HbA1c as a marker to reduce lower limb amputation in patients with type 2 diabetes mellitus

Background: Diabetes mellitus is one of the most serious and prevalent chronic diseases worldwide. One of the most common complications of diabetes in the lower extremity is the diabetic foot ulcer which is the precursor to ~85% of lower extremity amputations in persons with diabetes. Materials and Subjects: This is a case- control study which was carried out at Jabir Abu-Aliz Specialized Center, Khartoum State, Sudan between October 2006 and April 2007. Forty type 2 diabetes cases with septic foot (group 1 cases), 40 type 2 diabetes cases without septic foot (group 2 cases), and 40 healthy controls participated in this study. Their demographic data were collected. Serum HbA1c levels were estimated by affinity chromatography method. Results: The level of HbA1c was 9.947±1.40%, 7.908±0.45% and 6.462±0.07%. in group 1, group 2, and the healthy control respectively. There was significant increase in percentage level of HbA1c in group 1 cases compared to group 2 cases and healthy control (p = 0.002, 0.001 respectively). We found very low correlation between fasting blood sugar and HbA1c in group 1 cases (r = + 0.331; p=0.042). Conclusion: This study indicates that the progression to the complication of foot ulcer in type 2 diabetic patients was correlated to the level of HbAlc. These data may suggest a beneficial effect of considering measurement of HbA1c as a routine test especially for elderly diabetic patients with diabetes for long period. This may help to maintain blood glucose levels in the normal or near normal range and to provide an opportunity for patients to live out their normal life expectancies with minimal complications. Keywords: glycohemoglobin, neuropathy, septic foot, glycemic control.Sudan Journal of Medical Sciences Vol. 3 (3) 2008: pp. 227-23

Genetic analysis of some Egyptian rice genotypes using RAPD, SSR and AFLP

nformation of genetic similarities and diversity among superior Egyptian rice genotypes is necessary for future rice breeding programs and derivation of plant lines. Genetic variability and relationships among seven Egyptian rice genotypes namely Giza 178, Giza177, Giza 175, Giza171 Giza 172, Sakha 102, and Sakha 101 were established by using eight RAPD primers, six SSR primer pairs, eight AFLP primer combinations. The level of polymorphism as revealed by RAPD, SSR and AFLP was 72.2, 90, and 67.9%, respectively. The highest genetic relationship as revealed by combined RAPD, SSR, and AFLP was detected between Giza 175 and Giza177 (83.4%), while the lowest similarity was found between Giza 178 and Sakha 101 (61.5%). Dendrograms derived from different techniques include minor differences inclustering pattern but did not affect the main grouping of the different genotypes. Moreover RAPD, SSR and AFLP-based dendrograms clustered the two genotypes Giza171 and Giza 172 together and the two genotypes Giza 175 and Giza 177 in the same cluster. RAPD, SSR, and AFLP techniques characterized the seven rice varieties by a large number of unique markers, which revealed 17, 4, and 65 unique markers, respectively. It could be concluded that each type of the three molecular approaches of DNA analysis could identify the different rice genotypes, and some of the Egyptian rice genotypes under investigation have probably originated from closely related ancestors and possess high degree of genetic similarity

Study of the physico-chemical and bacteriological quality of water intended for consumption in the town of Gagal, southwestern Chad

The city of Gagal suffers from insufficient drinking water, and the population turns to surface water, wells and drillings without guarantee of quality. In order to characterize the hydrogeochemical and bacteriological properties of the waters of the aquifer system in the city of Gagal, to contribute to improving its knowledge, field campaigns were undertaken to sample the groundwater.The present study focuses on the hydrogeochemical and bacteriological characterization of drinking water in Gagal, southwestern Chad. The methodology consisted of acquiring existing data, a field campaign, and a chemical and bacteriological analysis of the water in the laboratory. The results of the physicochemical analyses revealed that the values of the parameters such as conductivity, pH (5.23), Ca²⁺ (26.11 mg/L), Mg²⁺(5.14 mg/L), Na⁺(3.54 mg/L), K⁺(1.34 mg/L), HCO3-(81.74 mg/L), Cl-(11.77 mg/L), SO4-(1.94 mg/L), and NO3- (8.70 mg/L) conformed to the WHO potability standards. Piper's diagram showed calcic and magnesian bicarbonate facies represented by 75%; and calcic and magnesian sulfate chloride facies in 25% of the analyzed waters. The bacteriological (Total coliforms (0 to more than 135,200 CFU/100 ml), Escherichia coli (0 and 14,400 CFU/100 ml), faecal enterococci (0 and 4600 CFU/100 ml)) study confirmed that the water from the wells and boreholes showed pollution of bacterial origin. Using these waters may endanger the populations with the risks of hydric diseases

