Association between albuminuria and abnormal cardiac findings in patients with type 2 diabetic nephropathy: role of urine albumin excretion

Background: diabetic patients have higher morbidity and mortality rates from cardiovascular diseases compared with non-diabetic background population and this is distinct particularly in the patients with high Urinary Albumin Excretion [UAE]. The main aims of our study were to detect abnormal cardiac Jindings in patients with type 2 diabetic nephropathy and its relatioe to increased levels of UAE

Methods: our descriptive; cross sectional study consisted of 105 diabetic patients with documented diabetic nephropathy who attended diabetic out-patient clinic of internal medicine department, Assiut University Hospital, where routine investigation, glycated hemoglobin[HbA1c], 24-hour UAE and Trans-Thoracic Echocardiography [TTE] was done for all patients

Results: We evaluated 105 patients with type 2 diabetic nephropathy [56 males and 49 females] where patients were divided into two groups; group I included those with microalbuminuria [39%] [Age: 54.3 +/- 14.4y[mean +/- standard deviation]] years and group I1 included those with macroalbuminuria [61%] [Age: 59.7 +/- 7.9 y]. In comparison between two groups we found that there were significant relationship between the degree of albuminuria, occurrence of left Ventricular Hypertrophy [LVH] and Segmental Fall Motion Abnormality [SWMA] with [P < 0.001 and P=0.032] respectively

Conclusion: our data indicate a possible link between abnormal cardiac findings and progression of diabetic nephropathy. Data also suggest that assessment of cardiac morbidity by echocardiography in patients with diabetic nephropathy may be mandatory for early preventive strategies

Exploring the clinicopathological parameters affecting the outcome in Egyptian patients with multiple myeloma

Background: Multiple myeloma [MM] is a plasma-cell neoplasm in which the interplay of several clinical, pathological and genetic parameters affects the patient's prognosis and response to treatment and survival

Aim: The aim of this study was to evaluate the different clinicopathological parameters of MM patients in correlation with response to therapy, progressionfree survival [PFS] and overall survival [OS]

Methods: This retrospective study was performed on 60 MM patients diagnosed at NCI, Cairo University from January 2005 to December 2008. The patients were evaluated for different clinicopathological parameters which were correlated to their response to treatment, OS and PFS

Results: Sixty patients were followed up for a median period of 21 months wherein about 90% received 1st line treatment: 34 VAD, 17 MP and 3 dexamethasone. Six patients [10%] were referred for BSC. CR was achieved by 15%, 11.7% achieved good PR, 6.7% achieved PR, 22.1% have stable disease, 35% experienced disease progression. ECOG PS-I patients have 39 months median survival compared to 12 months for patients with PS ECOG-II [P 0.005]. Patients with multiple skeletal lesions [>/= 3] have median OS of 19 months [P 0.03]. Patients who presented with plasmacytoma have better OS than those without [38 months versus 14 months] [P<0.05]. Patients <60 years old have a better median OS compared to patients >60 years [37 months versus 12 months] [P 0.001]. OS was 39 months in female patients versus 14 months in male patients [P0.025]. Median OS was 9 months for patients with comorbidities versus 27 months for those without [P0.01], 39 months for patients with non-detected paraproteinuria versus 18 months for those with paraproteinuria [P 0.045], 18 months for stage II disease versus 12 months for stage III disease [P0.001], 12 months for patients with elevated serum LDH versus 39 months for those with normal levels [P 0.001], 27 months for patients with normal serum creatinine level versus 13 months for those with elevated levels [> 1.4 mg/dl] [P 0.005], 27 months for patients with normal serum calcium levels versus 10 months for those with hypercalcemia [P 0.03]

Conclusion: Besides FISH-guided molecular cytogenetic classification of myeloma abnormality, a specific risk-stratification model based upon the patient's age, sex, performance status, lytic bone lesions, plasma cells labeling index, serum creatinine, calcium, LDH, B2M and paraproteins in serum and urine, can depict the response to treatment, OS and PFS of patients with MM

Effect of perinatal exposure to monosodium glutamate on the visual cortex of adult albino rats

