Stereotactic Radiosurgery for Motor Cortex Region Arteriovenous Malformations

Abstract OBJECTIVE The optimal management of arteriovenous malformations (AVMs) in critical brain locations remains controversial. To reduce the risk of an AVM hemorrhage and to enhance the possibility of preserving neurological function, stereotactic radiosurgery was performed in 33 patients with newly diagnosed or residual AVMs located within the motor cortex. The role of embolization also was examined. METHODS During a 9-year study period, 33 patients with AVMs located primarily in the motor cortex region were treated with stereotactic radiosurgery. These patients were followed up radiographically for a minimum of 36 months, or less if obliteration was documented before 36 months had elapsed. Of the 33 patients, 9 underwent embolization and 1 underwent microsurgery before radiosurgery. Nine patients required a second radiosurgery. The mean AVM target volume was 4.35 cc, and the average radiation dose to the AVM margin was 20 Gy. The median follow-up was 36 months (range, 10–91 mo), and angiographic follow-up of eligible patients was performed 24 or 36 months after radiosurgery. RESULTS Results were stratified by radiosurgical target volumes: less than 3 cc (Group 1), 3 to 10 cc (Group 2), and greater than 10 cc (Group 3). Overall (including second radiosurgery), 13 (87%) of 15 patients in Group 1 had complete obliteration confirmed by angiography. Nine (64%) of 14 patients in Group 2 exhibited nidus obliteration, and one (25%) of four patients in Group 3 demonstrated obliteration on a magnetic resonance imaging scan. Eight patients (24%) underwent second-stage radiosurgery after angiography revealed a persistent AVM nidus; three patients demonstrated complete obliteration on follow-up angiography. The obliteration rate was higher (87%) for AVMs with less than 3 cc target volume and lower (56%) for those with target volumes larger than 3 cc. One patient experienced worsening neurological function after radiosurgery, and one died from delayed AVM hemorrhage during the latency period. No patient bled after angiographically confirmed AVM obliteration. CONCLUSION Stereotactic radiosurgery is a successful and safe management option for patients with motor cortex AVMs. The obliteration of AVMs and the attendant low morbidity rates indicate a primary role for radiosurgery in these patients. Staged radiosurgery may be necessary to increase obliteration rates for larger AVMs or for those that are not obliterated after the first procedure.

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Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty

Arthroplasty ◽

10.1186/s42836-021-00070-y ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Zhijie Chen ◽

Kaizhe Chen ◽

Yufei Yan ◽

Jianmin Feng ◽

Yi Wang ◽

...

Keyword(s):

Knee Flexion ◽

Tibial Slope ◽

Posterior Tibial ◽

Significant Difference ◽

Medial Unicompartmental Knee Arthroplasty ◽

Group 3 ◽

Group 2 ◽

Postoperative Knee ◽

Group 1

Abstract Objective To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). Methods Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2–11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre−/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. Results In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre−/postoperative HSS scores or postoperative knee ROM. Conclusion A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.

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The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

Blood Purification ◽

10.1159/000515639 ◽

2021 ◽

pp. 1-7

Author(s):

Emre Erdem ◽

Ahmet Karatas ◽

Tevfik Ecder

Keyword(s):

Serum Ferritin ◽

Hemodialysis Patients ◽

Rank Test ◽

Significant Difference ◽

All Cause Mortality ◽

Group 3 ◽

Group 2 ◽

The Relationship ◽

Group 1

Introduction: The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. Methods: A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin <800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin >1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. Results: Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, p = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; p = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; p = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; p = 0.063). Conclusion: Time-averaged serum ferritin levels >1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

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Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation

Cartilage ◽

10.1177/19476035211030991 ◽

2021 ◽

pp. 194760352110309

Author(s):

Alexandre Barbieri Mestriner ◽

Jakob Ackermann ◽

Gergo Merkely ◽

Pedro Henrique Schmidt Alves Ferreira Galvão ◽

Luiz Felipe Morlin Ambra ◽

...

