History Of Schistosomiasis Research Articles

Expression profiles of circulatingmicroRNAs in newly-developed advanced schistosomiasis patients

To study the expression profiles of circulating microRNAs (miRNAs) in newly-developed advanced schistosomiasis patients. Ten healthy controls (Group 1), ten patients with schistosomiasis history (without advanced schistosomiasis, Group 2) and ten patients with newly-developed advanced schistosomiasis (Group 3) were randomly selected from Jiangsu Province. The expression profiles of 570 human related circulatingmiRNAs were measured and analyzed with the Agilent Human microRNAs microarray Rel 12.0. Compared to the healthy controls, four miRNAs were up-regulated, while 16 miRNAs were down-regulated in the patients with newly-developed advanced schistosomiasis. Moreover, six miRNAs were up-regulated, while 21 miRNAs were down-regulated in the patients in Group 2. Among of them, the expression level of miR-383 was significantly decreased by 4.23 and 11.82 folds in Group 2 and Group 3, respectively. There are significant differences among the healthy controls, patients with schistosomiasis history (without advanced schistosomiasis) and the patients with newly-developed advanced schistosomiasisin the expression profiles of circulatingmiRNAs. Moreover, circulating miR-383 might be involved in the development of newly-developed advanced schistosomiasis.

Pathological Pattern of Urinary Bladder Cancer: Data from a Single Egyptian Institute

Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence and histopathology of urinary bladder cancer.Aim: To investigate the histological pattern among patients treated for bladder cancer at our institution over a 5-year period.Methods: This retrospective study was conducted by reviewing the medical records of 632 patients treated for urinary bladder cancer at the departments of Urology and Clinical Oncology, Al Azhar Faculty of Medicine, between January 2011 and December 2015.Results: The study included 632 patients. Their age ranged from 27-87 years old with a median of 62 years. Male to female ratio was about 6:1. Fifty-nine percent of the patients had Non-Muscle Invasive Bladder Cancer (NMIBC) versus 41% had Muscle Invasive Bladder Cancer (MIBC). Patients with history of schistosomiasis were 46.5%; besides, 67.9% of the patients were smokers. Transitional Cell Carcinoma (TCC) was the predominant histological type (87.5%), followed by Squamous Cell Carcinoma (SCC) 9.1%, mixed SCC and TCC (2.8%), and other subtypes 0.6%.Conclusion: Our study confirms that the histopathological pattern of urinary bladder cancer in Egypt is still changing. Over the last decades, the incidence of bladder SCC is declining and bladder TCC is rising. Yet the incidence of bladder SCC is the lowest compared to previous reports.

Schistosoma mansoni associated glomerulopathy with IgA mesangial deposits: case report

Renal involvement is a severe form of schistosomiasis and occurs in 10% to 15% of patients with the hepatosplenic form of the disease. Nephrotic syndrome is the most common clinical presentation. It is a complication caused by immune complexes (IC), it is rare to appear in the Brazilian context with a immunoglobulin A (IgA) deposits. When installed the renal injury by Schistosoma mansoni, classically presents as membranoproliferative glomerulonephritis (mesangiocapillary) with lobular accentuation. To report a case of schistosomiasis nephropathy that appeared 7 years after treatment of hepatosplenic schistosomiasis with histologic pattern of mesangial proliferative glomerulonephritis with IgA deposits in mesangium. Clinically developed with progressive decrease of proteinuria with angiotensin receptor blocker (ARB). It was reported a case of a 36 years old patient, brown, with classical sintoms of nephrotic syndrome (proteinuria > 3.5 g/24h, hypoalbuminemia and hypercholesterolemia), however with hepatosplenic schistosomiasis history 7 years ago and portal hypertension. Patient underwent renal biopsy which showed IgA deposits in mesangial, being more intense than immunoglobulin G (IgG), accompanied by C1q and C3, with 4/13 glomeruli sclerotic, standard light mesangial glomerulonephritis renal injury with IgA deposits. Patient began taking ARB with progressive improvement in proteinuria. Patients with glomerulonephritis by schistosoma don't show improvement of disease progression with antiparasitic treatment. However the anti-proteinuric treatment can slow the progression of end stage kidney disease.

