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In addition to being a good food source, freshwater snails are considered one of the positively and negatively influencing invertebrates on the environment. Several biotic and abiotic factors are thought to affect the distribution and the dynamics of these snails. Freshwater snails are the most dominant and conspicuous individuals of the freshwater biota in Damietta Governorate. In this study, freshwater snails were collected monthly from 5 geographically and environmentally different sites at Damietta Governorate at the north of Egypt during June 2017-May 2018. Seven snail species; Lanistes carinatus, Lanistes varicus, Pila wernei, Segmentorbis angustus, Melanoides tuberculata, Biomphalaria alexandrina, and Gabbiella senoriansis, were identified. Lanistes carinatus was the most abundant species (56.4%) in the collection sites. Besides, Al-Inaniyyah village had the highest snail species abundance and variety. The abundance of the most recorded species varied seasonally; the highest abundance was recorded during summer while the lowest was during winter. The abundance of some snail species correlated positively or negatively with some physico-chemical parameters; water temperature, dissolved oxygen, conductivity, total dissolved salts, and electrical conductivity. Two types of trematode cercariae; gymnocephalus cercariae and xiphidiocercariae, were harvested from Lanistes carinatus. The highest prevalence of both cercarial types was detected during summer. The correlation between the prevalence of both cercarial types and the physico-chemical parameters were determined. Xiphidiocercariae were the most predominant cercarial type in Damietta Governorate. Our findings suggest that the invasion of some freshwater snails is likely to be the cause of the low prevalence or complete absence of some medically important intermediate snail hosts. We recommend further characterization of the distribution of freshwater snails and the interrelationships among them in Egypt, and suggest a controlled use of selected snail species to combat their medically important analogues.

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BACKGROUND: Preoperative dexmedetomidine administration blunts haemodynamic and hormonal responses to tracheal intubation and reduces anaesthetic requirements. We hypothesized that dexmedetomidine would reduce the maternal haemodynamic and hormonal responses to elective caesarean delivery without harmful neonatal effects. METHODS: After ethical approval, 68 parturients scheduled for elective caesarean delivery under general anaesthesia were randomly allocated to receive either placebo, or 0.2, 0.4 or 0.6 µg/kg/h intravenous dexmedetomidine (n=17 per group) 20 min before induction. Anaesthesia was induced using a rapid-sequence technique with propofol and suxamethonium, and was maintained with 0.5-0.75 minimum alveolar concentration sevoflurane. Changes in maternal heart rate, mean blood pressure, minimum alveolar concentration sevoflurane, uterine tone, serum cortisol level, and Apgar scores, Neurologic Adaptive Capacity Scores and acid-base status were recorded. RESULTS: After induction, patients receiving dexmedetomidine had smaller increases in heart rate (P<0.001) than those in the placebo group. Patients who received 0.4 and 0.6 µg/kg/h infusions of dexmedetomidine showed slower heart rates (-21.5% and -36%, respectively; P<0.001), lower mean blood pressures (-17% and -25%, respectively; P<0.001), sevoflurane minimum alveolar concentrations (-40% and -44.5%, respectively; P<0.001) and serum cortisol levels (-27% and -34.6%, respectively; P<0.001) and higher sedation scores for the first 15 min after extubation and greater uterine tone (P<0.002). Apgar scores, NACS and acid-base status were similar in the four groups. CONCLUSION: Preoperative administration of dexmedetomidine 0.4 and 0.6 µg/kg/h is effective in attenuating the maternal haemodynamic and hormonal responses to caesarean delivery under sevoflurane anaesthesia without adverse neonatal effects.

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OBJECTIVES: Proton-pump inhibitors are often recommended in the treatment of laryngitis secondary to gastric reflux. Despite prospective treatment studies reporting high efficacy, only one previous report has been placebo-controlled and blinded. The objective of this study was to determine the efficacy of omeprazole in treating proven reflux laryngitis. STUDY DESIGN: Prospective, placebo-controlled, randomized, double-blind clinical trial. METHODS: Fifty-three patients with one or more reflux laryngitis symptoms were recruited to undergo 24-hour dual-channel pH probe testing. Thirty patients with more than four episodes of laryngopharyngeal reflux were enrolled. By random assignment, 15 patients received 40 mg omeprazole twice a day and the other 15 received placebo for a period of 2 months. Symptoms (hoarseness, throat pain, lump in throat sensation, throat clearing, cough, excessive phlegm, dysphagia, odynophagia, and heartburn) and endoscopic laryngeal signs (erythema, edema, and mucus accumulation) were recorded initially, at 1 month, and 2 months. RESULTS: In general, most symptom scores improved over time for both the omeprazole and placebo groups. Hoarseness, when patients begin with low hoarseness symptom scores, and throat clearing improved significantly more in patients on omeprazole than in those on placebo during the 2-month study. Throat pain, lump in throat sensation, excessive phlegm, difficulty swallowing, pain with swallowing, and heartburn showed improvement in both treatment arms, signifying the possibility of a placebo effect. Endoscopic laryngeal signs did not change significantly over the course of the study for either treatment group. CONCLUSIONS: A placebo effect appears to exist in the treatment of reflux laryngitis. However, hoarseness, when initially scored low, and throat clearing resulting from reflux laryngitis are effectively treated by omeprazole.

