STRYDE versus PRECICE magnetic internal lengthening nail for femur lengthening

INTRODUCTION

Magnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening.

METHODS

A single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE® group (30 femora) and PRECICE® group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications.

RESULTS

No statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE® and PRECICE®, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE® and PRECICE®, respectively). No mechanical nail complications were reported in the STRYDE® group compared to three events of nail failure in the PRECICE® group. One femur in the PRECICE® group needed BMAC injection for delayed healing compared to four femurs in the STRYDE® group.

CONCLUSION

The STRYDE® MILN yields comparable functional results to those of PRECICE® MILN and shows fewer mechanical nail complications. However, STRYDE® MILN requires a slower distraction rate and yields slower healing (larger BHI).

LEVEL OF EVIDENCE

Level III, Therapeutic study.

Clinico-Epidemiological Characteristics of Patients With Inflammatory Bowel Disease in Egypt: A Nationwide Multicenter Study

Background and Aims

Ulcerative colitis (UC) and Crohn's disease (CD) are the most common types of Inflammatory bowel disease (IBD), with variable responses to traditional therapies and unpredicted prognosis. In Egypt and most developing countries, the lack of recent epidemiological and prognostic data adversely affects management strategies. We collected and analyzed data of patients with IBD from multiple centers across Egypt to evaluate patients' clinical and epidemiological characteristics.

Methods

This retrospective multicenter study included patients diagnosed with IBD between May 2018 and August 2021, at 14 tertiary gastroenterology units across Egypt. Record analysis addressed a combination of clinico-epidemiological characteristics, biochemical tests, stool markers, endoscopic features, histological information, and different lines for IBD treatment.

Results

We identified 1104 patients with an established diagnosis of IBD; 81% of them had UC, and 19% showed CD. The mean age of onset was 35.1 ± 12.5 years ranging from 5 to 88 years, the mean duration of illness at inclusion was 13.6 ± 16.7 years, gender distribution was almost equal with a significant male dominance (60.4%, p = 0.003) among patients with CD, 57% were living in rural areas, and 70.5% were from Delta and Coastal areas. Two hundred nineteen patients (19.8%) displayed comorbid conditions, primarily associated with CD. The most frequent complaints were diarrhea (73.2%), rectal bleeding (54.6%) that was significantly higher among patients with UC (64%, p < 0.001), and 46.8% with abdominal pain (more often with CD: 71%, p < 0.001). Conventional therapy was effective in treating 94.7% of patients. The main lesion in patients with CD was ileal (47.8%); patients with UC mainly exhibited proctosigmoiditis (28.4%). Dysplasia was detected in 7.2% of patients, mainly subjects with UC.

Conclusions

To our knowledge, our effort is the first and largest cohort of Egyptian patients with IBD to describe clinical and epidemiological characteristics, and diagnostic and management approaches. More extensive prospective studies are still needed to fully characterize disease distribution, environmental factors, and pathological features of the disease.

P–265 Investigating the nanotoxicity of solid silica nanoparticles in gametes following in vitro exposure

Study question

Do solid silica nanoparticles qualify as a new research tool for the in vitro transfer of compounds into gametes prior to Assisted Reproductive Technology (ART).

Summary answer

Solid silica nanoparticles (SSNPs) could be used as an intra-gamete delivery system to deliver therapeutic biomolecules into gametes prior to ART.

What is known already

Sperm-mediated gene transfer (SMGT) results in the production of transgenic embryos; however, the success rate of this technique is low. Nanoparticles are an efficient intra-cellular delivery system in vitro. Naturally cell-secreted nanoparticles are involved in the development of gametes. Mesoporous silica nanoparticles have been shown to carry large amounts of compounds and to interact with gametes without toxic effects, thus providing an alternative to naturally secreted nanoparticles. However, this technique is associated with some limitations, such as the size of these nanoparticles. SSNPs can be synthesised on a smaller nanoscale, thus providing higher potential to penetrate gametes and delivering biomolecules.