Keyword(s):

Clinical Outcomes ◽

Autologous Chondrocyte Implantation ◽

Second Generation ◽

Cartilage Lesion ◽

Chondrocyte Implantation ◽

Group 3 ◽

Group 2 ◽

Autologous Chondrocyte ◽

Group 1

Objective To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years’ follow-up. Methods A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient’s mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. Results Neither pre- nor postoperative PROMs differed between groups ( P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). Conclusion Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. Level of Evidence Level III, retrospective comparative study.

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A tissue-engineered urinary conduit in a porcine urinary diversion model

Scientific Reports ◽

10.1038/s41598-021-94613-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Arkadiusz Jundziłł ◽

Piotr Kwieciński ◽

Daria Balcerczyk ◽

Tomasz Kloskowski ◽

Dariusz Grzanka ◽

...

Keyword(s):

Computed Tomography ◽

Urinary Diversion ◽

Porcine Model ◽

Histological Evaluation ◽

Metabolic Complications ◽

Group 3 ◽

Group 2 ◽

The Right ◽

Group 1

AbstractThe use of an ileal segment is a standard method for urinary diversion after radical cystectomy. Unfortunately, utilization of this method can lead to numerous surgical and metabolic complications. This study aimed to assess the tissue-engineered artificial conduit for urinary diversion in a porcine model. Tissue-engineered tubular polypropylene mesh scaffolds were used for the right ureter incontinent urostomy model. Eighteen male pigs were divided into three equal groups: Group 1 (control ureterocutaneostomy), Group 2 (the right ureter-artificial conduit-skin anastomoses), and Group 3 (4 weeks before urostomy reconstruction, the artificial conduit was implanted between abdomen muscles). Follow-up was 6 months. Computed tomography, ultrasound examination, and pyelogram were used to confirm the patency of created diversions. Morphological and histological analyses were used to evaluate the tissue-engineered urinary diversion. All animals survived the experimental procedures and follow-up. The longest average patency was observed in the 3rd Group (15.8 weeks) compared to the 2nd Group (10 weeks) and the 1st Group (5.8 weeks). The implant’s remnants created a retroperitoneal post-inflammation tunnel confirmed by computed tomography and histological evaluation, which constitutes urostomy. The simultaneous urinary diversion using a tissue-engineered scaffold connected directly with the skin is inappropriate for clinical application.

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Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.3.peds13381 ◽

2014 ◽

Vol 14 (1) ◽

pp. 1-11 ◽

Cited By ~ 33

Author(s):

Matthew B. Potts ◽

Sunil A. Sheth ◽

Jonathan Louie ◽

Matthew D. Smyth ◽

Penny K. Sneed ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Functional Outcomes ◽

Arteriovenous Malformations ◽

Target Volume ◽

Neurological Deficits ◽

Single Institution ◽

Risks And Benefits ◽

Scale Scores ◽

Time Of Presentation

Object Stereotactic radiosurgery (SRS) is an established treatment modality for brain arteriovenous malformations (AVMs) in children, but the optimal treatment parameters and associated treatment-related complications are not fully understood. The authors present their single-institution experience of using SRS, at a relatively low marginal dose, to treat AVMs in children for nearly 20 years; they report angiographic outcomes, posttreatment hemorrhage rates, adverse treatment-related events, and functional outcomes. Methods The authors conducted a retrospective review of 2 cohorts of children (18 years of age or younger) with AVMs treated from 1991 to 1998 and from 2000 to 2010. Results A total of 80 patients with follow-up data after SRS were identified. Mean age at SRS was 12.7 years, and 56% of patients had hemorrhage at the time of presentation. Median target volume was 3.1 cm3 (range 0.09–62.3 cm3), and median prescription marginal dose used was 17.5 Gy (range 12–20 Gy). Angiograms acquired 3 years after treatment were available for 47% of patients; AVM obliteration was achieved in 52% of patients who received a dose of 18–20 Gy and in 16% who received less than 18 Gy. At 5 years after SRS, the cumulative incidence of hemorrhage was 25% (95% CI 16%–37%). No permanent neurological deficits occurred in patients who did not experience posttreatment hemorrhage. Overall, good functional outcomes (modified Rankin Scale Scores 0–2) were observed for 78% of patients; for 66% of patients, functional status improved or remained the same as before treatment. Conclusions A low marginal dose minimizes SRS-related neurological deficits but leads to low rates of obliteration and high rates of hemorrhage. To maximize AVM obliteration and minimize posttreatment hemorrhage, the authors recommend a prescription marginal dose of 18 Gy or more. In addition, SRS-related symptoms such as headache and seizures should be considered when discussing risks and benefits of SRS for treating AVMs in children.