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The aims of this study were to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in the United Arab Emirates (UAE), to describe the different mutations in the population, to determine its prevalence, and to study inheritance patterns in families of G6PD-deficient individuals. All infants born at Tawam Hospital, Al-Ain, UAE from January 1994 to September 1996 were screened at birth for their G6PD status. In addition, those attending well-baby clinics during the period were also screened for the disorder. Families of 40 known G6PD-deficient individuals, selected randomly from the records of three hospitals in the country, were assessed for G6PD deficiency. Where appropriate, this was followed by definition of G6PD mutations. Of 8198 infants, 746 (9.1%), comprising 15% of males and 5% of females tested, were found to be G6PD deficient. A total of 27 families were further assessed: of these, all but one family had the nt563 Mediterranean mutation. In one family, two individuals had the nt202 African mutation. The high manifestation of G6PD deficiency in women may be due to the preferential expression of the G6PD-deficient gene and X-inactivation of the normal gene, and/or to the presence of an 'enhancer' gene that makes the expression of the G6PD deficiency more likely. The high level of consanguinity which, theoretically, should result in a high proportion of homozygotes and consequently a higher proportion of females with the deficiency, was not found to be a significant factor.

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Observations and analysis of glottal characteristics are critical in choosing the best modality for surgery in patients with unilateral vocal fold paralysis (UVP). This study suggests that multiple glottal characteristics influence the vocal product in patients with UVP. In addition to the horizontal position of the paralyzed vocal fold (deviation from the midline), the glottal area, degree of bowing of the paralyzed and contralateral vocal folds, maximum separation between vocal folds, compensatory glottal maneuvers, and the vertical glottic closure plane significantly influenced the quality of the voice. Clinicians should be aware of these observations to facilitate treatment planning and assessment of the results of surgical procedures used to improve voice quality in cases of UVP.

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The term sulcus vocalis has been applied to a spectrum of disorders ranging from minor vocal fold indentations to destructive lesions causing severe dysphonia. To clarify the pathophysiology and to develop a more rational approach to treatment, we report a series of sulcus patients including 20 surgical cases. Clinical and histopathologic analysis produced a clinically useful classification: type 1 is a physiologic variant accentuated by atrophy but with intact lamina propria; types 2 (sulcus vergeture) and 3 (sulcus vocalis) are characterized by severe dysphonia, loss of vibratory activity, and destruction of the functional superficial lamina propria. These latter cases respond favorably to microsurgery designed to remove destroyed tissue, release scar contracture, and promote mucosal redraping by regional undermining. Further study of the extracellular matrix of the superficial lamina propria (Reinke's space) might indicate a common pathway in the pathogenesis of sulcus deformities and other related benign vocal fold lesions.

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A male child with cherubism, visual impairment due to optic atrophy and short stature is described. This association has not been reported previously.

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The purpose of this paper is to present a protocol for the use of standard forms in the evaluation of laryngeal structure and function in patients with voice disorders. The forms are designed to cover all the essential parameters needed to reach an accurate descriptive diagnosis which allows us to have an appropriate therapy plan according to the individual's detailed observations. It also gives us a consistent standardized evaluation form to measure changes after therapy whether behavioral, medical or surgical, and to compare different observations across patients. Reporting observations in this consistent manner will make characteristic patterns of different vocal behaviors readily obvious to the researcher or the clinician and reduce the possibility of missing any important details. The protocols are: indirect laryngoscopy, video-stroboscopic-evaluation form, functional voice and auditory perceptual voice evaluation.

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The tegument of the ancyrocephaline monogenean gill parasite Cichlidogyrus halli typicus is basically similar to that of other monogeneans. However, there are some tegumental features shared with relatively few other monogeneans, namely the presence in the surface tegument of extensive regions of homogeneous granular cytoplasm, a close association between myofibres and the basal region of the tegument and the production of two different tegumental secretory bodies by the same cyton. It is suggested that the regions of homogeneous granular cytoplasm found in the troughs between the circular muscle fibres provide some kind of support for the tegument, perhaps related to contraction of the tegumental circular muscle fibres and body shape changes. Three kinds of transtegumental sensory structures are recognized, namely a uniciliated bulb, a bulb bearing a non-ciliary process and a non-ciliated bulb. The latter two kinds are reported for the first time in monogenans. Possible functions of these sensory structures are discussed.

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In a 1-year seasonal study of the numbers of the stomach-inhabiting monogenean Enterogyrus cichlidarum in Tilapia nilotica in the River Nile, Egypt, prevalence and intensity reached a height in spring and infection levels were surprisingly high in winter. T. zillii harboured fewer parasites but seasonal changes were similar. No parasites were found in T. galilaea. The prevalence and intensity of the infection with E. cichlidarum rose significantly with increasing size of the host. Some of the possible reasons for these fluctuations are discussed. Immature enterogyrids were more abundant in the posterior sector of the stomach and adult enterogyrids showed a preference for the anterior sector. No significant difference was found in the numbers of enterogyrids in male and female hosts.

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