Study design, size, duration

This was an experimental in vitro study that investigated the effects of SSNPs on the motility of boar sperm and the degeneration of hamster oocytes, as determined by ooplasm shrinkage.

Participants/materials, setting, methods

SSNPs (20 nm) were conjugated with fluorescein diacetate–5-maleimide (FDA5M), a fluorescent protein. FDA5M-labelled SSNPS were incubated with boar sperm (N = 3) at 10 and 30µg/ml/107 sperm for four-hours. Motility parameters were assessed by computer-assisted sperm analysis (CASA). Binding potential was evaluated by fluorescent microscopy. Hamster oocytes (7 oocytes/group) were incubated with FDA5M-labelled SSNPs at 100, 150, and 300µg/ml, for two-hours; ooplasm shrinkage was evaluated. Time/matched control sperm was incubated in phosphate-buffered saline and oocytes in KSOM.

Main results and the role of chance

Exposure to FDA5M-labelled SSNPs did not affect total or progressive sperm motility (P = 0.6735 and 0.9606, respectively), average-path velocity or straight-line velocity after 4-hours of incubation (P = 0.7459 and 0.8696, respectively) compared to controls. SSNPs at 10 µg/ml significantly increased sperm curvilinear velocity after 1-hour (P = 0.0495) and linearity and straightness after 4-hours (P = 0.0389 and 0.0312, respectively). SSNPs at 30 µg/ml significantly increased sperm linearity after 3- and 4-hours (P = 0.0384 and 0.005, respectively). The proportion of sperm showing green fluorescence was significantly higher in the 30µg/ml dose of SSNPs than the 10µg/ml dose after 4-hours (P < 0.00001). In oocytes, the zona pellucida remained morphologically intact and the ooplasm exhibited green fluorescence. The ooplasm of 42% of the oocytes at 300µg/ml showed ooplasm shrinkage (a sign of degeneration); no oocytes showed shrinkage at doses of 100 and 150µg/ml of SSNPs. The green fluorescence in the sperm head and the ooplasm indicated the ability of SSNPs to spontaneously interact non-invasively with these gametes either by surface association or by cell-internalisation. This could provide a safe and non-invasive intra-gamete delivery system for research purposes and clinical therapy. This system could be used to deliver specific agents into gametes prior to ART to improve outcomes.

Limitations, reasons for caution

The SSNPs are non-biodegradable; it remains unknown as to how gametes or embryos might react with SSNPs over long time periods. The nanotoxicity of SSNPs has not yet been investigated over the long term. SSNPs have still to be tested with embryos to evaluate their effect on embryonic development.

Wider implications of the findings: SSNPs could be functionalised to target the nucleus of mammalian gametes and embryos to act as a carrier for oligonucleotides and genes to correct chromosomal abnormalities and to provide genetic therapy in these gametes and embryos to treat hereditary diseases before intra-uterine transfer.

Trial registration number

Not applicable

Humerus Lengthening: A Comparison of the Internal Lengthening Nail to External Fixation

Introduction: Magnetic internal lengthening nails (MILNs) have been used for humeral lengthening to avoid complications associated with external fixation. Purpose/Questions: We compared the 1-year Disabilities of the Arm, Shoulder and Hand (DASH) score, adjacent joint range of motion (ROM), bone healing index (BHI), length achieved, distraction rate, and complications when lengthening the humerus using MILN vs using external fixation. Methods: We conducted a retrospective cohort study of 18 patients (22 humeri) from January 2001 to March 2020 divided into 2 groups, the MILN group (7 patients, 7 humeri) and the mono-lateral fixator group (11 patients, 15 humeri). Results: The MILN group showed larger improvement of DASH scores (average 26.8 and 8 for MILN and fixator groups, respectively), less loss of elbow ROM (average 5° and 7° for MILN and fixator groups, respectively), and shorter time to full recovery of elbow ROM (average 39 days and 122 days for MILN and fixator groups, respectively). In the MILN group, there was slower distraction rate (average 0.66 mm/day and 0.86 mm/day for MILN and fixator groups, respectively), less lengthening achieved (average 5.2 cm and 7 cm for MILN and fixator group, respectively), and a lower lengthening percentage (average 19% and 41% for MILN and fixator group, respectively). Bone healing index (BHI) of 0.94 and 0.99 months/cm for the MILN and the fixator groups were similar. Conclusion: Humeral lengthening using the MILN allowed for early full recovery of joint ROM with comparable functional and radiographic outcomes compared with using external fixators.

Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome

INTRODUCTION

The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named "terrible triad" as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow.

METHODS

A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1 year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS) at 1 year and elbow range of motion.

RESULTS

At final follow up for each patient (13.4 ± 1.2 months) The Quick-DASH score at 1 year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1 year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.Loss of elbow extension at 1 year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°.

CONCLUSION

A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair and replacement, in the setting of terrible triad injury, yields comparable results.

LEVEL OF EVIDENCE

Level II, Therapeutic study.

Hybrid fixation for adolescent both-bones diaphyseal forearm fractures: Preliminary results of a prospective cohort study

INTRODUCTION

Both-bone forearm fractures account for 3.4% of all pediatric fractures and 26% of all pediatric upper extremity fractures. Although non-operative management remains a feasible treatment option for children older than 10 years, they have a higher incidence for malunion due to their limited bone remodelling potential. Therefore, surgical intervention could be advocated for this age group, however the optimal method of surgical fixation in this age group remains controversial.Authors wanted to evaluate hybrid fixation (plating of ulna & elastic nail for radius) of adolescent both-bone forearm fractures in a large single-institution cohort of patients.

METHODS

A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from February 2016 to February 2019.A total of 60 patients (age 10-16 years) with both-bones forearm fracture were enrolled. Patients were assessed radiographically for union as well as clinically using the "Outcome Grading System" developed by Martus et al. for functional assessment of surgical management of pediatric forearm fractures using forearm rotation range of motion & complications rate.

RESULTS

At final follow up for each patient (24 months) Union was achieved in all cases. Delayed union occurred in 4 patients (2 radii & 2 ulnae) with no case of combined radius & ulnar delayed union. At final follow up, the mean supination range was 81.27° ± 4.1°, while the mean pronation range was 68.17° ± 3.03°. The "Outcome Grading System" results were: 48 cases (80%) scored excellent, 10 cases (16.7%) scored good & 2 cases (3.3%) scored fair.

CONCLUSION

Hybrid fixation method in adolescent both-bones forearm fracture could be a viable option in managing these injuries & may reduce the problem of ulnar non-union encountered when using elastic stable intramedullary nail (ESIN) in that age group.

LEVEL OF EVIDENCE

Level II, Therapeutic study.

Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty

Background

Ankle distraction arthroplasty has emerged as an alternative treatment for ankle arthritis. There are few reports on the magnetic resonance imaging (MRI) findings after distraction arthroplasty. This study sought to determine whether there are positive changes on MRI after ankle distraction and improvements on X-ray. Additionally, patient-reported outcomes and joint range of motion (ROM) after ankle distraction are described.

Materials and methods

Thirty-two patients (mean age 49 years) who underwent ankle distraction had pre-operative and one-year postoperative MRIs, which were graded using a modified whole-organ magnetic resonance imaging score (WORMS). Ankle joint space and ROM were measured. A non-validated three-item questionnaire was administered to assess functional outcomes.

Results

Although the anterior quadrant of the ankle showed a trend to improvement in cartilage morphology on the postoperative MRI, the WORMS did not demonstrate a significant difference in any of its subcategories. While reduction in joint osteophytes was observed and maintained short term, this was mainly due to resection intraoperatively. X-rays revealed a significant increase in joint space, and there was a significant increase in ankle dorsiflexion. Eight-seven percent of the patients were satisfied with their functional outcome.

Conclusion

At short-term follow-up, MRI scores after ankle distraction arthroplasty did not demonstrate significant improvement despite positive changes on X-ray and improved clinical outcomes and ankle ROM. Further study on larger patient numbers with longer follow-up is required.