Schistosomiasis control progress and endemic situation in Sichuan Province

To understand the schistosomiasis control progress and endemic situation, so as to provide the evidence for formulating the strategy of schistosomiasis elimination in Sichuan Province. The schistosomiasis history data, working reports of schistosomiasis prevention and control, schistosomiasis surveillance data, and data of schistosomiasis prevention and control capacity were collected and analyzed for the schistosomiasis control progress and epidemic situation in Sichuan Province from 2004 to 2015. There were 63 schistosomiasis endemic districts in 11 cities in Sichuan Province, and the standard of schistosomiasis transmission interruption was achieved in the whole province in 2015. Currently, the area with Oncomelania hupensis snails was 2 537.54 hm2, and there were 1 769 advanced schistosomiasis patients. From 2004 to 2015, the accumulated survey area with snails was 433 065.80 hm2, and the area of snail control by molluscicides was 251 259 hm2. There were 26.017 144 million person-times of schistosomiasis blood tests and 7.89 million person-times of chemotherapy. There were 1.276 117 million head-times of cattle that received the schistosomiasis examinations. The schistosomiasis patients and livestock and the area with snails were decreased year by year. Since 2010, there were no local schistosome-infected residents and livestock and since 2004, there were no schistosome-infected snails. However, in some area, the professional personnel were less, the technology and hardware lagged behind, and the schistosomiasis prevention and control capacity was weak. Sichuan Province achieved the standard of schistosomiasis transmission interruption in 2015. In the future, the comprehensive schistosomiasis prevention and control strategy still should be strengthened, including the promotion of schistosomiasis prevention and control capacity, establishment of sensitive early-warning surveillance system, and implementation of accurate schistosomiasis prevention and control, in order to consolidate the control achievements and realize the aim of schistosomiasis elimination as soon as possible.

Discussion on ultrasonographic characteristics of schistosomal appendicitis lesions

To discuss the ultrasonographic characteristics of schistosomal appendicitis lesions. Among the patients with schistosomal hepatopathy who were discovered by Color Doppler ultrasound in Huzhou Central Hospital from January 2012 to December 2015, 50 cases with clear history of schistosomiasis and treatment were chosen as a schistosomal hepatopathy group, meanwhile, 50 normal people, who came from non-endemic areas, without schistosomal hepatopathy and schistosomiasis history were chosen as a control group. The two groups were examined by ultrasound scan of the appendix, and the data of the largest diameter of the appendix and the thickness of the appendix wall were collected, and the sonographic characteristics of their appendixes, such as whether the echo of the appendix wall was even or not, were observed. The minimum internal diameter of the appendix cavity and the thickness of the appendix wall of the schistosomal hepatopathy group were (2.090 ± 0.790) mm and (1.332 ± 0.313) mm, respectively, the former was significantly narrower than that of the control group, while the latter was significantly thicker than that of the control group (t = 2.647, - 4.526, respectively, both P＜0.05). The proportions of those with inhomogeneous echo, indistinctness structure, uneven thickening of the appendix wall, as well as having intestinal contents in the appendix cavity in the schistosomal hepatopathy group were higher than those in the control group (χ2 = 12.000, 18.537, 24.008, 4.244, respectively, all P＜0.05). Schistosomal appendicitis lesions have obvious ultrasonographic characteristics under ultrasound. Ultrasound can play an important role in judging whether the appendix of schistosomiasis patients is involved and discovering the lesion of appendix early.

Complete rectal prolapse in young Egyptian males: Is schistosomiasis really condemned?

AIMTo investigate the assumption that schistosomiasis is the main cause of rectal prolapse in young Egyptian males.METHODSTwenty-one male patients between ages of 18 and 50 years with complete rectal prolapse were included in the study out of a total 29 patients with rectal prolapse admitted for surgery at Colorectal Surgery Unit, Ain Shams University hospitals between the period of January 2011 and April 2014. Patients were asked to fill out a specifically designed questionnaire about duration of the prolapse, different bowel symptoms and any past or present history of schistosomiasis. Patients also underwent flexible sigmoidoscopy and four quadrant mid-rectal biopsies documenting any gross or microscopic rectal pathology. Data from questionnaire and pathology results were analyzed and patients were categorized according to their socioeconomic class.RESULTSTwelve patients (57%) never contracted schistosomiasis and were never susceptible to the disease, nine patients (43%) had history of the disease but were properly treated. None of the patients had gross rectal polyps and none of the patients had active schistosomiasis on histopathological examination. Fifteen patients (71%) had early onset prolapse that started in childhood, majority before the age of 5 years. Thirteen patients (62%) were habitual strainers, and four of them (19%) had straining dating since early childhood. Four patients (19%) stated that prolapse followed a period of straining that ranged between 8 mo and 2 years. Nine patients (43%) in the present study came from the low social class, 10 patients (48%) came from the working class and 2 patients (9%) came from the low middle social class.CONCLUSIONSchistosomiasis should not be considered the main cause of rectal prolapse among young Egyptian males. Childhood prolapse that continues through adult life is likely involved. Childhood prolapse probably results from malnutrition, recurrent parasitic infections and diarrhea that induce straining and prolapse, all are common in lower socioeconomic classes.

