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2022
Amin, N. M., A. Raafat, M. A. M. Ismail, A. Elkazaz, and I. R. Abdel-Shafi, " ASSESSMENT OF FAECAL CALPROTECTIN LEVEL IN PAEDIATRIC AND GERIATRIC PATIENTS WITH CRYPTOSPORIDIOSIS ", J. Egypt. Soc. Parasitol. (JESP), vol. 52, issue 1, pp. 1-8, 2022. Abstract

Cryptosporidium parasite is one of the major causes of diarrhoea. Several parasites and host factors, including the Cryptosporidium genotype and the host immune status and age can influence the disease severity. In the present work the faecal calprotectin (FCAL) level was assessed in Cryptosporidium
infected patients, as a marker of intestinal inflammation in the paediatric and geriatric age groups, with correlation to Cryptosporidium genotype. Our results revealed that the prevalence of cryptosporidiosis in the geriatric patients was significantly higher than in the pediatric group. Genotyping revealed Cryp- tosporidium hominis as the frequently circulating species. Significantly high FCAL levels weredetect- ed in Cryptosporidium positive patients denoting the ongoing inflammatory process in cryptosporidio- sis. Additionally, FCAL levels were significantly greater in Cryptosporidium hominis compared to
Cryptosporidium parvum infection, while unaffected by age group. Further studies are needed to in- vestigate the impact of cryptosporidiosis in the elderly patients and to evaluate FCAL as a predictive marker of the disease outcome.
Keywords: Cryptosporidium, Genotypes, Faecal calprotectin, Children, Elderly

Ali, S. H., M. A. M. Ismail, A. A. El-Badry, E. Y. Abu-Sarea, A. M. Dewidar, and D. A. Hamdy, "An Association Between Blastocystis Subtypes and Colorectal Cancer Patients: A Significant Different Profile from Non-cancer Individuals ", Acta Parasitologica, vol. 1, issue 1, pp. 1-12, 2022. Abstract

Purpose Blastocystis is a common enteric human parasite of non-conclusive pathogenicity which may be determined by subtype (ST) variation. Colorectal cancer (CRC) is considered one of the primary causes of cancer mortality. Blastocystis ST7 has been shown to reduce benefcial intestinal microbiota and may exacerbate CRC. This study assessed the possible association between Blastocystis STs and CRC in comparison to non-cancer patients.

Material and Methods A total of 200 fecal samples were obtained from CRC (100) and non-CRC (100) individuals attending Beni-Suef University Hospital, Egypt. Blastocystis was searched for in all samples using microscopy and culturing. Positive subculture samples were genetically sequenced and subtyped using conventional polymerase chain reaction (PCR). Blastocystis STs were determined by sequencing and a phylogenetic tree was created. Related patient characteristics and tumor stages were analyzed for association with presence of Blastocystis.

Results Blastocystis was identifed in 52% and 42% of CRC and non-cancer individuals, respectively. ST1, 2, and 3 were isolated from both cancer and non-cancer individuals; however, for the frst time, ST7 was only isolated from CRC stool samples with signifcant association. Associated patient characteristics were evaluated as predictors.

Conclusion Blastocystosis is highly prevalent in CRC patients, predominantly in the latest CRC grades and stages. To the best of our knowledge, this is the frst study to report the identifcation of Blastocystis ST7 in CRC patients. To determine whether certain STs of Blastocystis are associated with CRC would require further research, including the role played by
gut microbiota.

Keywords Blastocystis · Subtypes · Colorectal cancer · Egypt

Ibrahim, S. S., M. A. Hassan, M. A. M. Ismail, M. I. Ali, D. M. KHALIL, A. M. RABEA, and A. Raafat, "CRYPTOSPORIDIOSIS PREVALENCE ASSOCIATED WITH GASTROINTESTINAL MANIFESTATIONS AMONG HEMODIALYSIS PATIENTS WITH CHRONIC RENAL DISEASE IN BENI-SUEF UNIVERSITY HOSPITALS, BENI-SUEF, EGYPT", J. Egypt. Soc. Parasitol. (JESP), vol. 52, issue 1, pp. 39-44, 2022. Abstract

Cryptosporidium spp. has an elevated incidence rate particularly in immune-compromised
patients including chronic renal disease (CRD) patients. This study evaluated cryptosporidiosis
among patients with chronic renal disease undergoing hemodialysis attending outpatient clinics
of Internal Medicine Department, Faculty of Medicine, Beni-Suef University Hospitals. Stool
samples were collected from 90 patients and examined for Cryptosporidium oocysts stained with
cold acid fast stain. The results showed 13.3% were infected with Cryptosporidium oocysts but without significant difference as to age, sex, and residence. The most frequent symptoms were
diarrhea and abdominal pain with significant difference, but without significance with other
clinical symptoms. Hypertension and duration of hemodialysis showed significant difference with the prevalence rate of cryptosporidiosis, without significant difference with diabetes.
Key words: Egypt, Cryptosporidium, Chronic renal disease, and Hemodialysis.