Level of evidence

IV, Case Series

How to cite this article

Haleem AM, Galal S, Nwawka OK, et al. Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty. Strategies Trauma Limb Reconstr 2020;15(3):157–162.

Calcaneal lengthening for the pes planovalgus foot deformity in children with cerebral palsy

PURPOSE

The objective of this study was to evaluate the operative management of pes planovalgus deformity in ambulatory cerebral palsy (CP) children by calcaneal lengthening osteotomy described by Evans.

METHOD

Fifteen children (10 girls and 5 boys) with average age 11 years 6 months (range, 8 years 4 months-14 years 6 months) with 22 feet with pes planovalgus (PPV) deformity were included in this study. Clinical evaluation was made according to Dogan's scale and graded as perfect, good, fair and poor. Preoperative and postoperative radiological assessment of anteroposterior talo-first metatarsal angle (AP-T1MT), anteroposterior talo-calcaneal angle (AP-TC), laterl Talo-first metatarsal angle (Lat. T1MT), lateral Talo-calcaneal angle (Lat. TC), and lateral Calcaneal pitch angle (Lat. CP) had been done for all feet. All feet were corrected with the modification of the calcaneal lengthening osteotomy described by Mosca.

RESULT

Clinical results were perfect in 18 feet (82%), good in 2 feet (9%) and fair in 2 feet (9%). Radiological results showed improvement in 20 feet, while 2 feet showed no improvement. The improvement was significant in Lat. T1MT (P ‹ 0.001), AP-T1MT (P < 0.05)., AP-TC and Lat. CP (P < 0.001, <0.001 respectively) whereas it was insignificant in Lat. TC (P > 0.05).

CONCLUSION

The results of the present study showed that the procedure reliably relieves pain in PPV foot in CP children and proved effective in addressing all components of the deformity in both hindfoot and forefoot clinically and Radiologically.

Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures

OBJECTIVES

The best fixation method for open tibial fractures has long been a matter of debate, many studies have recommended the use of intramedullary nails over external fixation for treating such fractures, recent studies also showed favorable results for the use of plates in managing open tibial fractures. However, there are very few (if any) reports in the literature comparing the use of minimally invasive plate osteosynthesis to reamed intramedullary nails in the fixation of open tibial fractures. The aim of this study was to compare the safety & efficiency of minimally invasive plate osteosynthesis to reamed intramedullary nails in treating open tibial shaft fractures.

DESIGN

A single-center, parallel group, prospective, randomized study.

SETTING

Academic Level 1 Trauma Center, during the period from October 2014 to December 2016.

PATIENTS

A total of 60 patients with open tibial fractures were randomized to reamed intra-medullary nails (R-IMN) (group A) or minimally invasive plate osteosynthesis (MIPO) (group B).

OUTCOME MEASUREMENT

Patients were assessed for union (clinical & radiographic) & complications (e.g.; non-union, infection).

RESULTS

No statistically significant differences were found between the 2 methods in term of the incidence of infection or non-union. Time to full union was shorter for the R-IMN group when compared to that of the MIPO group & that was found to be statistically significant.

CONCLUSION

MIPO technique has equal safety to R-IMN technique in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures, as both techniques have similar rate of infection & non-union. These findings suggest that the MIPO technique can be considered a valid treatment alternative for such fractures.

LEVEL OF EVIDENCE

Level II, Therapeutic study.

Sensitivity and Specificity Estimation for the Clinical Diagnosis of Highly Pathogenic Avian Influenza in the Egyptian Participatory Disease Surveillance Program