Validation of a Point-of-Care Circulating Cathodic Antigen Urine Cassette Test for Schistosoma mansoni Diagnosis in the Sahel, and Potential Cross-Reaction in Pregnancy.

On the shores of Lake Chad, schistosomiasis among mobile pastoralists was investigated in a field laboratory. Point-of-care circulating cathodic antigen (POC-CCA) cassette test, reagent strip, and filtration were conducted on urine samples. Fresh stool samples were subjected to the Kato-Katz technique, and fixed samples were examined with an ether-concentration method at a reference laboratory. POC-CCA urine cassette tests revealed a Schistosoma mansoni prevalence of 6.9%, compared with only 0.5% by stool microscopy. Three pregnant women with otherwise negative urine and stool testing had positive POC-CCA. This observation raises concern of cross-reactivity in pregnancy. Hence, two pregnant women in Switzerland with no history of schistosomiasis were subjected to POC-CCA and one tested positive. Our data suggest that POC-CCA can be performed under extreme Sahelian conditions (e.g., temperatures > 40°C), and it is more sensitive than stool microscopy for S. mansoni diagnosis. However, potential cross-reactivity in pregnancy needs further investigation.

A cross-sectional household cluster serosurvey of hepatitis C virus antibodies in an urban slum of Cairo, Egypt in 2004

BackgroundHepatitis C Virus (HCV) continues to be a burden to the Egyptian population and its economy. Despite all efforts, the prevalence of infection continues to be one of the highest in the world. The high national prevalence has been attributed to unintentional, nosocomial spread during an anti-schistosomiasis campaign conducted in the 1970’s, but that does not fully explain the persistent infection rates. Work is needed to further clarify risk associations. A serosurvey was performed in Manshiet Nasser, a slum in Cairo sometimes referred to as Mokattem Hills where a primary occupation is garbage collection and sorting, to characterize potential risk factors for infection.MethodsFollowing a detailed mapping and census of the area, a cluster sampling was performed and demographic and risk behavior data and a blood sample were collected from subjects older than 6 months. Blood samples were tested using 4th generation anti-HCV EIA kit.ResultsThe slum was estimated to house 45,000 residents. Blood samples were obtained from 2169 subjects. The age adjusted anti-HCV seroprevalence was 9.1 %. Participants with HCV antibodies were more likely to be male, heads of households, subjects without formal education, and those with a lower standard of living. After adjustment of all prevalence ratios (aPR) for age, the following risk factors were significantly associated with higher risk of HCV infection: Garbage collection (aPR 1.5), history of blood transfusion (aPR 2.0), tattooing (aPR 1.4), history of schistosomiasis (aPR 1.5), and use of traditional latrines (aPR 2.0) or pits for sanitation (aPR 1.3). The results of the multivariate analysis indicated that age (p < 0.01), history of schistosomiasis (p < 0.05), garbage sorting (p = 0.05), blood transfusions (<0.001), and the use of traditional latrines for sanitation (p < 0.01) were significantly associated with infection.ConclusionWhile HCV prevalence among those over 30 could be attributed to anti-schistosomiasis injections, the prevalence in younger age indicates ongoing transmission. Although specific behavioral risks were not identified, HCV infection appears to be an occupational hazard of garbage collection and sorting in this environment. Given the large reservoir of HCV infection in the population, further effort needs to be made to identify and mitigate new infections.

