Assessment of adiponectin as a marker for severity of pulmonary tuberculosis

To evaluate the serum levels of adiponectin in patients with both active and old pulmonary Tuberculosis [TB] and their possible relation with the severity of the disease, forty patients of both sexes suffering from pulmonary TB [20 cases active and 20 cases old] were matched with 20 healthy control volunteers in this study from February 2014 to June 2014. Body mass index [BMI] and serum levels of adiponectin were measured in all subjects. Both BMI and serum levels of adiponectin were significantly different between active TB patients and control. Comparing old TB patients with controls also have the same results. No correlation between BMI and serum adiponectin level in old TB patients was found, while adiponectin levels in active TB patients show a significant negative correlation. Increased adiponectin in serum of TB patients may be a promising marker for severity of the disease independent of BMI

Diagnostic and screening utility of biochemical markers for osteoporosis and osteopenia in Saudi women

Postmenopausal osteoporosis is a major health problem worldwide and in Saudi Arabia as it leads to bone fragility and increased liability for fragile fractures, particularly in neck of femur and vertebrae. The present study was designed to determine the value of different screening tests to find out the most sensitive serum and urinary markers of osteoporosis among Saudi women and to clarify the relationship between E[2] deficiency and these markers in peri-menopause, early or postmenopausal women without hormonal replacement therapy. This study included 37 Saudi women aged 40 to 60 years. They were categorized into 3 groups according to their bone mineral density [BMD]: Group I: 15 Normal control [T-score up to -1.5], Group II: 12 Osteopenic women [T-score between -1.5 to 2.5]and Group III:10 Osteoporotic women [T-score below 2.5]. For all subjects, dual energy X-ray absorptiometry [DEXA] was performed. Osteocalcin [OC], alkaline phosphatase [ALP], free galactosyl hydroxylysine [Gal-Hyl], calcium [Ca], inorganic phosphorus [P] and estradiol [E[2]] were measured in serum, whereas, deoxypyridinoline [Dpd] and creatinine levels were measured in urine. Simultaneously both osteopenic and osteoporotic groups showed significant decreases in BMD when compared to the controls. Osteocalcin, ALP and Gal-Hyl showed significant increase [p<0.0001] among the osteopenic and osteoporotic groups versus the control group. Significant decrease in E[2] levels were obvious among the osteopenic [p<0.0001] and osteoporotic [p<0.0001] women when judged against the controls. Urinary Dpd was significantly increased in the osteopenic and osteoporotic groups [p<0.001]. In osteoporotic group, significant negative correlations were observed between OC and BMD. Positive correlations were detected among the osteoporotic group between OC and ALP and between OC and Gal-Hyl. High significant negative correlations were confirmed between E[2] and OC among both the osteopenic and the osteoporotic groups. Also, a significant negative correlation was established between E[2] and Dpd in the osteoporotic group. In comparing between osteopenic and osteoporotic groups, significant decrease was recognized in BMD and significant increase was predicted regarding ALP, [p<0.05], Gal-Hyl [p<0.0001] and Dpd [p< 0.001]. Urinary Dpd may be a simple indicator for osteoporosis in postmenopausal women; however, screening should include the measurement of serum estradiol, galactosyl hydroxylysine, alkaline phosphatase and Osteocalcin to increase the sensitivity and specificity of primary screening to identify the groups at higher risk of osteoporosis which is the keystone in prevention of disabling fragility fractures

Macrophage migration inhibitory factor in systemic lupus erythematosus and its expression in lupus nephritis