Many developing countries lack sufficient resources to conduct animal disease surveillance. In recent years, participatory epidemiology has been used to increase the cover and decrease the costs of surveillance. However, few diagnostic performance assessments have been carried out on participatory methods. The objective of the present study was to estimate the diagnostic performance of practitioners working for the Community-Based Animal Health and Outreach (CAHO) program, which is a participatory disease surveillance system for the detection of highly pathogenic avian influenza outbreaks in Egypt. CAHO practitioners' diagnostic assessment of inspected birds was compared with real-time reverse-transcriptase polymerase chain reaction (RRT-PCR) test results at the household level. Diagnostic performance was estimated directly from two-by-two tables using RRT-PCR as a reference test in two different scenarios. In the first scenario, only results from chickens were considered. In the second scenario, results for all poultry species were analyzed. Poultry flocks in 916 households located in 717 villages were inspected by CAHO practitioners, who collected 3458 bird samples. In the first scenario, CAHO practitioners presented sensitivity (Se) and specificity (Sp) estimates of 40% (95% confidence interval [CI]: 21%-59%) and 92% (95% CI: 91%-94%), respectively. In the second scenario, diagnostic performance estimates were Se = 47% (95% CI: 29%-65%) and Sp = 88% (95% CI: 86%-90%). A significant difference was observed only between Sp estimates (P < 0.01). Practitioners' diagnostics and RRT-PCR results were in very poor agreement with kappa values of 0.16 and 0.14 for scenarios 1 and 2, respectively. However, the use of a broad case definition, the possible presence of immunity against the virus in replacement birds, and the low prevalence observed during the survey would negatively affect the practitioners' performance.

Non-parallel screw fixation for femoral neck fractures in young adults

INTRODUCTION

Current literature shows divergence of views regarding screws positioning in femoral neck fractures fixation. The goal of this study is to evaluate the efficiency of divergent screw fixation for fracture neck of femur (NOF).

METHODS

The study was conducted at an academic Level 1 Trauma Center. This is a retrospective study conducted from October 2013 to October 2016. The study included 41 patients (33 males, 8 females) suffering from fracture NOF who were fixed using BDSF technique (26 within 24 h. & 15 after 24 h.). The average age was 41.5 y (23-49 y). According to Garden classification; 17 patients (41.5%) were type 4, 24 patients (58.5%) were type 3. According to Pauwel's classification; 8 cases (19.5%) were type III, 25 cases (61%) were type II & 8 cases (19.5%) were Type I. Thirty-six cases (88%) were trans-cervical, 4 Sub-capital (9.5%) and 1 (2.5%) Basi-cervical. Six patients had comminution at the fracture site. We evaluated radiographic outcomes of union, femoral neck shortening, screws back-out & femoral head avascular necrosis (AVN). We also evaluated functional outcome using the Harris hip score. Follow-up was 24 months on average (ranging from 20 to 29 months).

RESULTS

One patient was lost during the follow up, the remaining 40 cases gave the following results regarding union: 38 united (within 3-4 months), 2 patients were un-united & one of them developed AVN. Twenty-seven patients (71%) had femoral neck shortening <5 mm, 8 patients (21%) had shortening 5-10 & 3 patients (8%) had shortening >10 mm. Shortening was on average 3 mm (0-15). Screws back-out distance was on average 4 mm (0 to16). Patients with mild femoral neck shortening had Harris hip score of 96 on average (92-100), those with moderate shortening had a score of 75 on average (72-79), those with severe shortening had a score of 62 on average (56-68).

CONCLUSION

The Authors believes this method provides better union rate & less incidence of femoral neck shortening than that of the conventional inverted triangle screws configuration reported in literature. However multi-center studies & long term follow-up is needed to fully evaluate this method.

Dynamic locked plating for fixation of distal femur fractures using near- cortical over-drilling: Preliminary results of a prospective observational study

INTRODUCTION

Nonunion after locked plating of distal femur fractures is not uncommon. Authors wanted to assess if "Dynamic" locked plating using near-cortex over-Drilling technique would provide a mechanical environment the promotes callus formation, thereby avoiding non-union encountered when applying locked plates with the conventional method.