2021
Hassan, M. A., and M. A. M. Ismail, " PERSPECTIVES ON TOLERANCE TO PARASITIC INFECTIOUS DISEASES ", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 3, pp. 485-492, 2021. Abstract

Immune responses to infectious parasitic diseases appear to be simply directed towards kill-
ing or clearing the parasite. However, the immunological strategies constitute a complex inco-
rporated network of immune mechanisms to eradicate the parasite itself in addition to preser-
vation of the integrity of host tissues. Resistance and tolerance are believed to be two distinct
complementary host defense immune strategies. Mechanisms triggering infectious tolerance to
parasitic infections are still poorly recognized but seem to be centered on controlling parasite-
induced tissue damage in the infected host. It is becoming obvious that realizing infectious tol-
erance as a prominent constituent of defense strategy deliver significant conceptions in coex-
istence of host-parasite relationship. This data may also pave the way to new therapeutic app-
roaches in many parasitosis.
Key words: Immune response, Tolerance, Parasitic infections, Resistance, Review

Morsy, S. M., M. A. M. Ismail, and M. M. I. Ghallab, " SEROPREVALENCE OF TOXOPLASMA GONDII IN SCHIZOPHRENIC PATIENTS VERSUS HEALTHY INDIVIDUALS AND ITS POSSIBLE IMPACT ON HUMAN SERUM DOPAMINE LEVEL ", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 2, pp. 365 - 370, 2021. Abstract

Several studies demonstrated a high seroprevalence of Toxoplasma gondii in schizophrenic
patients than healthy individuals. This case control study determined the serprevalence of T.
gondii among schizophrenic patients and healthy individuals at Kafrelsheikh University
Hospitals and to estimate its effect on serum dopamine level. T. gondii IgG was detected in
52.2% &23.9% of schizophrenic patients and healthy individuals respectively with signi-
ficance (P value = 0.005). Serum dopamine level was higher in schizophrenic patients than
healthy individuals with statistical significance (P = <0.001) and also higher in T. gondii IgG
positive than T. gondii IgG negative patients with statistical significance (P = <0.001).
Key words: Toxoplasma gondii, Schizophrenic Non-schizophrenic, Dopamine level

FAHMY, M. A., A. A. Abdel Aal, S. I. HASSAN, M. A. Shalaby, M. A. M. Ismail, R. A. KHAIRY, M. A. Badawi, A. A. AFIFE, and H. O. FADL, "Antiparasitic and immunomodulating effects of nitazoxanide, ivermectin and selenium on Cryptosporidium infection in diabetic mice ", Braz J Vet Parasitol, vol. 30, issue 4, pp. 1 - 16, 2021. Abstract

The present work aims to investigate the antiparasitic and the immunomodulating effects of nitazoxanide (NTZ) and ivermectin (IVC) alone or combined together or combined with selenium (Se), on Cryptosporidium infection in diabetic mice. The results revealed that the combined NTZ and IVC therapy achieved the highest reduction of fecal oocysts (92%), whereas single NTZ showed the lowest reduction (63%). Also, adding Se to either NTZ or IVC resulted in elevation of oocyst reduction from 63% to 71% and from 82% to 84% respectively. All treatment regimens, with the exception of NTZ monotherapy, showed a significant improvement in the intestinal histopathology, the highest score was in combined NTZ and IVC therapy. The unique results of immunohistochemistry in this study showed reversal of the normal CD4/CD8 T cell ratio in the infected untreated mice, however, following therapy it reverts back to a normal balanced ratio. The combined (NTZ+ IVC) treatment demonstrated the highest level of CD4 T cell expression. Taken together, NTZ and IVC combined therapy showed remarkable anti-parasitic and immunostimulatory effects, specifically towards the CD4 population that seem to be promising in controlling cryptosporidiosis in diabetic individuals. Further research is required to explore other effective treatment strategies for those comorbid patients.
Keywords: Cryptosporidium, ivermectin, selenium, CD4, CD8, diabetes.

ELASKARY, H. M., M. A. M. Ismail, A. S. ELGHAREEB, E. Y. Abu-Sarea, A. A. ABDULGHANI, and S. S. Ibrahim, "CO-INFECTION OF GIARDIA LAMBLIA AND HELICOBACTER PYLORI INFECTION AMONG CHRONIC KIDNEY DISEASED PATIENTS UNDERGOING HEMODIALYSIS IN BENI-SUEF UNIVERSITY HOSPITALS", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 3, pp. 585-596, 2021. Abstract

Giardia lamblia and Helicobacter pylori are two microorganisms that grow in duodenum and
stomach; and sharing the same mode of infection. Chronic kidney disease (CKD) is an end
stage disease causing uremia that requires hemodialysis (HD). The association of Giardia
lamblia and H. pylori infection has been known to be common and hemodialysis may play an
important role on this co-infection. This study evaluated the interrelation of Giardia lamblia
and H. pylori in patients of CKD treated with hemodialysis.
A case-control study performed on two hundred stool samples collected from patients attend-
ing Beni-Suef University Hospital suffering from diarrhea and other GIT symptoms. One hun-
dred patients suffering from CKD and treated with hemodialysis and a hundred control group
with normal kidney functions of both genders. Both groups were subjected to copro-
parasitological examination and fecal immuno-assays.
The results showed that Giardia in 13 CKD patients with a mean age of 45.24±14.52 and in
22 cross-matched control patients. Males showed prevalent of (66%), who were from rural are-
as (66.5%) and using tap water (83.5%). H. pylori infection was in 22 patients CKD and in 27
control patients. Co-infection was found in 10 CKD patients and 19 of control.
Keywords: Egypt, Patients, Giardia lamblia, H. pylori, Co-infection, CKD, Hemodialysis.