Predictive values of ultrasound-based scoring system in morbidly adherent placenta for high risk group

Background: The objective of the present study was to find out the predictive values of an ultrasound-based scoring system in diagnosis of morbidly adherent placenta (MAP) for high risk group. Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt.Methods: 63 full term pregnant women (≥37 weeks of gestation) with high risk of morbidly adherent placenta underwent elective cesarean section. Placental assessment by 2 D ultrasound based on ultrasound scoring system in morbidly adherent placenta, these data were recorded for further comparison with intraoperative data for degree of placental adherence.Results: Incidence of MAP was 7.93% (4.76% had a focal form and 3.17% had a complete form of accreta). As regarding to scoring system, 82.5 of cases had a low risk (< 5), 9.5% had a moderate risk (6-7) and 7.93% had a high risk (8-12) of development of morbidly adherent placenta with p value <0.0001. The sensitivity, specificity, positive and negative predictive values of the US scoring system for morbidly adherent placenta were (92.3%, 94.1%, 87.453% and 98.2%) respectively.Conclusions: Ultrasound based scoring system had a high predictive value (sensitivity, specificity, positive and negative predictive values) in diagnosis of morbidly adherent placenta for pregnant women have any risk factors for developing MAP

Prevalence of Helicobacter Pylori Infection in Pregnant Women with Hyperemesis Gravidarum

Background: Hyperemesis gravidarum (HG) is a severe form of vomiting that occurs in 0.3-2% of all pregnant women. There is geographic difference in the prevalence of Helicobacter Pylori (H. Pylori). The exact prevalence in Egypt is not well-studied. Objectives: To detect prevalence and risk factors for H. Pylori in pregnant women with HG. Patients and Methods: This was a cross-sectional study. The study was conducted at the Department of Obstetrics and Gynecology, South Valley University hospitals. Results: The study included 100 pregnant women with HG.In this study, the H. Pylori stool antigen testing was positive in 44 cases out of 100 cases, making a prevalence of 44%. Risk factors of H. Pylori was rural residence (adjusted OR: 3.45; CI:1.12-10.94; and P value: 0.03), recurrence of vomiting in the current pregnancy (adjusted OR was 3.85; CI:1.15-12.91; and P value: 0.03), and anemia (adjusted OR: 0.74; CI: 0.55-0.98; and P value: 0.04) Conclusion: H. Pylori affects 44% of women with HG. There was significant association between H. pylori and the rural residence, the recurrence of vomiting in the same pregnancy, and the presence of anemia

The type VII secretion system of <i>Staphylococcus aureus</i> secretes a nuclease toxin that targets competitor bacteria

The type VII protein secretion system (T7SS) plays a critical role in the virulence of human pathogens including Mycobacterium tuberculosis and Staphylococcus aureus. Here we report that the S. aureus T7SS secretes a large nuclease toxin, EsaD. The toxic activity of EsaD is neutralised during its biosynthesis through complex formation with an antitoxin, EsaG, which binds to its C-terminal nuclease domain. The secretion of EsaD is dependent upon a further accessory protein, EsaE, that does not interact with the nuclease domain, but instead binds to the EsaD N-terminal region. EsaE has a dual cytoplasmic/membrane localization and membrane-bound EsaE interacts with the T7SS secretion ATPase, EssC, implicating EsaE in targeting the EsaDG complex to the secretion apparatus. EsaD and EsaE are co-secreted whereas EsaG is found only in the cytoplasm and may be stripped off during the secretion process. Strain variants of S. aureus that lack esaD encode at least two copies of EsaG-like proteins most likely to protect themselves from the toxic activity of EsaD secreted by esaD(+) strains. In support of this, a strain overproducing EsaD elicits significant growth inhibition against a sensitive strain. We conclude that T7SSs may play unexpected and key roles in bacterial competitiveness

Phagosomal Rupture by Mycobacterium tuberculosis Results in Toxicity and Host Cell Death