Monosodium glutamate [MSG], the sodium salt of glutamate, is commonly used as a flavor enhancer in many food preparations. Its use has become controversial because of reports of adverse reaction in people who have eaten foods that contain monosodium glutamate. One of these adverse reactions was the blurring of vision. The aim of this study was to investigate the impact of monosodium glutamate [MSG] on visual cortex of albino rats. A total 20 pregnant female rats were randomly divided into two groups. Control group and treated group which received monosodium glutamate by gastric gavages in a dose of 2 g/kg b.w from late pregnancy until the end of weaning. Offspring of two groups were left until puberty [2 month old pregnancy until the end of weaning. Offspring of two groups were left until puberty [2 month old rats]. The offspring of both groups were sacrificed at 60 days and their visual cortices were prepared for histological examination by light and electron microscope. The results revealed severe neuronal degeneration. The neurons of treated visual cortex contained hyperchromic, pyknotic nuclei. The cytoplasm became vacuolated and contains large lipofuscin pigments. The mitochondria became swollen with indented membrane, the Golgi apparatus were absent with the presence of few rough endoplasmic reticulum and free ribosome. The blood vessels were dilated with the presence of perivascular edema. It is concluded that the oral intake of monosodium glutamate during pregnancy and lactation has degenerating effect on the visual cortex of the raf's offspring

Improvement in systemic chemotherapy options for advanced cases of bilharzial bladder cancer

Bilharzial bladder cancer is a major health problem in Egypt, as well as some African and Asian countries it represents a distinct clinicopathologic disease. In order to investigate efficacy of chemotherapy in cases with advanced bilharizial bladder cancer as well as different clinicopathologic factors, that may impact response to chemotherapy, we conducted a phase III study, upon 58 patients, over the period from April 1999 to Dec. 2002. The 58 patients had pathologically proven bladder carcinoma on top of previous bilharzial cystitis presenting with either metastatic, inoperable, or recurrent disease. The 55 patient's evalvuable for response, 26 patients were randomized to receive single agent epidoxorubicin, claimed to be most active single agent in cases of bilharzial bladder cancer and the remaining 29 patients received the combination of epidoxorubicin with vincristine alternating with etoposide and ifosfamide. The clinicopathologic characteristics of the two groups were comparable, except for the higher frequency of grade 3 tumors in the combination chemotherapy group. Those who received single agent chemotherapy, had a response in only 4 cases response rate [15.38%] with only 2 cases achieving complete remission, those receiving combination chemotherapy had a response in 11 patients [response rate of 37.9%] with only 2 patients achieving complete responses. In terms of disease control rate [CR+PR+SD] epirubicin had a control rate of 46. 15%, with a mean TDP of 8 months and mean OS of 9 months, versus 62% for those receiving combination treatment with a mean TDP of 7 months and a mean OS. of 9.4 months. The 5 year actuarial PFS rate for patients who have achieved PR and CR in both treatment groups [15 patients] was 20.5%, SE = 5.8. Combination treatment group had a higher PFS of 36.2%, in contrast to 15.4% in the group receiving epidoxorubicin treatment, a difference that proved to be statistically significant [p=0.04]. Patients randomized to receive combination treatment had a higher 5 year overall survival rate of 37.9%, versus 25.5% in patient receiving epidoxorubicin treatment, however, this difference was not statistically significant [p=O.4]. Seventy six percent of patients receiving combination treatment expressed both MDR and p53 versus 33% and 50% respectively for those receiving single agent epidoxorubicin, yet such occurrence had no statistically significant correlation with response, but MOR affected OS and PFS for responding cases. Toxicity from treatment was in the form of vomiting, mucositis, diarrhea, leucopenia, anemia and were all comparable between both groups except for alopecia which was more prominent in those receiving single agent epidoxorubicin Among different clinicopathologic variables only the pathologic cell type seemed to affect response

Identification and characterization of resistance gene analog [RGA] and the leaf rust resistance gene Lr21 from the wheat cultivar Giza 168