Raafat, A., I. R. Abdel-Shafi, M. A. M. Ismail, and N. M. Amin, "EFFICACY OF FECAL CALPROTECTIN AS A MARKER FOR THE PATHOGENICITY OF BLASTOCYSTIS HOMINIS ", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 3, pp. 641-646, 2021. Abstract

Fecal calprotectin (f-CP) is a marker of inflammation in intestine, calprotectin is released by
whilte blood cells, macrophages, and epithelial cells.
This study used the f-CP level as a factor to determine the pathogenicity of Blastocystis hom-
inis. The f-CP levels were measured in Blastocystis hominis patients as compared to negative B.
hominis ones with gastrointestinal symptoms related to healthy controls.
A total of 235 stool samples were divided into three groups. G1: 88 stool samples of patients
with gastrointestinal complaints positive only for blastocysts hominis. G2: 75 stool samples of
patients with gastrointestinal complains and B. hominis free. G3: 72 stool samples of healthy
volunteers, with neither gastrointestinal symptoms nor microbiological infection.
The levels of f-CP were determined by specific ELISA showed that the f-CP concentration was
highest in G1 & G2 as compared separately with G3, with significant differences (P < 0.001),
but without significant difference between G1 & G2 (p =0.453).
Keywords: Blastocystis hominis, Fecal calprotectin, Gastrointestinal symptoms.

FADL, H. O., M. A. M. Ismail, and E. A. El Saftawy, "EVIDENCE OF ANTI-DOUBLE STRANDED DNA ANTIBODIES AND C-REACTIVE PROTEIN IN EGYPTIAN PATIENTS WITH HIGH ANTI-SCHISTOSOMA MANSONI ANTIBODY TITER", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 1, pp. 147 – 152, 2021. Abstract

Schistosomiasis is one of the major public health diseases that induced a diversity of immuno-
logic reactions. Significant association between autoreactive antibodies and autoimmune disor-
ders was suggested. This study investigated the presence of anti-double stranded DNA (anti-ds DNA) antibodies and inflammatory biomarker, C-reactive protein (CRP) in 89 Egyptian pa-
tients, with Schistosoma mansoni clinical evidence and high anti-Schistosoma antibody titer. The
results showed positive serum anti-ds DNA antibodies in 11/89(12.4%) of them, without signifi-
cance to age, sex or anti-Schistosoma antibody titers. CRP was positive in 20/89(22.5%) of pat-
ients, with significant correlation with anti-ds DNA antibodies (P=0.000).
Keywords: Egypt, Schistosoma mansoni-anti-ds DNA- CRP- autoimmune disease.

ELMALLAWANY, M. A., M. A. M. Ismail, S. S. Attia, R. Ahmed, M. N. Alkady, S. Elkholy, A. Shaker, D. O. HELMY, and R. K. NAHNOUSH, "FEASIBILITY OF A RAPID LATERAL FLOW TEST FOR SIMULTANEOUS DETECTION OF GIARDIA LAMBLIA AND CRYPTOSPORIDIUM PARVUM IN DUODENAL ASPIRATES OF PATIENTS SUFFERING FROM CHRONIC LIVER DISEASES AND ELIGIBLE FOR UPPER ENDOSCOPY ", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 2, pp. 305 - 312, 2021. Abstract

Chronic liver diseases (CLDs) represent an important health issue in developing countries and
are commonly associated with impaired immunity. This increases the susceptibility to various in-
fectious agents including parasitic infections, which should be properly managed to avoid life
threatening complications. This study assessed the feasibility of rapid, easy and applicable
screening test for Giardia and Cryptosporidium within 150 CLDs patients suitable for upper en- doscopic examination. Stool samples, duodenal aspirates and duodenal biopsies were examined
for G. lamblia and C. parvum by different diagnostic techniques. The results showed stool mi-
croscopy (13.3% & 7.3%), duodenal aspirate microscopy (5.3% & 4.7%), rapid lateral flow im- mune-chromatographic assay (RLFIA) applied on duodenal aspirate samples (16.7% & 10%), duodenal biopsies histopathological examination (6.7% & 5.3%) and direct fluorescent antigen detection in stools (16.7% & 9.3%) for giardiasis and cryptosporidiosis respectively. The high
sensitivity of lateral flow immune-chromatographic assay in detecting Giardia and Cryptospor-
idium in duodenal fluid samples proved a good screening test for these patients.
Key words: Egypt, Chronic liver disease patients, Giardia, Cryptosporidium, Immunofluocen-
ce, duodenal aspirate, rapid immune-chromatography.