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Evaluation of the TGS TA system for the detection of anti-Toxoplasma antibodies

Microbiologia Medica ◽

10.4081/mm.2017.6583 ◽

2017 ◽

Vol 32 (1) ◽

Author(s):

Olivia Arpino ◽

Annalisa Cianflone ◽

Maria Teresa Manco ◽

Alessia Paganini ◽

Massimo De Paschale ◽

...

Keyword(s):

High Avidity ◽

Past Infection ◽

Recent Infection ◽

Igm Antibodies ◽

Igg Avidity ◽

Avidity Test ◽

Group 3 ◽

Group 2 ◽

Group 1

Background and aims. The aim of the present study was to evaluate the new chemiluminescence TGS TA system of Technogenetics (Milan, Italy) for detecting anti-Toxoplasma IgG and IgM antibodies and IgG avidity. The TGS TA system was compared with our chemiluminescence routinely used system, LIAISON XL, supplied by Diasorin (Saluggia, Italy), for the detection of IgG and IgM antibodies. Only in positive IgM samples (retrospective study) and for the IgG avidity (if existent), TGS TA system was compared to an Enzyme Linked Fluorescent Assay (ELFA) test (VIDAS, BioMérieux, Marcy-l’Étoile, France). Materials and methods. Three hundred and one sera samples, from women who came to our centre for the routine follow up pregnancy, were examined with the TGS TA system and divided in 3 groups according to IgG and IgM screening LIAISON XL tests: 106 were non-immune women (Group 1), 100 were pregnant with past infection (Group 2) and 95 were pregnant with positive or equivocal IgM (82 with positive IgG and 13 with negative IgG) (Group 3). Results. The overall concordance of the IgG results between LIAISON XL and TGS TA was 99.3%: 100% in Group 1, 98% in Group 2 and 100% in Group 3. The overall concordance of the IgM results between LIAISON XL and TGS TA was 93.9%: 100% in Group 1, 94% in Group 2 and 82.8% in Group 3. In Group 3, the concordance between the results of the IgG avidity with the ELFA and TGS TA tests was 81.7%. Comparing the clinical diagnosis obtained with our protocol and that of the TGS TA system, the overall concordance was 92.7%: 100% in Group 1, 92.0% in Group 2 and 78.9% in Group 3. Conclusions. The overall concordance of IgG antibodies is excellent for both protocols while for IgM antibodies is very high in the first group and lower in the third group, due to the presence of non-specific IgM subjects in this group. The TGS TA avidity test seems to predict ealier the maturation of the IgG compared to the ELFA test since many samples with low avidity with the ELFA were seen with moderate avidity with TGS TA and all those with borderline avidity with the ELFA were seen with high avidity with TGS TA. This system shows to be a valuable tool with overall good clinical correlation and able to clearly identify nonspecific subjects, those with a non-recent infection.

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Comparison of Changes in Number of Hyperreflective Dots After İntravitreal Ranibizumab or Dexamethasone İmplant in Patients with Branch Retinal Vein Occlusion

10.21203/rs.3.rs-736656/v1 ◽

2021 ◽

Author(s):

Aylin Karalezli ◽

Sema Kaderli ◽

Ahmet Kaderli ◽

Cansu Kaya ◽

Sabahattin Sul

Keyword(s):