Leaf [brown] rust caused by Puccinia triticina is a fungal disease of wheat [Triticum aestivum L.] that causes significant yield losses annually in many wheat-growing regions of the world. Host-plant resistance is the most economically viable and environmentally responsible method for controlling Puccinia triticina, the causal agent of leaf rust in wheat. The identification and utilization of new resistance sources is critical to continue the development of improved cultivars. The objective of this work was to identify defense-related genes against rust in the Egyptian rust resistant cultivar Giza168. Specific primers were designed on the basis of converse motifs of cloned resistance genes of the resistance gene analog [RGA] and leaf rust resistance gene [Lr21] in wheat [Triticum aestivum L.]. The designed PCR primers were subsequently used for RT-PCR using RNA isolated from a resistant variety to amplify fragments of 445 bp and 235 bp for RGA and Lr21 genes, respectively. The amplified products were cloned, sequenced and submitted to the GenBank. The nucleotide sequences of the amplified fragments were aligned with their corresponding genes using the BLAST. The expressions of the two genes in the infected and healthy plants were studied using RT-PCR. The RGA expression was induced and detected by RT-PCR, which is up-regulated by fungal infection. The Lr21 expression was detected on both healthy and infected plants, although the expression was higher in infected plants

Lower uterine segment morphological changes after caesarean section and its relation to abnormal uterine bleeding

The aim of this study was to use transvaginal sonography [TVS] in women with history of caesarean section to detect the presence of morphological changes in the lower uterine segment and to assess the relation of these changes to abnormal uterine bleeding [AUB]. The study included 114 women with history of previous caesarean section done more than 6 months ago. The study population was divided into two groups according to the presence of AUB; group 1, the symptomatic group [n=28] and group 2, the asymptomatic group [n=86]. TVS was performed at day 8 to 12 of the menstrual cycle for evaluation of lower uterine segment and previous scar. Among women with AUB, 20 [71.4%] had post-menstrual spotting, 5 [17.9%] had mid-cycle metrorrhagia, and 3 [10.7%] had both symptoms. Caesarean scar diverticula were more common among those with abnormal uterine bleeding [75% Vs. 30%, p<0.001]. In both symptomatic and asymptomatic patients, diverticula were more frequent in patients who performed CS more than 5 years ago [p<0.001]. In women with history of previous cesarean deliveries who have spotting bleeding after the end of menstruation or non-cyclic bleeding not related to menstruation, cesarean section scar defects should be added to the differential diagnosis of their condition

rare late complication of Meckel's diverticulum: diverticulitis induced parietal abscess presenting with multiple abdominal wall fecal fistulae. a case report and review of the literature

This paper presents a case report of 5 years old boy who presented with abdominal pain and fever to the pediatric reception room since four weeks. He was examined and investigated and the possibility of appendiciditis was excluded and a diagnosis of acute non specific mesenteric adenitis was coined. Follow-up medical treatment with antibiotics and conservative measures yielded a parietal abscess in the right iliac region. Simple incision drainage revealed pus and intestinal fecal content. A fecal fistula of appendicular origin was thought for and conservative management continued. However, investigation revealed a communication to the small intestines, and the multi-orifices draining fistulae caused a severe water and electrolyte imbalance with acidosis and emaciation. A decision at exploration revealed a complicated Meckel's diverticulitis, stuck to the abdominal wall and penetrating the muscular wall to end in an arborisation of fistulae in the right iliac fossa and right lumbar region. Resection anastomosis ensured a sound healing of the condition. The peritoneal cavity was exempted from any leak or peritonitis

impact of the genetic polymorphism of paraoxonase gene [PON1] on the incidence of coronary vascular disease in Saudi population

Cardiovascular diseases as being one of the major causes of morbidity and mortality drags attention for the study of their pathogenesis which seems multifactorial including habitual/ environmental and genetic causes. The major cause for atherosclerosis is deposition of oxidized lipoproteins in the blood vessel. Paraoxonase [PON1], an enzyme tightly linked to HDL plays an important role in decreasing the susceptibility of LDL-cholesterol for oxidation, thus minimizing atherosclerotic changes in the blood vessels. Paraoxonase activity in the serum alone is not a determining factor for this role. This function is also controlled and affected by many polymorphisms occurring in the PON1 gene, The aim of this study was to evaluate the effect of one of this genetic polymorphism [at position 192] on cardiovascular diseases in Saudi population. This study included 169 subjects [100 cases and 69 controls]. For all participants in the study paraoxonase activity, lipid profile, Apo A-l and genetic polymorphism was done. The percentage distribution of this genetic polymorphism differs in Saudi population than those observed in previous studies as in Mexican population and is more similar to those in Japanese population. There was no significant difference in the genetic distribution between control and CVD groups. The activity of paraoxonase was lower in the CVD group compared to the control; also there was no significant correlation between this genetic polymorphism and the lipid composition of the blood. PON1 activities toward paraoxon are lower in subjects with CVD than in control subjects regardless of the PON1 genotype although the PON1 activity is much lower in RR genotype than QQ genotype