METHODS

This study was conducted at an academic Level 1 Trauma Center. This is a prospective study conducted from November 2015 to November 2016. Follow-up was 10 months on average (ranging from 8 to 12 months). The study included 20 patients with 20 fractures (13 males, 7 females). The average patients' age was 41.2 years (18-64 years). According to the Müller AO classification of distal femur fractures (33A-C) there were 15 cases with extra-articular fractures (AO 33A), 5 patients with intra-articular fractures (AO 33C). Dynamic Locked plating using near-cortical over-drilling technique was done for all patients. Two blinded observers assessed callus score on 6-week radiographs using a 4-point ordinal scale. A 2-tailed t-test. Two-way mixed intra-class correlation testing was performed to determine reliability of the callus measurements by the 2 observers.

RESULTS

All patients achieved union, time to union was 13.4 weeks on average (range form 8-24 weeks). Delayed union was observed in 2 patients. The average callus score for fractures was 1.8 (SD 0.6). All fractures united in alignment except 1 fracture which united in valgus malalignment, the deformity was appreciated in the postoperative radiographs. No wound related complications, no loss of reduction, no catastrophic implant failure or screw breakage were detected.

CONCLUSION

Dynamic locked plating using near-cortex over-drilling is a simple technique that uses standard locked plates that promotes callus formation when used for fixing distal femur fractures.

External fixation of paediatric subtrochanteric fractures using calcar rather than neck pins

Subtrochanteric femoral fractures in children are uncommon and have received limited attention in the literature. Its treatment is controversial, and different options are available: traction, spica casting, internal fixation and external fixation. The aim of this study is to present our results with external fixation of subtrochanteric femoral fractures in children using Ilizarov frame. Between January 2012 and January 2014, 14 patients with closed subtrochanteric femoral fractures were treated in Cairo University School of Medicine Teaching Hospital. The average age at the time of injury was 6.4 years (range 3.8–11.5 years). Pathological fractures and fractures associated with neuromuscular diseases were excluded from this study. Two patients were multiply injured with abdominal injuries (as ruptured spleen). In all cases, a low profile Ilizarov frame was inserted using two half pins inserted proximally from greater to lesser trochanters parallel to the hip joint orientation line (line between tip of greater trochanter and femoral head centre) and secured to an arch, and another three half pins were inserted distally perpendicular to the femoral shaft and secured to an arch that was connected by three rods to the proximal arch. No post-operative spica was used. Average follow-up was 18 months (range 12–36 months). All fractures united with anatomical alignment within an average of 8 weeks (range 6–12 weeks). There were no deep infections and no significant limb length discrepancies. At the latest follow-up, no patient had any restriction of activities. External fixation with a low profile Ilizarov frame appears as a good treatment option for subtrochanteric femoral fractures in children.

Level of evidence: Level IV.

Circulation of avian influenza H5N1 in live bird markets in Egypt

The poultry meat trade in Egypt depends mainly on live bird markets (LBMs) because of insufficient slaughterhouses, lack of marketing infrastructure, and cultural preference for consumption of freshly slaughtered poultry. There are two types of LBMs in Egypt: retail shops and traditional LBMs where minimal, if any, food safety standards or veterinary inspection are implemented. Before January 2009, LBMs were considered to be a missing link in the epidemiology of avian influenza in Egypt. This incited us to initiate this surveillance to better understand the perpetuation of H5N1 and the risk of infection in poultry markets. Seventy-one out of 573 (12.4%) examined LBMs were positive for the H5N1 subtype by real-time--quantitative polymerase chain reaction (RT-qPCR) from January to April 2009. Where a 70.4% detection rate from LBMs had waterfowl only as a solitary sold species, a 26.8% detection rate from LBMs had waterfowl mixed with chicken and/or turkey, and 2.8% from LBMs had only turkey. Higher incidence, 40.8%, of positive LBMs was recorded during the cold month of February and concentrated mainly in the highly populated Nile Delta. These findings revealed wide circulation of H5N1 avian influenza virus in LBMs in Egypt, which poses a threat to public health and the poultry industry. Long-term control measures are required, and routine surveillance of bird markets should be conducted year-round.

