Path dependence and universal health coverage: The case of Egypt

Universal health coverage (UHC) is the big objective in health policy which several countries are seeking to achieve. Egypt is no different and its endeavors to attain UHC have been going on since the 1960s. This article discusses the status of UHC in Egypt using theories of political science and economics by analyzing the historical transformations in the Egyptian health system and its institutional settings. This article then specifically examines the path dependence theory against the sociopolitical background of Egypt and assesses any pattern between the theory and the current UHC status in Egypt. The important finding of this analysis is that the health policies and reforms in Egypt have been significantly influenced and limited by its historical institutional structure and development. Both the health policies and the institutional settings adopted a dependent path that limited Egypt’s endeavors to achieve the universal coverage. This dependent path also yielded many of the present-day challenges as in the weaknesses of the healthcare financing system and the inability to extend health coverage to the poor and the informal sector. These challenges subsequently had a negative impact on the accessibility of the healthcare services

Impetigo herpetiformis during the puerperium triggered by secondary hypoparathyroidism: a case report

A 38-year-old multiparous woman with post thyroidectomy hypoparathyroidism developed pruritic erythematous patches with multiple pustules on its margins on her thighs and groin accompanied by fever few days after delivery by caesarean section. Impetigo herpetiformis was diagnosed based on the typical clinicopathological findings. The patient was treated with intravenous fluids, calcium, Calcitrol and corticosteroids. The correction of hypocalcaemia was accompanied with rapid improvement of her skin disease and general condition. Our case is the fourth case of impetigo herpetiformis initially presented during puerperium and the first case of puerperal impetigo herpetiformis that is precipitated by secondary hypoparathyroidism. The awareness of the possible occurrence of impetigo herpetiformis during the puerperium allows early diagnosis, treatment and prevention of maternal complications

Hyperechogenic renal parenchyma in potential live related kidney donors: Does it justify exclusion?

The aim of this work is to asses theimportance of ultrasonic grade I echogenicity inpotential kidney donors in the absence of urinaryabnormality and with perfect renal function.Thirty four living related kidney donors with thisabnormality were included, age range between 23-48years. Ten matched healthy donors were studied ascontrols.All cases were thoroughly investigated includingmeasuring GFR by isotopic scan and estimation ofrenal reserve by dopamine and aminoacid infusion.Renal biopsy was done for 17 cases of theechogenicity group and 8 controls. Our resultsshowed that the renal reserve was comparable in bothgroups. Glomerular changes were found in 41% ofapparently normal donors and only one case ofcontrols.Conclusion: Grade I echogenicity may be sign ofunrecognised kidney disease. Renal biopsy ismandatory when such related donors are the onlyavailable

Avascular bone necrosis of the femoral head after renal transplantation: Is it avoidable?

Background: Avascular osteonecrosis (AVN) is a seriousosseous complication after renal transplantation (RT). Itsprevalence clearly decreased from 20% to 4% possiblydue to the use of calcinurin inhibitors (CNI), reduction ofsteroid doses and use of steroid free regimens. The aimof our study was to evaluate the frequency of AVNamong our kidney transplant recipients and to determinethe risk factors for its occurrence.Patients and methods: Among 1785 kidney transplantrecipients who received renal allografts between March1976 and December 2005, 40 patients (2.24%) developedAVN with a mean age of 31.3 10.2 years. Eightykidney transplant recipients without AVN were selectedto be a matched control group. The localization of AVNwas the femoral head in all cases.Results: AVN was diagnosed at a mean of 20.4 monthsafter transplantation. The following risk factors werestatistically significant; sirolimus-based regimen,hypercholesterolemia, overweight with body mass index(BMI)>26 and those with HLA A9, HLA B35 and DRB15.Conclusions: We concluded that the proper managementof hypercholesterolemia, maintenance of ideal bodyweight as well as avoidance of sirolimus-basedimmunosuppressive regimen in genetically predisposedpatients may be an effective preventive strategy to avoidAVN

Induction of antibacterial metabolites by co-cultivation of two Red-Sea-sponge-associated actinomycetes <i>Micromonospora</i> sp. UR56 and <i>Actinokinespora</i> sp. EG49

Liquid chromatography coupled with high resolution mass spectrometry (LC-HRESMS)-assisted metabolomic profiling of two sponge-associated actinomycetes, Micromonospora sp. UR56 and Actinokineospora sp. EG49, revealed that the co-culture of these two actinomycetes induced the accumulation of metabolites that were not traced in their axenic cultures. Dereplication suggested that phenazine-derived compounds were the main induced metabolites. Hence, following large-scale co-fermentation, the major induced metabolites were isolated and structurally characterized as the already known dimethyl phenazine-1,6-dicarboxylate (1), phenazine-1,6-dicarboxylic acid mono methyl ester (phencomycin; 2), phenazine-1-carboxylic acid (tubermycin; 3), N-(2-hydroxyphenyl)-acetamide (9), and p-anisamide (10). Subsequently, the antibacterial, antibiofilm, and cytotoxic properties of these metabolites (1&ndash;3, 9, and 10) were determined in vitro. All the tested compounds except 9 showed high to moderate antibacterial and antibiofilm activities, whereas their cytotoxic effects were modest. Testing against Staphylococcus DNA gyrase-B and pyruvate kinase as possible molecular targets together with binding mode studies showed that compounds 1&ndash;3 could exert their bacterial inhibitory activities through the inhibition of both enzymes. Moreover, their structural differences, particularly the substitution at C-1 and C-6, played a crucial role in the determination of their inhibitory spectra and potency. In conclusion, the present study highlighted that microbial co-cultivation is an efficient tool for the discovery of new antimicrobial candidates and indicated phenazines as potential lead compounds for further development as antibiotic scaffold

The genus <i>Micromonospora</i> as a model microorganism for bioactive natural product discovery

This review covers the development of the genus Micromonospora as a model for natural product research and the timeline of discovery progress from the classical bioassay-guided approaches through the application of genome mining and genetic engineering techniques that target specific products. It focuses on the reported chemical structures along with their biological activities and the synthetic and biosynthetic studies they have inspired. This survey summarizes the extraordinary biosynthetic diversity that can emerge from a widely distributed actinomycete genus and supports future efforts to explore under-explored species in the search for novel natural products