Low-molecular-weight heparin plus low-dose aspirin versus low-dose aspirin alone in preventing adverse obstetric outcomes in high risk pregnant women

To compare the efficacy of combined low-molecular-weight heparin [LMWH] plus low-dose aspirin [LDA] versus LDA alone in improving pregnancy outcome in cases with high-risk of preeclampsia. In this prospective randomized study, fifty pregnant women with high-risk factors were randomly allocated into two treatment groups; group A [n=25] received LDA and group B [n=25] received LMWH in addition to LDA. Preeclampsia occurred in 7 cases [28%] in group A and in 3 cases [13.6%] in group B [p=0.297]. Two cases of group A developed severe preeclampsia. Gestational age at delivery was 36.7 +/- 2.2 weeks in group A versus 38.1 +/- 0.85 weeks in group B [p=0.001]. The fetal weight in group A was 2393 +/- 407 and 2865 +/- 364 in group B [p<0.001]. Fetal complications occurred in 8 cases [32%] in group A an one case of group B [p=0.025]. No cases of serious side effects of LMWH have been recorded. Combined low-molecular-weight heparin plus low-dose aspirin appear to be more effective than low-dose aspirin alone in preventing adverse obstetric outcomes in pregnant families with previous history of preeclampsia, chronic hypertension, renal diseases, or diabetes

Maternal vitamin B12 and the risk of fetal neural tube defects

Folic acid insufficiency is a known risk factor for neural tube defects [NTDs], while the role of vitamin B12 is questionable. Thus, our purpose was to investigate if low maternal serum vitamin B12 is associated with an increased risk of NTDs. Prenatal Diagnosis and Clinical Genetics Clinics, National Research Center, in collaboration with the Radioisotope Department, Nuclear Research Center. The study groups included 36 women who were, or had been, pregnant with a NTD-affected fetus. The control groups comprised 35 healthy women with normal prior or current pregnancy and uncomplicated obstetric histories. Fasting plasma homocysteine, serum folate and cobalamin [vitamin B12] were performed. Odds ratio [OR] and 95% confidence intervals were calculated. The fasting homocysteine was significantly higher in the study groups as compared to the controls. The median serum folate concentrations were similar in cases and controls. While the median vitamin B12 concentrations were significantly lower in the study groups compared to the controls. Low vitamin B12 concentration was associated with an approximately 2 to 3 fold increased risk for NTDs. Low maternal serum of vitamin B12 can be considered an important etiologic factor for the development of neural tube defects in our population. This may help in both genetic counseling for families with history of NTDs malformation, and as a preconceptional prophylactic measure by maternal supplementation of vitamin B12 and folic acid

Prevalence of hepatitis C virus infection in patients with B-cell non-Hodgkin's lymphoma

The purpose of this study was to determine the prevalence of chronic hepatitis virus infection [HCV] in patients with B-cell non-Hodgkin's lymphoma [B-cell NHL]. This controlled, cross sectional study included 30 patients with B-cell non-Hodgkin's lymphoma [B-cell NHL], 30 patients with malignant hematologic neoplesia other than B-cell NHL [control group I] and 30 patients randomly selected from general medical patients and healthy blood donors with non-malignant conditions [control group II]. All study populations were tested for antibodies to HCV by using a second-generation enzyme-linked immunosorbent assay [Anti-HCV EIA II]. Positive and indeterminate results were subjected to confirmatory testing using RLBA-hepatitis C virus [recombinant-based immunoblot assay- RIBA II]. Hepatitis C virus RNA was detected by a reverse transcription polymerase chain reaction [RT-PCR] assay. The results of this study indicated a higher prevalence of hepatitis C virus infection in patients with B-cell non-Hodgkin's lymphoma than in the control groups. The prevalence of hepatitis C virus infection in the two control groups, in turn, seems to fall within the estimated prevalence in the general population. These results raise the possibility for a subslantial role of chronic HCV infection in the aetiopathology of non Hodgkin's lymphoma