Kadry, G. M., M. A. M. Ismail, N. M. El-Sayed, H. S. El-Kholy, and D. M. H. El-Akkad, "In vitro amoebicidal effect of Aloe vera ethanol extract and honey against Acanthamoeba spp. cysts", Journal of Parasitic Diseases, vol. 45, issue 1, pp. 159-168, 2021. Abstract

This study evaluated in vitro effect of different concentrations of Aloe vera (A. vera) ethanol extract and honey against Acanthamoeba spp. cysts in comparison with chlorhexidine (the drug of choice for treatment of Acanthamoeba infection) at different incubation periods. Four different concentrations of the tested agents were used, 100, 200, 400, and 600 μg/ml for A. vera ethanol extract and 25, 50, 100, and 200 μg/ml for honey. Isolated Acanthamoeba spp. cysts from keratitis patients were incubated with different concentrations of the tested agents as well as chlorhexidine 0.02% (drug control) for different incubation periods (24, 48, 72 h). After each incubation period, the effect of A. vera extract and honey against Acanthamoeba cysts was assessed by counting the number of viable cysts, determining the inhibitory percentage and detecting the morphological alternations of treated cysts compared to non-treated and drug controls. Both A. vera ethanol extract and honey showed a concentration and time-dependent effect on the viability of Acanthamoeba cysts. In comparison with chlorhexidine (the drug control), A. vera ethanol extract possessed a potent cysticidal activity at all tested concentrations throughout different incubation periods, except for concentration 100 μg/ml which recorded the lower inhibitory effect. With increasing the dose of A. vera ethanol extract to 200, 400, 600 µg/ml, the recorded inhibitory percentages of Acanthamoeba cysts viability were 82.3%, 92.9% and 97.9% respectively, after 72 h compared to 76.3% of chlorhexidine. Similarly, honey at concentrations of 50–100 µg/ml gave higher inhibitory effect of 59% and 76.7%, respectively compared to chlorhexidine which showed an inhibitory percentage of 55.7% after 24 h. Meanwhile, the lowest tested concentration of honey (25 µg/ml) gave an inhibitory effect by 47.7–67% which was less than that of chlorhexidine throughout different incubation periods. With increasing the dose of honey to 200 µg/ml, the inhibitory effect was 98.9% after 72 h higher than that of chlorhexidine (76.9%). Using a scanning electron microscope, Acanthamoeba cysts treated by A. vera ethanol extract showed alternations in their shapes with flattening, collapsing, and laceration of their walls. Also, treated cysts by honey were highly distorted and difficult to identify because most of them were shrinkage and collapsed to a tiny size. On the other hand, chlorhexidine showed less structural and morphological changes of Acanthamoeba cysts. A. vera ethanol extract and honey had considerable cysticidal effects on Acanthamoeba cysts. They may give promising results for treatment of Acanthamoeba keratitis.

Waly, W. R., M. A. G. M. Ismail, E. Y. Abu-Sarea, and W. M. Abdelwahab, "Intestinal parasitic infections and associated risk factors in diabetic patients: a case-control study", Journal of Parasitic Diseases, vol. 45, issue 4, pp. 1106-1113, 2021. Abstract

Diabetes mellitus (DM) is a metabolic disease that puts the individual at immune-suppression state. The present study aims to detect the burden of intestinal parasites and associated risk factors among diabetic patients in a case-control study. Stool samples from 100 diabetic patients, and 100 non-diabetic controls attending Beni-Suef University Hospital were collected and processed by direct smear examination, concentration technique, permanent staining by modified Ziehl-Neelsen and modified trichrome stains, and culture on nutrient agar plates. The overall prevalence of intestinal parasites was 38%; higher in diabetic patients (44%) than control group (32%) with non-statistical significance. The most predominant intestinal parasites detected among diabetics were Blastocystis hominis (29%), followed by Cryptosporidium sp. (12%), Giardia lamblia (7%), Microsporidia sp. (5%), Entamoeba histolytica/dispar, Hymenolepis nana, and Capillaria philippinensis (each representing 2%). No statistical difference was detected between both groups in all parasites except for Microsporidia sp. (P = 0.008). In diabetic patients; age ≥ 41 years, living in rural areas, and patients having uncontrolled and complicated DM were significantly associated with intestinal parasitosis by univariate analysis (P = 0.016, 0.035, 0.014, 0.043) respectively. By multivariate analysis, age and rural residence were the only statistically significant risk factors (OR = 6.192, and 2.614) respectively. Intestinal parasites were highly associated with diarrhea (P < 0.001), and flatulence (P = 0.042) in the diabetic patients. Diabetic patients should be screened routinely for intestinal parasites, especially the opportunistic ones, and treated for their overall well-being.