Survival within macrophages is a central feature of Mycobacterium tuberculosis pathogenesis. Despite significant advances in identifying new immunological parameters associated with mycobacterial disease, some basic questions on the intracellular fate of the causative agent of human tuberculosis in antigen-presenting cells are still under debate. To get novel insights into this matter, we used a single-cell fluorescence resonance energy transfer (FRET)-based method to investigate the potential cytosolic access of M. tuberculosis and the resulting cellular consequences in an unbiased, quantitative way. Analysis of thousands of THP-1 macrophages infected with selected wild-type or mutant strains of the M. tuberculosis complex unambiguously showed that M. tuberculosis induced a change in the FRET signal after 3 to 4 days of infection, indicating phagolysosomal rupture and cytosolic access. These effects were not seen for the strains M. tuberculosisΔRD1 or BCG, both lacking the ESX-1 secreted protein ESAT-6, which reportedly shows membrane-lysing properties. Complementation of these strains with the ESX-1 secretion system of M. tuberculosis restored the ability to cause phagolysosomal rupture. In addition, control experiments with the fish pathogen Mycobacterium marinum showed phagolysosomal translocation only for ESX-1 intact strains, further validating our experimental approach. Most importantly, for M. tuberculosis as well as for M. marinum we observed that phagolysosomal rupture was followed by necrotic cell death of the infected macrophages, whereas ESX-1 deletion- or truncation-mutants that remained enclosed within phagolysosomal compartments did not induce such cytotoxicity. Hence, we provide a novel mechanism how ESX-1 competent, virulent M. tuberculosis and M. marinum strains induce host cell death and thereby escape innate host defenses and favor their spread to new cells. In this respect, our results also open new research directions in relation with the extracellular localization of M. tuberculosis inside necrotic lesions that can now be tackled from a completely new perspective

A two-step strategy for the complementation of M. tuberculosis mutants

The sequence of Mycobacterium tuberculosis, completed in 1998, facilitated both the development of genomic tools, and the creation of a number of mycobacterial mutants. These mutants have a wide range of phenotypes, from attenuated to hypervirulent strains. These phenotypes must be confirmed, to rule out possible secondary mutations that may arise during the generation of mutant strains. This may occur during the amplification of target genes or during the generation of the mutation, thus constructing a complementation strain, which expresses the wild-type copy of the gene in the mutant strain, becomes necessary. In this study we have introduced a two-step strategy to construct complementation strains using the Ag85 promoter. We have constitutively expressed dosR and have shown dosR expression is restored to wild-type level

Specificity of a whole blood IGRA in German nursing students

<p>Abstract</p> <p>Background</p> <p>Interferon-gamma release assays (IGRA) are used for tuberculosis (TB) screening in healthcare workers (HCWs). However, data on specificity of IGRA in serial testing of HCWs is sparse. Therefore the specificity and the negative predictive value of the IGRA - QuantiFERON-TB Gold In-Tube (QFT) - in German nursing students was investigated.</p> <p>Methods</p> <p>194 nursing students at the start of their professional career were tested with the QFT. 14 nursing students were excluded from the specificity analysis, due to exposure to mycobacterium tuberculosis. Two of these subjects were QFT- positive. None of them developed disease during the year of follow-up. A study group of 180 students, all with very low risk of prior TB infection, remained in the specificity analysis. Subjects were monitored for at least two years with respect to the development of active TB disease. IGRA was performed at the start of the training and after one year.</p> <p>Results</p> <p>The mean age of the study group (n = 180) was 23 years (range 18-53) with 70.9% female and 99.4% German born. The specificity of QFT was 98.9% (178/180; 95% CI 0.96-0.99); lowering the cut-off from 0.35 IU/ml to 0.1 IU/ml would have decreased specificity only slightly to 97.8% (176/180; 95% CI 0.94-0.99). Of the 154 nursing students available for re-testing, one student who initially scored positive reverted to negative, and one student initially negative converted to positive. None of the monitored group with initially negative QFT results developed TB disease, indicating a high negative predictive value of the IGRA in this population.</p> <p>Conclusions</p> <p>Following our data, QFT can serve as an effective tool in pre-employment TB screenings for HCWs. As its negative results were stable over time, specificity of the QFT in serial testing of HCWs is high. As the risk of acquiring TB infection in the German healthcare system appears to be low, our data supports the recommendation of performing TB screening only in those HCWs with known contact to TB patients or infectious materials.</p