Life-Threatening Variceal Bleed Caused by Secondary Portal Hypertension Controlled by Emergent Splenopneumopexy

Introduction: Variceal bleeding is a common and feared complication of portal hypertension. In cases of recurrent bleeding despite pharmacologic therapy and endoscopic variceal ligation, portal decompressive therapy is often pursued. We present a case of a life-threatening variceal bleed caused by portal hypertension secondary to extensive pre-sinusoidal thrombosis as a result of schistosomiasis. The patient's bleeding was managed with emergent splenopneumopexy, a procedure that created a portopulmonary shunt via anastomosis of the splenic veins and pulmonary veins. Case Description: A 49-year-old male with past medical history of schistosomiasis initially presented to a community hospital with hematemesis and hematochezia. An EGD revealed multiple grade 3 esophageal varices that were banded with resolution of bleeding. Three weeks later, the patient had recurrent hematemesis requiring hospitalization. CT of the abdomen/pelvis revealed occlusion of portal, splenic, and superior mesenteric veins. An EGD was repeated but no targets for band ligation were identified due bleeding and presence of clots. A TIPS procedure was attempted but was unsuccessful due to completely occluded vasculature. The patient experienced ongoing hematemesis and hematochezia with hypotension requiring resuscitation. He was stabilized and transferred to our hospital for higher level of care. Upon arrival, he was intubated for airway protection. A Blakemore tube was placed for balloon tamponade and he was taken to the OR for emergent surgery. The patient underwent splenopneumopexy for creation of a portopulmonary shunt as well as transection of the esophagus with primary esophageal anastomosis. The patient did well post-operatively, remaining hemodynamically stable and did not have any further bleeding. The etiology of his pre-sinusoidal thrombosis was thought to be secondary to schistosomiasis given prior history of infection. A hypercoagulable workup was unremarkable and liver biopsy revealed normal hepatic parenchyma. The patient received empiric treatment for schistosomiasis and was discharged 14 days post operatively. Six months after discharge, the patient had not had any further bleeding. Discussion: Splenopneumopexy was first developed in Japan in the 1960s for treatment of portal hypertension in patients with Budd-Chiari Syndrome. The operation induces a portopulmonary shunt via anastomosis of the superior pole of the spleen and exposed pulmonary veins in the left lower lobe. In our patient's case, extensive pre-sinusoidal thrombosis from schistosomiasis precluded successful TIPS procedure and in the setting of refractory variceal bleeding, the patient's life was ultimately saved by emergency decompressive surgery with splenopneumopexy.Figure 1Figure 2

Knowledge, attitude, and practices towards schistosomiasis among rural population in Yemen.

BackgroundSchistosomiasis is highly prevalent in Yemen, with an estimated 3 million cases, particularly among rural communities. This community-based study aims to evaluate the knowledge, attitude and practices (KAP) on schistosomiasis among rural communities in Yemen.MethodsA cross-sectional study was carried out among 250 households from ten rural districts in Yemen. Overall, 400 children were screened for urogenital and intestinal schistosomiasis. Moreover, parents were interviewed using a pre-tested questionnaire to collect information about the demographic and socioeconomic information and their KAP concerning schistosomiasis.ResultsA total of 127 (31.8 %) children were found to be excreting schistosome eggs in either their urine or faeces (22.5 % S. haematobium and 8.0 % S. mansoni). Although 92.4 % of the respondents had heard about schistosomiasis, 49.8 %, 68.0 % and 47.2 % had knowledge concerning the transmission, signs and symptoms, and prevention, respectively. In addition, 77.1 % considered schistosomiasis as harmful while 48.5 % believed that schistosomiasis could be prevented, albeit their practices to prevent infections were still inadequate. Significant associations between the KAP and age, education, employment status and household monthly income were reported (P < 0.05). Moreover, a significantly higher level of knowledge was reported among the respondents who had infected children compared to those with no infected family members (P < 0.05). Multiple logistic regression analysis revealed that the level of education and the history of schistosomiasis were the most important factors associated with the KAP concerning schistosomiasis among this population.ConclusionThis study reveals that knowledge about the cause, transmission, symptoms and prevention of schistosomiasis among the rural population in Yemen was inadequate, and that this could be a challenging obstacle to the elimination of schistosomiasis in these communities. Besides the current mass drug administration, school and community-based health education regarding schistosomiasis is imperative among these communities to significantly reduce the transmission and morbidity of schistosomiasis.

Clinicopathological characteristics of urothelial bladder cancer in patients less than 40 years old.