Genetic diversity in Egyptian and Italian goat breeds measured with microsatellite polymorphism

Seven microsatellite markers were used to study genetic diversity of three Egyptian (Egyptian Baladi, Barki and Zaraibi) and two Italian (Maltese and Montefalcone) goat breeds. The microsatellites showed a high polymorphic information content (PIC) of more than 0.5 in most of the locus-breed combinations and indicated that the loci were useful in assessing within- and between-breed variability of domestic goat (Capra hircus). The expected heterozygosity of the breeds varied from 0.670 to 0.792. In the geographically wider distributed Egyptian Baladi breed there were indications for deviations from random breeding. Analysis of genetic distances and population structure grouped the three Egyptian goat breeds together, and separated them from the two Italian breeds. The studied Mediterranean breeds sampled from African and European populations seem to have differentiated from each other with only little genetic exchange between the geographically isolated populations.

Towards a universal dissolution medium for carbamazepine

The aim of this study was to develop a dissolution medium for assessment of various carbamazepine (CBZ) formulations with different strengths. The design of a system inhibiting transformation of the anhydrous CBZ (CBZ A) to the dihydrate form (CBZ D), with minimum surface-active properties and suitable sink was investigated. The effect of pH, different concentrations of sodium lauryl sulphate (SLS), polyvinylpyrrolidone (PVP), and methyl cellulose (MC) on dissolution rate, solubility, dissolution solubility, and polymorphic transformation of CBZ was assessed. Solution-mediated transformation of CBZ A into CBZ D was monitored using optical microscopy, Fourier transform infrared spectroscopy and differential scanning calorimetry. Results showed that different strengths (100, 200, 400 mg) of the same CBZ tablet formulation exhibited different dissolution patterns, in 1% SLS (USP system). Such differences were reduced in 0.5% SLS solution which provided sufficient sink for up to 200 mg CBZ. It was also shown that solubility of CBZ A could not be detected in the media under study (water, SGF, SIF, and SLS solutions) due to its rapid transformation into CBZ D. The use of 3% PVP solution protected CBZ A from conversion for 75 min, while 0.01% MC completely inhibited the transformation up to 24 h. Therefore, a medium consisting of 0.5% SLS and 0.01% MC was selected. The medium provided: a) protection against transformation of CBZ A to CBZ D, b) increased solubility of CBZ A (204 mg % compared to 128 mg % of CBZ D in 0.5% SLS), c) suitable sink for up to 400 mg CBZ and d) overlapping dissolution profiles of various strengths of the same CBZ formulation. The suggested system may be a step in the way of solving CBZ dissolution problems that forced the USP to specify two similar dissolution tests with two different limits for conventional 200 mg CBZ tablets.

Study of In‐Vitro Release Characteristics of Carbamazepine Extended Release Semisolid Matrix Filled Capsules Based on Gelucires

Various extended release carbamazepine (CBZ) formulations have been developed previously, in order to reduce the frequency of dosing in chronic therapy and to decrease the variability in drug plasma concentration. In the present study, the suitability of different grades of Gelucires (G, glyceride based excipients) to formulate CBZ extended release capsules by the application of semisolid matrix (SSM) filling capsule technology was investigated. The possible modification of CBZ release kinetics by using Gelucire blends or inclusion of hydrophilic additives in the SSM was studied. The effect of ageing on some selected formulations was also evaluated, using scanning electron microscopy and differential thermal analysis. Twenty-one capsule formulations were prepared and assessed for their release characteristics. The mechanism of drug release from the test formulations was studied. The following results were obtained: a) Release data could not be correlated to the melting point (mp) of Gelucires used, pointing to relative lipophilicity of the base as a more important determinant of drug release. Among Gelucire grades having melting points higher than 37 degrees C, the release rate proved to be highly dependent on the HLB value and matrix composition. b) CBZ release occurred by different mechanisms, including matrix disintegration, diffusion and or erosion depending on the vehicle employed. c) Zero order release profiles of CBZ were obtained from SSM-based on G50/13, G53/10 and their blends in ratios higher than 1:1 and G53/10 containing croscarmellose sodium. d) The ageing study revealed that these latter formulations, except those based on G50/13, also showed high dissolution stability during one year of shelf ageing. e) PVP, as a polymorphic transformation inhibitor, can be used to reduce the storage-induced changes of some grades of Gelucires. From the above data, it can be concluded that different grades of Gelucires and their blends as well as hydrophilic additives could be successfully used to formulate CBZ extended release SSM filled capsules with various release kinetics.