Ibrahim, S. S., M. A. M. Ismail, H. M. ALASKARY, E. M. Khalil, D. M. KHALIL, and A. Raafat, "POTENTIAL ROLE OF TRICHOMONAS VAGINALIS IN WOMEN WITH PRIMARY AND SECONDARY INFERTILITY IN BENI-SUEF, EGYPT ", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 1, pp. 119 – 126, 2021. Abstract

Trichomoniasis plays a crucial role in causing some health problems such as ectopic pregnancy, un- desirable outcomes of pregnancy and infertility.
This study evaluated the role of T. vaginalis in infertile women and assessed the relationship be- tween trichomoniasis and female infertility in unexplained primary or secondary infertilities. A total of 90 female patients suffered from infertility were examined for trichomoniasis by Giemsa stained wet mount smears, and the Modified Diamond’s medium culture as a diagnostic reference.
The results showed that T. vaginalis was 9/90 (10%) by culture method with significance with pri- mary unexplained infertility.
Keywords: Egypt, Trichomonas vaginalis, Infertility, Modified Diamond’s medium culture.

ALASKARY, H. M., M. A. M. Ismail, E. Y. Abu-Sarea, E. M. FAROUK, E. S. EL-WAKIL, M. A. EL-BADRY, A. Raafat, M. M. Ahmed, and S. S. Ibrahim, "SILVER NANOPARTICLES AS APROMISING TREATMENT FOR BLASTOCYSTIS HOMINIS IN EXPERIMENTALLY INFECTED MICE", J. Egypt. Soc. Parasitol. (JESP), vol. 51, issue 2, pp. 343 - 354, 2021. Abstract

Blastocystis is an opportunistic parasite causes gastro-intestinal symptoms including irrita-
ble bowel syndrome (IBS). This study evaluated the effect of probiotics and silver nanopar-
ticles on Blastocystis hominis in mice and compared between both probiotics (Lactobacillus)
and silver nanoparticles as compared to metronidazole. A cross-sectional study was done in
which stool samples were collected from patients suffering from IBS.The stool samples
were examined microscopically to detect B. hominis and any co-parasitism. All positive
stool samples were cultured on Modified Jones' media. BALB/C mice were infected by iso-
lated Blastocystis. The effect of probiotics and silver nanoparticles on blastocystosis was
tested in experimentally infected mice. Cysts' mean count in stool of infected mice markedly
decreased; with a decrease in serum levels of nitric oxide and glutathione antioxidants com-
pared to drug control one. There wasintestinal villi improvement of infected groups treated
with probiotics and silver nanoparticles,with mild inflammation and decrease of Blastocystis
at the intestinal surface as compared to theinfected group metronidazole treated.
Keywords: Blastocystis hominis, Irritable bowel syndrome, Nanoparticles, Probiotics.

2020
Ibrahim, S. S., M. A. M. Ismail, M. A. Shaker, D. M. KHALILI, and A. Raafat, "BLASTOCYSTIS HOMINIS IN DIABETIC AND NON DIABETIC PATIENTS WITH IRRITABLE BOWEL SYNDROME IN BENI-SUEF CITY, EGYPT", J. Egypt. Soc. Parasitol. (JESP), vol. 50, issue 3, pp. 683 – 688, 2020. Abstract

Blastocystis is an opportunistic infection that is considered to cause gastro-intestinal sympt-
oms, including inflammatory bowel syndrome (IBS). It was also found that diabetic patients might be at a higher risk of infection with intestinal parasites causing gastro-intestinal sympt-
oms especially Blastocystis. This study assessed the rate of Blastocystis infection in patients
suffering from IBS associated with diabetes mellitus (DM), in comparison with the non-diabe-
tic IBS group. Two hundred stool samples were collected. All the participants were IBS-dia-
gnosed patients. It is noted that 100 were without any history of chronic diseases based on his-
tory taking, while the other 100 were known to be diabetic. Blastocystis was diagnosed by di-
rect microscopy of wet preparations; Lugol's iodine staining after concentration, and Modified
Jones' Culture. Blastocystis was detected in 37%, 65%, & 87% samples, respectively in IBS di-
abetic patients. But, the parasite was found in 21%, 25%, & 42% samples, respectively in IBS
non-diabetic patients. The only considerable risk factor for Blastocystis infection was the pres-
ence of DM, as it increased the possibility of infection more than 9 times.
Key words: Diabetic patients, Blastocystis hominis, Irritable bowel syndrome.

