroleptic used was chlorpromazine with an average dose of 300 mg daily. ECT was used concurrently 6 times in 10 cases. Lithium prophylaxis was not used.

Electroencephalographic abnormalities in 351 Nigerians with epilepsy

A review of the electroencephalographs of 351 epileptic patients admitted to the Ahmadu Bello University Teaching Hospital, Kaduna from March, 1982 to November, 1984 is presented. Those under 20 years age group predominated in the cohort studied. The frequencies of generalised epilepsy and partial epilepsy were almost equal. Partial epilepsy with complex symptomatology was common and petit mal was relatively rare. The inter-ictal EEG record was normal in 35.6% who were usually young and presumably suffered from idiopathic epilepsy. Differences existing in the EEG records reported and those reported in Nigeria and elsewhere are discussed. The need for an epidemiological study of the general population in the Northern Nigeria is emphasized.

The historical development of western psychiatric practice in northern Nigeria--an uphill struggle

The historical development of psychiatric services in what was Northern Nigeria is given. It started with the time when the only thing done for very psychotic patients was custodial in prisons. The appearance of many psychopharmacological agents after 2nd World War made possible the establishment of psychiatric units in general hospitals for the treatment of acute cases only. The arrival of Oshodi in 1961 led to the evolution of modern psychiatric services with the unit he started in Kaduna-Zaria at the apex of the services provided throughout the Northern States. The unit in Kaduna was to evolve into a University Teaching Department. It is still at the apex of psychiatric services of most of the ten Northern States. Some of the other erstwhile peripheral units have also metamorphosed into nuclei of the four younger University Teaching Units. From only one psychiatrist up to 1977, there are now 12 out of the just over 60 psychiatrists in the whole country, practicing in the Northern States. Relative mental health for the more than 50% of the 100 million people of Nigeria living in the Northern States by the year 2000 is very much in doubt unless something is done with dispatch.

Epidemiology of bacterial pathogens associated with infectious diarrhea in Djibouti

During a survey examining the causes of diarrhea in the East African country of Djibouti, 140 bacterial pathogens were recovered from 209 diarrheal and 100 control stools. The following pathogens were isolated at comparable frequencies from both diarrheal and control stools: enteroadherent Escherichia coli (EAEC) (10.6 versus 13%), enterotoxigenic E. coli (ETEC) (11 versus 10%), enteropathogenic E. coli (EPEC) (7.7 versus 12%), Salmonella spp. (2.9 versus 3%), and Campylobacter jejuni-C. coli (3.3 versus 5%). Surprisingly, the EAEC strains isolated did not correspond to well-recognized EPEC serogroups. No Yersinia spp., enteroinvasive E. coli, or enterohemorrhagic E. coli were isolated during the course of this study. Only the following two genera were recovered from diarrheal stools exclusively: Shigella spp. (7.7%) and Aeromonas hydrophila group organisms (3.3%). Shigella flexneri was the most common Shigella species isolated. Patients with Shigella species were of a higher average age than were controls (27 versus 13 years), while subjects with Campylobacter or Salmonella species belonged to younger age groups (2.6 and 1.6 years, respectively). Salmonella cases were more often in females. Shigella diarrhea was associated with fecal blood or mucus and leukocytes. ETEC was not associated with nausea or vomiting. Anorexia, weight loss, and fever were associated with the isolation of Salmonella and Aeromonas species. EAEC, ETEC, EPEC, and Shigella species were resistant to most drugs used for treating diarrhea in Africa, while the antibiotic most active against all bacteria tested was norfloxacin. We conclude that in Djibouti in 1989, Shigella and Aeromonas species must be considered as potential pathogens whenever they are isolated from diarrheal stools and that norfloxacin should be considered the drug of choice in adults for treating severe shigellosis and for diarrhea prophylaxis in travelers.

[Aeromonas hydrophila in the drinking water in Djibouti: commensal germ or diarrhea-causing agent?]

To investigate the bacteriological quality of drinking water used by inhabitants of the Republic of Djibouti who were not supplied with piped running water, we analysed 16 fresh-water samples from various sources. Only 3 samples were sterile; they were taken from village pumps and from a water-truck. Eleven samples yielded colonies of Aeromonas hydrophila too numerous to be counted; they were taken from water tanks, metal barrels, or wells dug in either dry river beds or along the seashore. We speculate that this high isolation frequency of Aeromonas hydrophila in fresh water samples may be related to conditions that are exceptionally favourable for the growth of the bacterium (e.g. high temperature and elevated concentrations of certain salts and minerals in the fresh water of Djibouti). We wonder nevertheless whether the infected water supplies were a source of diarrhoea for humans. Indeed, antibiotic resistance patterns were dissimilar when the 11 environmental strains were compared to 7 strains of Aeromonas hydrophila isolated from diarrhoeal patients in Djibouti during the same period. More studies are needed to determine if Aeromonas hydrophila is always a commensal inhabitant of fresh water in Djibouti, or if it can be a cause of infectious diarrhoea. Accordingly, Public Health authorities in Djibouti will be able to decide if water from wells and tanks is safe for drinking, or if it needs disinfection before consumption.