Mycotoxins in breast milk and its health hazards on breast fed infants in Sharkia, Egypt

In recent years, International Health Officials issued several warnings about the contamination of food with moulds and mycotoxins, as an emerging important health and economic problem. Mycotoxins are naturally occurring secondary metabolites of moulds that may be present in food products. Mycotoxicosis occur more frequently in developing countries, with hot and humid climate, favorable for the growth of moulds. The contamination of human breast milk with mycotoxins has been a matter of considerable concern. However, despite the recognition of the potential risk to humans, there are very few data in the literature regarding prevalence and impact of these toxic substances on infant health. The objective of this study was to identify if serum and breast milk of lactating mothers, are contaminated with mycotoxins [Aflatoxin and Ochratoxin], in Sharkia Governorate, and to study the effect of these toxins on kidney and liver functions of their exclusively breast fed infants. The results shows high total contamination rate of mothers' sera samples [82%], with aflatoxin, ochratoxin, and both, accounting for 10%, 34% and 38%, respectively. Breast milk samples were also highly contaminated [82%] with aflatoxin, ochratoxin, and both, in rates of 10%, 32% and 40%, respectively. Meanwhile, infants' sera accounted for 80% contamination rate with 10%, 32%, and 38%, respectively. Significant positive correlation between mothers' milk aflatoxin and ochratoxin on one side and that in infants' and mothers' sera on the other side was observed. Meanwhile, a significant negative correlation between infants' serum aflatoxin and infants' length/ age was reported. As markers of kidney function in study infants, both urinary microalbumin and beta 2 - microglobulin were significantly higher in infants positive for ochratoxin or ochratoxin and aflatoxin, than in those negative for this mycotoxin. In conclusion, subjects of Sharkia Governorate, Egypt, including the sample population of lactating mothers, are exposed to contamination by mycotoxins; lactating infants of mothers contaminated with mycotoxins, who were exposed to these mycotoxins prenatally, continue to be exposed, postnatally via breast milk. Finally, that mycotoxins may have adverse effects on the growth of infants, with the length/age as the most sensitive anthropometric measurement and that ochratoxin possibly have a nephrotoxic effect, in contaminated lactating infants. A wider scale study that includes different governorates is needed to facilitate the design and plan for a prevention and control program

Study of atresia in the ovary of bagrus bayad during the reproduction cycle by histological and electron microscopic investigation

Atretic follicles in ovary of the Nile teleost fish, Bagrus bayad, were followed through out the spawning period. They have been examined under light microscope. Six types of atresia have been distinguished, Two of them have been subjected to the electron microscope examination. In general, atretic follicles have been found in mature and tertiary yolk oocytes stage. They were measured to be larger than 400 micro in diameter. The Observed sequences for atretic follicles were as follows: erosion of thecal layer, hypertrophy of granulosa, and finally dissolution of ooplasm. In ultra structure examination erosion of thecal layer appeared as ill-defined cell outline with obvious separation between granulosa and thecal layer. Beside, junction of complex vanished. In addition, the zona radiata ruptured to small fragments. In conclusion atresia in Bagrus bayad is a functional activity of oocyte development which might be influenced by hormonal mechanism that regulate oocyte growth and recruitment

effect of autologous fibrin glue [AFG] on fluid drainage after modified radical mastectomy

Patients who have modified radical mastectomy for breast carcinoma accumulate serosanguineous fluid, potentially resulting in seroma. Fibrin glue has been shown to be effective in reducing seroma formation in animal models, and in some studies on man. The objective of this study was to determine whether an autologous fibrin glue [AFG] is safe and effective when used as a sealant agents in this patients and to determine the dose response of these agent on the time and amount of fluid drainage. Fourty patients were included in this study. One hour before surgery the blood was withdrown from the patients to prepare AFG by using the ammonium sulphate precipitation method. After completion of modified radical mastectomy the patients were randomly divided into four groups each one contain ten cases. The first group was the control group, but in the second group AFG was used with 4mL in axillary site and 4mL at the skin flap site. In the third group 8mL was sprayed both in axillary site and skin flap site. The fourth group included cases to them l6mL of AFG were applied to the axillary site and 8 mL to the skin flap site. The wound was closed very rapidly after sealant application and two drains were left. Post operative antibiotic for three days was used to all cases beside close observation to daily fluid drainage for 12 days. The results showed that AFG application reduced the time to drain removal [5.4 +/- 2.4 days] and decrease the amount of fluid drainage of the fourth day of surgery more obviously in group 4 [492 +/- I89 ml.] and without complications related to the sealant. For that we recommended its use to all cases subjected to modified radical mastectomy