Urothelial bladder cancer (UBC) is rare in young patients and as a result little information as to tumor type and clinical course are available. We present clinicopathological data of a large series of patients less than 40 years with bladder carcinoma. We included in this retrospective study covering the period from 1992 to 2013 patients less than 40 years with a first diagnosis of bladder cancer. Lesions were classified according to the WHO 2004 classification by uropathologists of ten centers. Stage, grade, multifocality, smoking habits, recurrence, and survival were studied. The cohort comprised of 152 patients, 113 males and 39 females with a mean age of 33.2 years. The large majority of the patients (142) was diagnosed with an urothelial carcinoma, the ten others with various histopathological diagnoses. In the age group less than 30 years old, 40.3 % of the cases concerned a papillary urothelial neoplasia of low malignant potential (PUNLMP). In the age group over 30 years, the proportion of PUNLMP decreased to 27.2 %. Only 5.6 % of the UBC was associated with carcinoma in situ. In 14.1 %, a high grade muscle invasive UC was found; 7.0 % had lymph node and 4.9 % distant metastasis at time of presentation. Four patients presented with a history of schistosomiasis; all had an infiltrating carcinoma. After initial resection, 36 patients relapsed, 17 % as PUNLMP, 53 % as pTa low grade, and 30 % as pTa-pT2 high grade UC. During follow-up, 6 % of the patients died. PUNLMP is the most frequent entity in this patient group. It is important that the PUNLMP entity is maintained in future classification systems.

Adenocarcinoma of the Urinary Bladder in Egypt: Potential Risk Factors

Background: Urothelial carcinoma (UC) and squamous cell carcinomas (SCC) of the urinary bladder have been well studied worldwide, but little is known about adenocarcinoma aside from its clinical features. Our objective was to examine associations between adenocarcinoma and known risk factors for UC and SCC in Egypt. Methods: We used data from our multi-center case-control study in Egypt where questionnaires inquired about tobacco smoking, schistosomiasis and other exposures by 101 cases of bladder adenocarcinoma and 3,737 population-based controls. Logistic regression models estimated the adjusted odds ratio (AOR) and 95% confidence interval (CI) of these associations. Results: The mean (SD) age for adenocarcinoma was 55.3 (9.8) and 54.2 (11.3) among men and women, respectively. There was an association with schistosomiasis, albeit higher for women than for men (AOR (95% CI): 4.58 (2.13 - 9.86) and 1.77 (1.05 - 2.98), respectively). Among men, smoking either cigarettes or water pipes was associated with adenocarcinoma (1.78 (0.85 - 3.75) or 1.97 (0.79 - 4.91), respectively), and the highest risk (3.34 (1.38 - 8.09)) was among those who smoked both water pipes and cigarettes. Conclusion: Smoking both cigarette and water pipe tobacco was associated with increased risk for adenocarcinoma of the bladder among males in this study, as was a history of schistosomiasis in both men and women. World J Nephrol Urol. 2015;4(3):227-231 doi: http://dx.doi.org/10.14740/wjnu228w

Successful outcome of postsplenectomy chemotherapy in an acute myeloid leukemia patient with massive bilharzial splenomegaly

Bilharzial hepatic fibrosis is usually accompanied by marked enlargement of the spleen. Schistosoma hematobium and Schistosoma mansoni infestation is endemic in Africa and southern part of Saudi Arabia. Patients with acute myeloid leukemia (AML) present with clinical features resulting from bone marrow failure, symptoms resulting from organ infiltration with leukemic cells (including splenomegaly), or both. Co-occurrence of bilharzial splenomegaly and AML is intuitively possible. Spontaneous splenic rupture has been reported to be catastrophic in both conditions and rarely splenic rupture may be the first manifestation of AML. Splenectomy is a considerable option in symptomatic splenomegaly in schistosomiasis. An enlarged spleen may also serve as a sanctuary site for residual leukemic cells after chemotherapy. Splenectomy has been reported in pediatric AML after chemotherapy and selected adult patients with myelodysplastic syndrome and myeloproliferative neoplasm (MPN). However, to the best of our knowledge, this is the first report of successful outcome of splenectomy prior to induction chemotherapy in an AML patient who presented with huge symptomatic splenomegaly due to past history of schistosomiasis, had also shown refractoriness to platelet transfusion due to hypersplenism and vaginal bleeding. Splenectomy in such a scenario was a difficult decision but was feasible with adequate expertise, vigilance and blood products availability. The patient is alive in complete remission with good performance status more than 2½ years after therapy.