The aim of this study was to access the potential involvement of MIF in SLE, its relationship with corticosteroid dose, also, to measure serum and urinary MIF levels in SLE as well as detecting renal MIF expression in SLE GN. Serum and urine MIF concentrations were measured by enzyme-linked immunosorbent assay in 20 SLE female patients with lupus nephritis, World Health Organization class II, III, IV, with mean age of 35.15 +/- 10.42 years and in 10 normal healthy, age matched, female volunteers. All patients were subjected to detailed clinical assessment and laboratory investigations. Serum and urinary MIF concentrations were measured by ELISA technique. Renal MIF expression was assessed by immunostaining of biopsy tissue. Univariate and multivariate regression analysis were used to examine the associations between serum and urine MIF concentrations, renal MIF expression, disease-related indices of SLE and corticosteroid use. A statistically significant 2.98-fold-increase was detected in mean urinary MIF [U MIF] levels in SLE patients compared to controls. While, mean Serum MIF [S MIF] showed no significant difference between cases and control. Both S and U MIF concentrations were positively correlated with SLICC/ACR DI but not with SLEIDAI. Corticosteroid doses showed a highly positive correlation with S MIF, serum creatinine and SLICC/ACR DI. Also a positive correlation was found between the different histopathologic grades of renal affection and the U MIF. Immunohistochemistry staining of all normal kidney specimens showed that MIF is constitutively weakly expressed by some glomerular and parietal epithelial cells and by most tubular epithelial cells. In contrast, there was a significant increase in glomerular and tubular MIF protein staining in SLE nephropathy. This increased MIF expression correlated positively with both S MIF and U MIF, SLICC/ACR DI and the daily steroid dose. This study shows that serum MIF is over-expressed in SLE patients and that the urine MIF concentration is significantly increased in SLE World Health Organization class IV patients and correlates with the degree of renal injury. Thus, urine MIF levels reflect MIF expression within the kidney

Complications of orthotopic ileal reservoirs

Objectives: To evaluate the early and late postoperative complications, upper urinary tract morphology and function and metabolic alterations which may occur after ileal continent orthotopic urinary diversion

Patients and Methods: Between July 1999 and January 2001, 42 male patients were subjected to radical cystoprostatectomy for bladder cancer and orthotopic urinary diversion at the urology departments of Cairo University and Suez Canal University Hospitals. All cases were evaluated clinically, bacteriologically, urodynamically and radiologically during the early and late postoperative periods [at 3 - 6 months and 6 - 18 months, respectively]. The patients were divided into three groups: in Group I [22 cases] a W neobladder was fashioned with the uretero-ileal anastomosis done by creating extramural serosally lined tunnels. In Group II [12 cases] a Camey II pouch was done with ureteroileal anastomosis by direct end-to-end anastomosis in four and by Le Duc technique in eight pouches. In Group III [8 cases] a Kock's pouch was done with the ureters being directly implanted in the afferent loop above the constructed intussusception ileal nipple valve. In all types of reservoirs we used 45 cm of the ileum. Preoperatively all but four ureters were normal. These four ureters were dilated and uretero-ileal anastomosis was done by extramural serosally lined tunnels

Results: In the early follow-up period total diurnal continence was achieved in 72%, 75% and 75% of the patients of Groups I, II and III, respectively, versus 91%, 83% and 88% in the late postoperative period. Nocturnal continence was achieved in 64%, 67% and 63% during the early postoperative period compared to 73%, 75% and 75% in the postoperative period for the three groups, respectively. In the early postoperative period complications occurred in 33% of the patients including ureteroileal leakage [9.5%], a prolonged pouchourethral anastomotic leakage [11.9%], wound dehiscence [4.7%], deep venous thrombosis [2.3%], bronchopneumonia [2.3%] and a prolonged ileus [2.3%]. Late complications occurred in 26.2% of the patients including urethral recurrence, pelvic recurrence and urethroileal anastomotic stricture in 4.8%, 14.2%, 4.8%, respectively and urethral stricture at the bulbomembranous junction in 2.4%. A higher incidence of renal deterioration was detected in cases where the ureters were implanted directly [60%] or in cases where the ureters were implanted by Le Duc technique [30%]. Deterioration was noted in 12.5% of the cases where the ureters were implanted in an intussusception nipple valve and in 4.5% of the renal units where the ureters were implanted in an extramural serosally lined tunnel. At 9 months postoperatively metabolic acidosis occurred in one patient with a Camey II neobladder

Conclusion: A number of early and late postoperative complications were encountered after orthotopic neobladder. Metabolic complications were found in the form of metabolic acidosis in one patient. The lowest incidence of renal deterioration was reported in cases with extramural serosally lined ureteroileal anastomosis