Theoretical calculations of radiation exposure from Egyptian phospho-gypsum

A theoretical study and computer simulation search program has been developed to calculate the gamma radiation doses from thin sheets of Egyptian phosphogypsum containing an average 226 Ra concentration of 750 Bq/kg. A comparison study using a natural gypsum has been made. The calculations presented in this paper are much more realistic in aspect that they take the geometry of the building materials into account. The methodology outlined in this paper can be used for calculations of gamma doses for any building material which satisfied assumptions used here, in particular that there is no significant absorption of gamma radiation in the air or the source material. The obtained results of this developed program are compared with other published results

Prevalence of hepatitis c virus infection in patients with B-cell non-Hodgkin's lymphoma

This controlled, cross-sectional study included 30 patients with B-cell non-Hodgkin's lymphoma [B-cell NHL], 30 patients with malignant hematologic neoplesia other than B-cell NHL [control group I] and 30 patients randomly selected from general medical patients and healthy blood donors with non-malignant conditions [control group II]. All study populations were tested for antibodies to HCV by using a second-generation enzyme-linked immunosorbent assay [anti-HCV EIA II]. Positive and indeterminate results were subjected to confirmatory testing using RIBA-hepatitis C virus [recombinant-based immunoblot assay-RIBA II]. Hepatitis C virus RNA was detected by a reverse-transcription polymerase chain reaction [RT-PCR] assay. The results revealed that infection with HCV was detected in nine patients with B-cell non-Hodgkin's lymphoma compared with two of 30 patients in control group I and one of 30 patients in control group II. All the three groups were matched as regarding age, sex and risk factors for hepatitis C virus infection. Patients with B-cell NHL who were HCV positive and HCV negative did not differ significantly with respect to the prevalence of low-grade [22.3% and 28.6%], or intermediate to high-grade lymphoma [77.7% and 71.4%]. In conclusion, the results of this study indicated a higher prevalence of hepatitis C virus infection in patients with B-cell non-Hodgkin's lymphoma than in the control groups. The prevalence of hepatitis C virus infection in the two control groups, in turn, seems to fall within the estimated prevalence in the general population

Bilateral buccinator mucomuscular flaps with double opposing z-plasty for repair of wide and/or complete cleft palate

Furlow procedure remains our procedure of choice for narrow and incomplete clefts. In wide clefts of the palate there is no enough tissue present to allow closure of the cleft without side-to-side tightness as to impede drastically palatal function. In this study we have combined the Furlow technique with bilateral buccinator mucomuscular flaps. We repaired 12 wide and/or complete clefts by this technique. Only one postalveolar fistula was reported. Further follow-up is going on to evaluate the long term effects of this technique on speech and maxillary growth

Bilateral buccinator mucomuscular flaps with double opposiong Z-plasty for repair of wide and/or complete cleft palate

Furlow procedure remains our procedure of choice for narrow and incomplete clefts. In wide clefts of the palate there is no enough tissue present to allow closure of the cleft without side-to-side tightness as to impede drastically palatal junction. In this study we have combined the Furlow technique with bilateral buccinator mucomuscular flaps. We repaired 12 wide and/or complete clefts by this technique. Only one postalveolar fistula was reported. Further follow-up is going to evaluate the long-term effects of this technique on speech and maxillary growth

Impact of some prognostic factors on breast cancer survival after postoperative adjuvant therapy

Our present study included 206 female breast cancer patients who underwent surgical management followed by postoperative adjuvant therapy. Patients referred to Radiation Oncology Unit, Radiology Department, Tanta University Hospitals during the period between September 1987 through December, 1991 were included in this study. Breast cancer patients [368] represent 41.5% of all female attended and 18.3% of all malignant cases. Of which 206 [23.5%] where studied. All patients were female with a mean age 46.5 [range 21-76 years]. All cases were followed for a minimum period of three years. The factors of prognostic importance were age, menstrual status, tumor size, and axillary nodal involvement on the other hand tumor site and histological types were of non-significant value