Schistosomiasis infection among primary school students in a war zone, Southern Kordofan State, Sudan: a cross-sectional study

BackgroundSchistosomiasis is a major health problem adversely affecting the health of vulnerable populations in Sudan.MethodsWe conducted a school-based survey to estimate the prevalence of schistosomiasis in 36 villages in Southern Kordofan (SK) State. A total of 2,302 primary school students were recruited. Each student completed a questionnaire and submitted one urine and one stool sample.ResultsThe prevalence of schistosomiasis haematobium was 23.7%, while schistosomiasis mansoni was not detected among the study participants. S. haematobium infection was identified in all areas, with the highest prevalence in the western locality of SK State. The infection was associated with the distance between home/school and open water sources. In addition, S. haematobium infection was associated with the existence of and distance to open water sources, higher frequency of contact with open water, absence of a health advocacy group in the school and history of schistosomiasis treatment.ConclusionsThis study highlights schistosomiasis as a public health problem in SK State. The findings will guide the schistosomiasis Control Program of the State Ministry of Health in developing and applying treatment plans for schistosomiasis in SK State.

Urinary Bladder Cancer Risk Factors in Egypt: A Multicenter Case–Control Study

We investigated associations between tobacco exposure, history of schistosomiasis, and bladder cancer risk in Egypt. We analyzed data from a case-control study (1,886 newly diagnosed and histologically confirmed cases and 2,716 age-, gender-, and residence-matched, population-based controls). Using logistic regression, we estimated the covariate-adjusted ORs and 95% confidence interval (CI) of the associations. Among men, cigarette smoking was associated with an increased risk of urothelial carcinoma (OR = 1.8; 95% CI, 1.4-2.2) but not squamous cell carcinoma (SCC); smoking both water pipes and cigarettes was associated with an even greater risk for urothelial carcinoma (OR = 2.9; 95% CI, 2.1-3.9) and a statistically significant risk for SCC (OR = 1.8; 95% CI, 1.2-2.6). Among nonsmoking men and women, environmental tobacco smoke exposure was associated with an increased risk of urothelial carcinoma. History of schistosomiasis was associated with increased risk of both urothelial carcinoma (OR = 1.9; 95% CI, 1.2-2.9) and SCC (OR = 1.9; 95% CI, 1.2-3.0) in women and to a lesser extent (OR = 1.4; 95% CI, 1.2-1.7 and OR = 1.4; 95% CI, 1.1-1.7, for urothelial carcinoma and SCC, respectively) in men. The results suggest that schistosomiasis and tobacco smoking increase the risk of both SCC and urothelial carcinoma. This study provides new evidence for associations between bladder cancer subtypes and schistosomiasis and suggests that smoking both cigarettes and water pipes increases the risk for SCC and urothelial carcinoma in Egyptian men.

Testicular schistosomiasis: A case report

To report a case of testicular Schistosomiasis with a suspicion of testicular cancer. Hospital record of a 16 year old patient with histopathology confirmation of testicular Schistosomiasis was reviewed and summarised. The patient who had painless testicular nodules and ultrasound features of heterogenous echotexture and hypoechoic focus was diagnosed as testicular cancer and treated with radical orchidectomy. Histopathology confirmed testicular Schistosomiasis and the patient had additional praziquantel therapy. Patient was followed up for over 26months post-operative. Testicular Schistosomiasis can mimick malignant testicular tumour. Hard nodular testicular mass in a patient with recent past history of schistosomiasis should arouse suspicion of testicular Schistosomiasis. Awareness and early presentation will prevent unwarranted orchidectomy.

Associations differ by sex for catechol-O-methyltransferase genotypes and bladder cancer risk in South Egypt