Abu-Sarea, E. Y., R. R. FAROUK, M. A. M. ISMAEL, M. S. SHEEMY, D. M. Ahmed, S. A. SENOSY, and M. A. Ghieth, "GIARDIASIS, HELICOBACTER PYLORI AND SERUM LEVELS OF SOME MICRONUTRIENTS.", J. Egypt. Soc. Parasitol. (JESP), vol. 50, issue 2, pp. 242 - 246, 2020. Abstract

Giardiasis and H. pylori in upper gastrointestinal system absorbed some vitamins and mineral
occurs. This study detected the serum levels of copper, zinc, vitamins B12 & B9 among giardi-
asis and/or H. pylori patients and compared the serum levels of these minerals and vitamins
among them. A total of 95 patients suffered from acute diarrhea were subjected to questionnaire
taking, stool analysis, iron/haematoxylin staining, H.pylori antigen detection and serum level
detection of zinc, copper, vitamins B12 & B9. Patients were divided into G1 (n=13) for micro-
scopic Giardia +ve, G2 (n=40) H. pylori +ve, G3 (n=6) both Giardia & H.pylori +ve, G4
(n=36) Giardia & H. pylori ve (control). The mean age of patients was 45.7±17. On compar-
ing variables among patients; residence, abdominal pain and flatulence were statistically significant (P< 0.05). Serum levels of zinc, vitamins B12 & B9 were within normal ranges, except copper level was higher than normal in all groups. G3 (co-infections) showed the lowest levels of zinc, vitamins B12 & B9. None of serum levels were statistically significant on comparing the four groups. Both giardiasis and H. pylori altered levels of micronutrients but during acute infection serum levels of zinc, vitamin B12 & B9 were still within normal ranges. Pattern of in- fection either chronic or acute were basic regarding micronutrients levels.
Keywords: Patients, Giardiasis, H. pylori, Copper, Zinc, Vitamins B12, & B9.

Abu-Sarea, E. Y., M. A. M. Ismail, R. M. Shaapan, A. S. S. Gawad, and M. A. Ghieth, "MALARIA AMONG IMMIGRANT̕ S WORKFORCE RETURNING FROM ENDEMIC DISTRICTS IN ALWOSTA CITY, EGYPT", J. Egypt. Soc. Parasitol. (JESP), vol. 50, issue 3, pp. 483-487, 2020. Abstract

This research aimed to encounter rapid diagnostic test (RDTs) efficacy to distinguish malaria
within patients with positive history to fever and/or travelling to endemic municipality. All over
a year, blood samples were amassed from patients visited different laboratories. Both thin, thick
blood films stained with Geimsa and rapid tests were used to diagnose malaria. Malaria was detected
by microscopy and RDTs (0.5%, & 0.9%, respectively) of patients. RDTs yielded 100%
sensitivity and 98.5% specificity. Samples detected by microscopy were also detected by RDTs.
All diagnosed malaria patients had history of travelling to Sudan or Yemen. RDTs proved confirmatory
tool to catch malaria suspected cases with fever history. Travelers from Sudan and
Yemen should be checked for malaria.
Key words: Egypt, Patients, Malaria, Rapid diagnostic tests, Microscopy.

FAHMY, M. A., A. A. Abdel Aal, S. I. HASSAN, M. A. Shalaby, M. A. M. Ismail, R. A. KHAIRY, and H. O. FADL, "POTENTIAL IMMUNOMODULATORY EFFECT OF SINGLE AND COMBINED THERAPIES AGAINST CRYPTOSPORIDIUM INFECTION IN IMMUNOSUPPRESSED MOUSE MODEL", J. Egypt. Soc. Parasitol. (JESP), vol. 50, issue 3, pp. 673 – 682, 2020. Abstract

Cryptosporidium species are related to protozoan parasites that infect the gastrointestinal tract
of a wide variety of animals, including humans. The host immune status is crucial for determi-
ning the susceptibility to infection, the outcome and the severity of the disease. Nitazoxanide®
is the only FDA approved drug to treat such opportunistic infection, yet demonstrates limited
and immune-dependent efficacy. The present work studied the effect of combination therapy in
treating cryptosporidiosis, plus exploring the possible modulating effect on the local adaptive
immune response in experimental dexamethasone immunocompromized mice model. The re-
sults showed that combination of selenium supplementation with ivermectin® or nitazoxanide
improved the oocysts reduction percentage compared to groups receiving single anti-parasitic
therapeutic drugs alone. Also, combination of ivermectin with nitazoxanide gave the best oo-
cysts reduction rates with the lowest score of ileitis severity. But, local expression of CD4 T
cells was down-regulated and unlikely could not be elevated enough even after all treatment
types. CD8 was up regulated in all treated groups as compared with non-treated control group,
indicating its possible role in reducing the serious threats of such opportunistic infection.
Keywords: Cryptosporidium- single therapy- combined therapies- CD4- CD8.

Aly, M. I., M.A.M.Ismail, G.A.Abd-Allah, M.Abdel-Latif, R.M.Shaapan, H.Salah, S. S. A. Gawad, and E.Y.Abu-Sarea, "Toxoplasmosis in Schizophrenic Patients: Immune-diagnosis and Serum Dopamine Level", Pakistan journal of Biological Sciences (Pak.J Bioi. ScL), vol. 23, issue 1028-8880, pp. 1131-1137, 2020. Abstract