First Year ◽

Intravitreal Ranibizumab ◽

Retinal Layers ◽

Vein Occlusion ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Purpose: To compare the effect of intravitreal ranibizumab (IVR) or intravitreal dexamethasone implants (IVD) on regression of hyperreflective dots (HRDs) on optical coherence tomography (OCT) B-scan in patients with branch retinal vein occlusion (BRVO). Methods: 37 eyes of 37 patients with cystoid macular edema who received IVR or IVD and followed up for at least 12 months were included in this study. The patients were divided into three groups according to intravitreal treatment. Group 1 consisted of 12 eyes who received only IVD, group 2 consisted of 10 eyes who received only IVR on a pro re nata and group 3 consisted of 15 eyes who received both IVD and IVR. OCT parameters (CMT, number of HRDs, status of external limiting membrane (ELM) and ellipsoid zone (EZ)) and best-corrected visual acuity (BCVA) were compared between the groups over the follow-up time. HRDs were categorized as HRD in inner retinal layers (from the internal limiting membrane to the inner nuclear layer) or HRD in outer retinal layers (from the outer plexiform layer to the outer border of the photoreceptor layer).Results: There was no significant difference between groups in terms of BCVA, CMT, HRDs in the inner and the outer retinal layers at baseline visit. (p˃0.05 for all) Comparing the baseline values in all groups, a significant decrease was observed in CMT in the first year. (For group 1; p=0.013, group 2; p=0.010; group 3, p<0.001) The BCVA was significantly increased after 1 year in all groups. (p=0.001, p=0.006, p<0.001) The mean number of HRDs in inner and outer retinal layers were significantly decreased in group 1 and group 3. (For group 1; p<0.001, p=0.001, for group 3; p<0.001, p<0.001) However, there was no significant difference in terms of the mean number of HRDs in inner and outer retinal layers for group 2. (p=0.134, p=0.477) At the first year, the number of HRDs in inner and outer retinal layers was significantly lower in group 1 and group 3 than group 2. (For inner HRDs; group 1 vs. group 2 p=0.007, group 2 vs. group 3 p<0.001. For outer HRDs group 1 vs. group 2 p<0.001, group 2 vs. group 3 p<0.001.) The BCVA was higher in group 3 than group 2 at 1year. (p=0.048). There was no significant difference in terms of post-treatment CMT and the number of HRDs between group 1 and group3 in posthoc tests (p=0.621, p=0.876, and p=0.632).Conclusion: The reduction in HRDs at 12 months and better BCVA after IVD intimates that the HRDs should be considered as inflammatory markers in the follow-up of CME in BRVO. Thus, IVD injection could be more appropriate for patients with higher HRDs after BRVO.

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Incidence of Severe Acute Respiratory Syndrome Coronavirus-2 infection among previously infected or vaccinated employees

10.1101/2021.07.03.21259976 ◽

2021 ◽

Author(s):

Noah Kojima ◽

Arash Roshani ◽

Matthew Brobeck ◽

Arthur Baca ◽

Jeffrey D Klausner

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Clinical Laboratory ◽

Exact Equation ◽

Previous Infection ◽

Group 3 ◽

Group 2 ◽

Measure Of Association ◽

Observation Period ◽

Group 1

Introduction: The protective effect of previous infection versus vaccination is poorly studied. Among a clinical laboratory that has been conducting routine workforce screening since the beginning of the pandemic, we aimed to assess the relative risk of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among individuals who were SARS-CoV-2 naive, previously infected, or vaccinated. Methods: Using an electronic laboratory information system, employees were divided into three groups: (1) SARS-CoV-2 naive and unvaccinated, (2) previous SARS-CoV-2 infection, and (3) vaccinated. Person-days were measured from the date of the employee first test and truncated at the end of the observation period. SARS-CoV-2 infection was defined as two positive SARS-CoV-2 PCR tests in a 30-day period. Individuals with fewer than 14 days of follow up were excluded. Incidence estimates and the 95% confidence intervals were calculated using the Poisson Exact equation. The incidence rate ratio (IRR) was used as a measure of association between groups. Analyses were performed on StataSE (StataCorp, College Station, TX). Results: We identified 4313, 254 and 739 employee records for groups 1, 2, and 3, respectively. The median age of employees was 29.0 years (interquartile range: 23.6, 39.9). During the observation period, 254, 0, and 4 infections were identified among groups 1, 2, and 3, respectively. Group 1 had an incidence of 25.9 per 100 person-years (95% CI: 22.8-29.3). Group 2 had an incidence of 0 per 100 person-years (95% CI: 0-5.0). Group 3 had an incidence of 1.6 per 100 person-years (95% CI: 0.04-4.2). The IRR of reinfection among those with previous infection compared to SARS-CoV-2 naive was 0 (95% CI: 0-0.19). The IRR of those vaccinated compared to SARS-CoV-2 naive was 0.06 (95% CI: 0.02-0.16). The IRR of those vaccinated compared to prior SARS-CoV-2 was 0 (95% CI: 0-4.98). Conclusion: Previous SARS-CoV-2 infection and vaccination for SARS-CoV-2 were associated with decreased risk for infection or re-infection with SARS-CoV-2 in a routinely screened workforce. The was no difference in the infection incidence between vaccinated individuals and individuals with previous infection. Further research is needed to determine whether our results are consistent with the emergence of new SARS-CoV-2 variants.