ObjectivesTo examine associations between urinary bladder cancer risk and polymorphisms of the gene encoding the catechol estrogen-metabolizing enzyme, catechol-O-methyltransferase (COMT), among Egyptian women and men. Materials and methodsWe used questionnaire and genotype data from a case-control study in Egypt. This analysis focused on South Egypt cases with confirmed urothelial (UC) or squamous cell (SCC) carcinoma of the bladder, and controls frequency-matched on sex, 5-year age-group, and residence governorate. Real-time PCR on blood specimen DNA was used to determine COMT genotypes encoding for Val/Val, Val/Met, and Met/Met, the enzyme forms associated with high, intermediate, or low activity, respectively. ResultsThe study sample, which included 255 women and 666 men, consisted of 394 cases with histologically confirmed UC (225) or SCC (n = 169), and 527 controls. The odds of having either type of bladder cancer were lower among men with genotypes encoding Val/Met or Met/Met than among those with the genotype encoding Val/Val, even after adjustment for other factors, such as smoking and schistosomiasis history [adjusted odds ratio (AOR): 0.64; 95% confidence interval (CI): 0.43, 0.96]; however, the association was statistically significant for SCC (AOR 0.57; 95% CI: 0.34, 0.96) but marginal for UC (AOR: 0.64; 95% CI: 0.39, 1.02). No significant associations were detected between bladder cancer risk and COMT genotypes among postmenopausal women. ConclusionsThese findings suggest that even after controlling for established risk factors, the involvement of COMT genotypes in bladder cancer risk differs among men compared with women in South Egypt.

La schistosomiase au Maroc : de sa découverte à l’après-élimination

This paper outlines the history of schistosomiasis in Morocco and the efforts made to eliminate it from the country. Since it was first diagnosed in 1914 in Marrakesh, schistosomiasis remained for decades a public health problem in Morocco. A national control programme was launched in 1982 and it led to a considerable reduction in the incidence and morbidity associated with the disease. Consequently, the programme shifted from disease control to an elimination process launched in 1994. This process aimed to eliminate the disease transmission by the end of 2004 and has helped to clear all known foci. Today, the challenge is to maintain schistosomiasis elimination and to be certified schistosomiasis-free by the World Health Organization.

Estrogen exposure and bladder cancer risk in Egyptian women

Objective To examine associations between reproductive history and urinary bladder cancer in Egyptian women. Methods We used questionnaire data from an ongoing, multicenter case–control study in Egypt. Controls were matched on age and residence area. This analysis focused on female cases with confirmed urothelial (UC) and squamous cell (SCC) carcinoma of the bladder. Results We recruited 779 women (540 controls, 239 cases; >98.0% nonsmokers). Younger age at menopause (<45 y) and older age at first pregnancy (>18 y) were factors significantly associated with increased risk of bladder cancer, even after adjusting for schistosomiasis history and other covariates in the multivariable logistic model; adjusted odds ratio and 95% confidence intervals were 1.98 (1.41, 2.77) and 6.26 (3.46, 11.34), respectively. On the other hand, multiple pregnancies or use of oral contraceptives were associated with decreased odds of having bladder cancer. Similar associations were observed with UC and SCC when analyzed separately; however, the magnitude of association with SCC was lower than with UC. Conclusion Our data suggest that early estrogen exposure, or the relative lack of it, plays a role in urinary bladder carcinoma development among Egyptian women.

Rigid Ureteroscopy for Ureteral Stones: Factors Associated with Intraoperative Adverse Events

To analyze some of the factors that may be associated with a higher incidence of complications during management of ureteral stones by rigid ureteroscopy. We reviewed all ureteroscopic interventions aimed at stone extraction and/or fragmentation in our institution from 2001 through 2005. A total of 442 interventions were eligible for inclusion. Our focus was concentrated on (1) patient characteristics (age, gender, duration of symptoms, history of urinary schistosomiasis, and history of surgery involving the affected ureter), (2) stone characteristics (number, length, width, and level of the ureter affected), (3) the affected reno-ureteral unit (which side was affected, the kidney's ability to excrete contrast medium, and the status of the ureter proximal and distal to the stone), and finally (4) experience level of the surgeon in charge (junior v senior). The occurrence of intraoperative adverse events was considered a dependent variable and was statistically related to each of the above factors as independent variables. Intraoperative adverse events were encountered in 121 interventions including stone migration in 54, minor mucosal injuries in 24, ureteral perforation in 12, ureteral avulsion in 2, and aborted procedure due to bleeding or edema in 29. Symptomatology present for more than 3 months, a negative history of schistosomiasis, a positive history of ureteral surgery, stones above the ischial spines, stones >5 mm in width, a dilated proximal ureter, kidneys that failed to excrete contrast medium, and involvement of a more junior urologist were factors that were associated with a statistically significantly higher incidence of intraoperative complications. Rigid ureteroscopic stone manipulation remains a procedure that should be handled cautiously. Existence of any of the above risk factors should alert urologists, particularly at training centers, to adopt all possible precautionary measures.