Background and Objective: Toxoplasma gondii is an obligate intracellular protozoan parasite widely distributed all over the world. It
has been associated with various psychiatric conditionsas schizophrenia. This study aiming to evaiuatethe association between Tgondii
infection and schizophrenia and to estimate the effect ofIgondiiinfection on the serum dopamine level among schizophrenic patients.
Materials andMethods: A case-control study was conducted over 45 schizophrenic patients and 44 normal controls. Serum IgMand gG
anti-1gondii antibodies were detected by a commercial ELISA Kit. The immunoblotting method was performed for the detection of IgG
anti- Toxoplasma dopamine was detected by the human dopamine ELISA kit. Results: Anti' T gondii gM was negative in all the 90
studied individuals. However, anti- 77 was positive in 25 schizophrenic patients (55.6%) and 13 normal healthy controls (28.9%).
mmunoblotting showed stronger specific reaction to proteins with molecular weights 50 and 60 kOa by+ve gG schizophrenic patients.
The serum dopamine level among schizophrenicpatients was increased as compared to healthycontrols (47.22 and 25.79%, respectively:
p <0.001 ). In addition, the dopamine levels in +ve igG were higherthan those of-ve IgG schizophrenic patients. Condusion:These results
suggest that chronic Tgondiiinfection causes high dopamine levels that may lead to schizophrenia. About 55% of schizophrenic patients
showed positive IgG reactions to Toxoplasma within this population, the dopamine levels were higherthan seronegative population and
revealed both 50 and 60 kOa proteins band specific to Toxoplasma.
Key words: Toxoplasmosis, schizophrenia, IgG, IgM, immunoblotting, dopamine

2019
Ismail, M. A. M., I.R.Aly, E.Y.Abu-Sarea, S. S. A. Gawad, and R.M.Shaapan, "Application of Latex Agglutination and Sandwich ELISA in Detection of Human Hydatidosis", Journal of Medical Sciences, issue 1682-4474, pp. 30-37, 2019.
Ismail, M. A. M., and H. O. Fadl, "CYCLOSPORA INFECTION IN RENAL TRANSPLANT RECIPIENT", Journal of the Egyptian Society of Parasitology (JESP), vol. 49, issue 3, pp. 727- 730, 2019. Abstract

Cyclospora cayetanensis (C. cayetanensis) can cause serious diarrheal illness in immunocompromised patients. The present work aimed to detect C. cayetanensis infection among patients with renal transplantation attending the nephrology unit of Kasr Al-Aini, Faculty of Medicine, Cairo
University. A total of 50 stool samples were collected and subjected to direct microscopy to screen
for parasitic stages. A modified acid fast staining technique (Kinyoun’s method) was used to detect
C. cayetanensis oocysts. Cyclospora oocysts were revealed in 5 (10%) of the stool samples examined. Other parasites detected among the patients included Cryptosporidium parvum 5 (10%) and
Blastocystis 15 (30%). 30% of the patients were suffering from diarrhea and or colic. All C. cayetanensis positive cases were presenting with diarrhea.
Keywords: Cyclospora cayetanensis, renal transplant recipients, modified aid fast

El-Badry, A. A., E.Y.Abu-Sarea, A.H.Mahmoud, M.A.Ghieth, and M.A.M.Ismail, "The first Entamoeba moshkovskii molecular detection in Egypt", Comparative Clinical Pathology Springer Nature, pp. 1-4, 2019. Abstract

Amebiasis infection is caused by Entamoeba histolytica. The nonpathogenic Entamoeba species, E. moshkovskii and E. dispar, are distinct but morphologically indifferentiable from E. histolytica, which led us to use of multiplex PCR to detect and molecularly differentiate Entamoeba species in fecal samples of a cohort of 504 diarrheic/dysenteric Egyptians attending outpatient clinics of the Beni-Suef University Hospital. E. moshkovskii was detected for the first time in Egypt, added to already reported E. histolytica and E. dispar. Molecular prevalence of all Entamoeba species was 10%. E. histolytica (1.4%) was the least prevalent Entamoeba, 6 times less than nonpathogenic amoebae (7.9%), E. dispar (4.6%), and E. moshkovskii (3.3%). Entamoeba coinfection was found in 0.8% of cases. Coproscopy had a limited diagnostic performance for the diagnosis of E.histolytica, giving false-positive and false-negative results. Use of molecular assays, a laboratory non-coproscopic method, is preferable as it differentiates amoeba infections and monitors the E. histolytica true prevalence for better treatment and effective control.
Keywords E. moshkovskii . E. histolytica . E. dispar . Multiplex PCR . Egypt

2018
Ismail, M. A. M., H. S. Eldin, A. S. A. E. Antably, M.A.Hassan, and E.M.Rizk, "Students’s perception of Parasitology across integration of basic medical curriculum; impact on student’s retention of knowledge and satisfaction", The Vth Conference of the Egyptian Parasitologists United Society, Ain Shams university, 24-25 March, 2018. Abstract