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The follow up of experimentally infected hamsters with Leishmania tropica immunized with different vaccines

Baghdad Science Journal ◽

10.21123/bsj.4.4.549-554 ◽

2007 ◽

Vol 4 (4) ◽

pp. 549-554

Author(s):

Baghdad Science Journal

Keyword(s):

Liver Weight ◽

Bcg Vaccine ◽

Leishmania Tropica ◽

Golden Hamsters ◽

Group 3 ◽

Group 2 ◽

Foot Pad ◽

Spleen Enlargement ◽

Group 1

Some parameters for advancement of Leishmania tropica infection were examined in three groups of golden hamsters, Group (1) inoculated with autoclaved killed Leishmania tropica , Group (2) inoculated with BCG vaccine alone while Group (3) Inoculated with mixed vaccine (autoclaved killed Leishmania with BCG). The follow up of experimentally infected animals with virulent isolation of Leishmania tropica was done for 90 days, the animals inoculated with mixed vaccine (autoclaved killed Leishmania with BCG) showed the minimum average in each of foot pad thickness (2.3 ± 0.05) mm after (60) days of infection, spleen enlargement (1.13±0.38) after (45) days of infection, spleen length (23.9±0.08) mm after (30) days of infection, liver weight(3.8±0.52) gm after (90) days of infection and estimated number of parasites in the spleen (0.91±0.04) million parasites after (30) days of infection. In conclusion, the mixed vaccine was effective to protect animals against subsequent infections which may cause lesions, and minimized the number of parasites in spleen for (90) days after infection.

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Study of Some Parameters to Evaluate Immunization against Leishmaniasis in Golden hamsters

Journal of Biotechnology Research Center ◽

10.24126/jobrc.2011.5.2.153 ◽

2011 ◽

Vol 5 (2) ◽

pp. 5-11

Author(s):

Fawzia A. Al-Shanawi ◽

Harith S. Al-Warid

Keyword(s):

Phosphate Buffer ◽

Saline Group ◽

Challenge Infection ◽

Leishmania Tropica ◽

Parasite Culture ◽

Golden Hamsters ◽

Group 3 ◽

Group 2 ◽

Group 1

Incubation period, smears, impression and parasite culture for each liver, spleen, foot and blood were observed along five times follow up (15,30, 45, 60, 75, 90) days after challenge infection with virulent Leishmania tropica isolate in four groups of golden hamsters, inoculated with (one, two, three) doses of different antigens as following: Group (1) inoculated with autoclaved killed Leishmania tropica, Group (2) inoculated with BCG vaccine alone while Group (3) Inoculated with mixed vaccines (autoclaved killed Leishmania + BCG) and (4) control animals inoculated with phosphate buffer saline. Group 3, was considered as the best vaccine in this study because animal inoculated with this vaccine showed the following results compared with other antigens: - No lesion appeared along 90 days of following up.- Negative foot impression and culture up to 15 and 30 days of infection respectively, - Negative spleen and liver impression up to 30 days of infection when comparing with other groups.

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