Effect of sickle cell trait on pregnancy: a prospective controlled study

The outcome of pregnancy in 192 women who have sickle cell trait was compared with that in 192 pregnant matched controls with normal hemoglobin. There was no statistically significant differences between the two groups in respect of the incidence of anemia, pregnancy induced hypertension, gestational diabetes mellitus or placental abruption. The only antenatal features which displayed significant differences between the two groups were in the occurrence of microscopic hematuria [11.4% versus 2.1%] and asymptomatic bacteriuria [8.3% versus 3.1%]. The incidence of urinary tract infection was higher in the sickle cell group but this difference was not statistically significant. There were no statistically significant differences between the two groups as regard to the incidence of preterm delivery, fetal distress, cesarean section, birth weight less than 2500 g or small for gestational age, incidence of stillbirth or perinatal mortality. The findings do not support previous reports that there may be definable pathologic correlates of child bearing in females with sickle cell trait

Prospective controlled study of subchorionic bleeding in threatened abortion

In a prospective study, the prevalence and prognostic significance of subchronic hematoma in patients with threatened abortion was determined. The study comprised 384 pregnant women who had vaginal bleeding in weeks 9-20 of pregnancy and a live fetus shown with sonography. Sonograms showed a subchronic hematoma in 64 patients [16.6%]. The average size of the hematoma was 24.9 ml [range 4- 160 ml]. The presence of a subchronic hematoma did not significantly affect the outcome of pregnancy. The rate of abortion was 12.5% in patients with subchronic hematoma and 11.9% in patients without evidence of subchronic hematoma. The rate of preterm delivery was 14.1% in patients with subchronic hematoma and 13.8% in patients without subchronic hematoma. No significant relationship was found between pregnancy outcome and site, echogenicity of the hematoma or the presence or absence of placental detachment. It was not the absolute volume but the relative volume of the hematoma that did affect the pregnancy outcome

Serum trace elements as possible indicators for nasopharyngeal carcinoma

This study was done on 11 patients with nasopharyngeal carcinomas and 12 normal control subjects. Serum iron, manganese, zinc and copper were measured before, and six months after irradiation of the malignancy. The preirradiation levels of serum zinc were significantly lower than the control level and showed significant rise after successful treatment, but remained at low levels in recurrent cases and cases with poor response to radiotherapy. The preoperative levels of serum copper were significantly higher than the control level and showed significant drop in successful cases, but remained at high levels in recurrent and case that did not respond adequately to radiotherapy. However, the serum levels of both iron and manganese did not show significant changes in malignant cases before and after irradiation. From this study, it may be concluded that the serum levels of zinc and copper may have good diagnostic and prognostic value in patients with nasopharyngeal carcinomas

Vascular territory of Pectoralis major myocutaneous flaps: anatomical study

The precise vascular territory of the pectoralis major muscle and variations of the acromiothoracic axis were investigated in a series of 50 fresh cadavers using dissection, selective intra-arterial dye injections and radiographic studies. The sternocostal portion and the clavicular head of the pectoralis major were found to have virtually independent vascular and nerve supplies. The pectoral artery supplied the former, whereas, the deltoid artery nourished the latter. The territory of the pectoral branch includes most of the sternocostal head, part of the clavicular head, and the skin over the sternocostal head except for the skin over the most medial and inferior part of the muscle. The pectoral artery runs more toward the lateral side of the sternocostal head than its medial side which may suggest that a lateral skin island has a better blood supply than the medial one. The dominant supply from the pectoral artery to the rib cage was found to enter around the fourth rib in the mid clavicular line. This supply is associated with an origin of the pectoralis major in this region. The rib segment which can be taken with the flaps as an osteomyocutaneous flaps extends from the costal cartilage medially to the anterior axillary line laterally on the fourth, fifth or sixth ribs. The deltoid artery supplies the skin over the shoulder. Suggestions, based on these anatomical studies, are offered to improve the versatility and safety of flaps designed in this area

Evaluation of the role of expansion hyoidplasty with and without hyoid suspension intreating obstructive sleep apnea

Obstructive sleep apnea [OSA] remains a therapeutic challenge, despite growing knowledge of the pathophysiology of the disease and development of new treatment modalities. This study included 50 patients with obstructive sleep apnea syndrome [OSAS] who underwent expansion hyoidplasty [EHP], 16 patients had EHP with hyoid suspension [HS] and 34 patients had EHP without HS. A subset of patients felt a subjective postoperative improvement confirmed by polysomnographic examination. EHP with HS, and EHP without HS had the same efficacy in treating the OSAS. Postoperative complications were minor irrespective of the surgical method used