Background: Parasitic diseases cause enormous mortality and morbidity worldwide Accordingly, Parasitology teaching should be modified in such a way that genuine information is complemented with clinical insight. Medical students have to make competent clinical decisions based on adequate scientific principles; consequently, they must be able to retain knowledge from the preclinical academic phase of their medical course. Integration of basic medical sciences in early years of medical education into clinical practice of later years is such an area under adequate study. Integrated approach to education may have important benefits for learning, retention and elaboration of well-organized knowledge that underlie effective clinical reasoning.
Aim: This paper aimed at outlining the development and implementation of a form of vertical integration between Parasitology curriculum as a part of undergraduate basic sciences together with clinical science practices performed on third year students in kasr Alainy School of Medicine, Cairo University in Egypt. Assessing how the students perceive and value this learning modality was also carried out.
Methods: A sample of 200 medical students from the third academic year (2017-2018) of Faculty of Medicine, Cairo University participated in this study. They were subjected to an integrated learning program which was launched by Medical Parasitology Department in co-operation with different Clinical Departments in Faculty of medicine Cairo University. To assess the results of this program, a questionnaire was introduced to appraise how this course helped the students to understand and correlate between academic and clinical data they were studying throughout the year. In addition, their final exam results were also evaluated and compared with other students of the same academic year not attending this integrated program.
Results: Students were defined in 2 groups; group A included students of main stream not attending the integrated program (n:664) and group B included those students receiving this program (n:200). As for final exam results, 93.2% of group A had passed the exam versus 95.5% of group B.
Concerning rating, it was found that group A students showed results of 49.1%, 29.1%, 15.1% and 1.4% for excellent, very good, good and fair ratings respectively while group B revealed 58.5%, 22.55%, 14.4% and 0.5% respectively for the same ratings. Questionnaire results revealed a high response by the students to the integrated program as a preferable teaching tool.

Conclusion:
This study proposed that perceived clinical relevance is a contributing factor to the retention of basic
parasitology knowledge. This could motivate curriculum planners to work on innovation through integration of academic information with clinical components for applied teaching throughout the medical course in Parasitology education. Further studies with increasing the number of participants and may be extending the study to cover more years could help improving results and could also give the chance to check for differences in ability for short and long-term retention of Parasitology knowledge amongst participants and non-participants.

Key words: Parasitology, Basic sciences, integration, student, learning medical education, clinical relevance.

Abdel Gawad, S. S., M.A.M.Ismail, N.F.A.Imam, A.H.A.Eassa, and E.Y.Abu-Sarea, "Detection of Cryptosporidium spp. in Diarrheic Immunocompetent Patients in Beni-Suef, Egypt: Insight into Epidemiology and Diagnosis", The Korean Journal of Parasitology, vol. 56, issue 2, pp. 113-119, April, 2018. Abstract

Cryptosporidium species is an important cause of gastrointestinal infections globally. This study aimed to shed light on its role in diarrheic immunocompetent patients in Beni-Suef, Egypt and to compare three diagnostic methods. Two hundred diarrheic patients, 37±16.8 year old, were enrolled. Stool samples were examined by light microscopy, using modified Ziehl-Neelsen stain (MZN) for Cryptosporidium spp. oocysts. Coproantigens were detected by sandwich ELISA. DNA molecular diagnosis was done by nested PCR. PCR yielded the highest detection rates (21.0%), compared to ELISA (12.5%) and MZN staining method (9.5%). The higher infection rates were in 20–40 year-old group, followed by 40–60 year-old. Association between epidemiologic factors was statistically not significant; positivity and gender, clinical manifestations, residence, source or water, or contact with animals. Cryptosporidiosis is an important enteric parasitic infection in Beni-Suef and PCR remains the gold standard for diagnosis.
Key words: Cryptosporidium, Beni-Suef, PCR, ELISA, modified Ziehl-Neelsen stain

ABDEL MAKSOUD, H. F., M. A. M. Ismail, N. M. Amer, E. D. M. H. Akkad, and M. Magdy, "DETECTION OF CRYPTOSPORIDIUM-INDUCED INTESTINAL TISSUE ALTERATIONS IN DEXAMETHASONE TREATED & UN-TREATED MICE", Journal of the Egyptian Society of Parasitology (JESP), vol. 48, issue 2, pp. 449-458, August, 2018. Abstract

Cryptosporidium parvum (C. parvum) is coccidian protozoan that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. C. parvum is considered one of the most important waterborne pathogen among the most relevant parasitic enteric agents in man and animals. It is resistant to all practical levels of chlorination and it is an obligate intracellular pathogen. It has been the cause of multiple diarrhea outbreaks in developed and developing countries. The present work was carried out to evaluate the pathological, immuno-histochemical and molecular changes in the ileocecal region induced by chronic irritation with different inoculum sizes of cryptosporidium (50,500 oocysts) in immunocompetent and immunosuppressed mice. The mice were euthanized at different dates starting from 14, 21, 36, 45, 57 till day 64 to study these transformations. Histopathological examination of the ileocecal region revealed neoplastic changes in the form of dysplasia, polypoid structures, architectural distortion, glandular crowding, marked cellular atypia, exophytic adenomatous polypi, intramuscular adenocarcinoma and marked nuclear anaplasia.
Key words: Cryptosporidium spp. Mice, Intestinal tissue alterations, Histopathology