Semisolid matrix filled capsules: an approach to improve dissolution stability of phenytoin sodium formulation

Seven semisolid fill bases were selected for the formulation of 24 capsule formulations, each containing 100 mg of phenytoin sodium. The fill materials were selected based on the water absorption capacity of their mixtures with phenytoin sodium. The fill matrices included lipophilic bases (castor oil, soya oil, and Gelucire (G) 33/01), amphiphilic bases (G 44/14 and Suppocire BP), and water-soluble bases (PEG 4000 and PEG 6000). The drug:base ratio was 1:2. Excipients such as lecithin, docusate sodium, and poloxamer 188 were added to some formulations. The dissolution rate study indicated that formulations containing lipophilic and amphiphilic bases showed the best release profiles. These are F4 (castor oil-1% docusate sodium); F10 (castor oil-3% poloxamer 188); F14 (G33/01-10% lecithin); F17 (G33/01-1% docusate sodium), and F20 (Suppocire BP). Further, the dissolution stability of the five formulations above was assessed by an accelerated stability study at 30 degrees C and 75% RH using standard Epanutin capsules for comparison. The study included the test and standard capsules either packed in the container of marketed Epanutin capsules (packed) or removed from their outer pack (unpacked). Release data indicated superior release rates of castor oil based formulations (F4 and F10) relative to standard capsules in both the unpacked and packed forms. For instance, the extent of drug release at 30 min after 1 month was 91% for F4 and F10 and 20% for standard capsules. Drug release from packed capsules after 6 months storage was 88% for both formulations F4 and F10 and 35% for standard capsules. In conclusion, the pharmaceutical quality of phenytoin sodium capsules can be improved by using a semisolid lipophilic matrix filled in hard gelatin capsules.

Infections in children under 5 years old and latrine cleanliness

The aim of this study is to assess the cleanliness of the latrine and its relation to occurrence of disease in children under 5 years old. A stratified random sample of 1327 households was conducted in 11 villages in Upper Egypt. It included a sub-sample of 541 children under 5 years living in households with latrines. The latrine cleanliness was assessed and its relationship to disease occurrence within a period of 2 weeks. Thirty-three percent (33.1%) of children under 5 years old with latrines in their household had infections, compared to 28.3% of those without latrines in the house. Infection with diarrhoea was found most in houses with latrine and water tap. A relation was found between latrine cleanliness score and presence of flies, house building material and maternal education, but none with occurrence of infection in children under 5 years old within a period of 2 weeks.

Study of serum copper and zinc in cases of hyperemesis gravidarum

The dehydration, electrolyte and metabolic changes which occur in hyperemesis gravidarum are well recognized. The aim of this paper was to study the changes in serum copper and zinc and their correlation with the changes in serum electrolytes that occur in patients with hyperemesis gravidarum. Serum copper, zinc, sodium and potassium and urinary chloride were measured in 30 patients suffering from hyperemesis gravidarum and compared to the levels in 10 normal pregnant women in their first trimester. There was no significant change in serum copper or zinc in patients with hyperemesis compared to normal pregnant women. Also, there was no significant correlation between the changes in the level of these trace elements and the decrease which occurred in serum sodium and potassium and urinary chloride.

Effect of aspirin on gastric acid secretion in the rat

The effects of aspirin on gastric acid and sodium have been studied in a perfused rat stomach preparation. In the pentagastrin-stimulated stomach, as intraluminal aspirin concentration increased, there was a significant fall in acid output together with a significant decrease in the loss of sodium from the gastric lumen. It was concluded that these observations were due to a back-diffusion effect resulting from disruption of the gastric mucosal barrier rather than parietal cell inhibition