Assessment of endovascular management of extracranial internal carotid artery stenosis

Background: Carotid artery stenting [CAS] had become widely used as an alternative to carotid endarterectomy [CEA] in revascularization therapy of carotid artery stenosis, especially in some high risk patients for surgical intervention

Objective: The purpose of this study was to evaluate the outcome and follow up of cases that undergo extracranial CAS at the Neuroendovascular Unit of Ain Shams University Hospital

Methods: During a 30 month period, 50 cases were enrolled and underwent carotid artery stenting with open cell [Protege [registered] - EV3] or closed cell [Wall stent[registered] - Boston scientific] stents. A filter device for embolic protection [Spider filter[registered] - EV3] was used. Clinical assessment with the National Institute of Health Stroke Scale [NIHSS] together with post procedural diffusion-weighted magnetic resonance imaging [DW-MRI] was used to determine cerebral embolization

Results: CAS was performed in 50 cases; 40 [80%] symptomatic and 10 [20%] asymptomatic. A similar number of open-cell and closed-cell stents were used. New acute cerebral emboli were detected with DW-MRI in 12% [6/50] of cases after the procedure. Three [3/50] cases [6%] showed corresponding clinical deterioration in NIHSS; two cases developed minor stroke and the third case developed a major stroke

Conclusion: CAS at Ain Shams Neuroendovascular Unit showed a high technical success rate and good short term clinical outcome

Cardioprotective and antioxidant effects of oleogum resin "Olibanum" from Bos Boswellia carteri Birdw. (Bursearceae) / 中国天然药物

One of the leading causes of death worldwide is cardiovascular disease, hence searching for a cure is an important endeavor. The totally safe, edible, and inexpensive Boswellia plant exudate, known as olibanum or frankincense, is considered to possess diverse medicinal values in traditional medicine and from recent biological studies. Investigating the cardioprotective and antioxidant activities of olibanum from a Boswellia species, family Bursearaceae, namely Boswellia carteri Birdw. was the aim of this study. Cardioprotective activity was evaluated using a model of myocardial infarction induced by isoprenaline (ISO), while antioxidant activity was tested adopting nitric oxide scavenging (NOS) and azino-bis-3-ethyl benzthiazoline-6-sulfonic acid (ABTS) assays. The results revealed a mild cardioprotective effect and weak antioxidant activity.

Secondary glaucoma as initial manifestation of uveal melanoma

Secondary glaucoma can be induced by a variety of local ocular problems. Intraocular tumors may initially present as secondary glaucoma. 8 consecutive patients with secondary glaucoma were found to have uveal melanoma. Thorough examination included detailed history, fundus examination with scleral depression, B scan ultrasonography, and CT/MRI scanning techniques. Results: A single case presented with spontaneous hyphema, two patients presented with secondary glaucoma, extraocular melanoma and metastases, a single case was found to have angle block by an iridociliary ring melanoma and 4 cases presented with neovascular glaucoma. Enucleation was necessary in all 8 cases. General ophthalmologists should be aware of these rare initial manifestations of intraocular tumors as secondary glaucoma. Enucleation would be recommended in most cases of intraocular malignancy manifesting as secondary glaucoma. One should be extremely cautious in doing a penetrating surgery in such cases

Awareness of World Health Organization methicillin-resistant Staphylococcus aureus guidelines at Alexandria university hospitals

This cross-sectional study aimed to assess knowledge of routes of transmission, awareness of MRSA control guidelines and reasons for non-adherence to guidelines among medical staff at Alexandria University hospitals. A random sample of 158 physicians and 47 nurses answered a self-administered questionnaire. Overall awareness of MRSA control guidelines was 67.3%, and nurses were significantly more aware than physicians [91.5% versus 60.1%]. The lowest awareness level was among anaesthesiologists; only 54.4% knew the correct transmission routes. Among medical staff overall, 70.0% accepted the necessity of screening measures for high-risk patients and 35.8% of doctors accepted the use of the same pair of gloves when caring for different body sites on an individual patient. Lack of resources was the most common justification for suboptimum adherence. The study showed low awareness levels of MRSA-related guidelines

Evaluation of specific biochemical indicators of Helicobactepylori-associated gastric cancer in Egypt

The aim of the study was to assess the accuracy of some specific biochemical indicators in discriminating between Helicobacter pylori-associated gastritis and H. pylori-associated stomach cancer [serum gastrin level, serum soluble E-cadherin and tissue COX-2 activity, as well as serodiagnostic markers for H. pylori infection] in order to find a simple diagnostic test that can reasonably predict the development of gastric cancer. The study participants comprised 20 patients with gastric carcinoma, 20 patients with positive H. pylori-associated gastritis and 20 individuals as the control group. Standard procedures and quality control measures were followed. Using cut-off values and ROC analysis to assess the diagnostic abilities of the biochemical indicators, E-cadherin showed the highest sensitivity [100%]. We suggest that close follow-up together with periodic endoscopic examination for all patients with persistent H. pylori infection and serum soluble E-cadherin level above 5 microg/mL is essential

Evaluation of two doses of triclabendazole in treatment of patients with combined schistosomiasis and fascioliasis

To determine the safety and efficacy of 2 consecutive doses of triclabendazole [TCBZ] in the treatment of Schistosoma mansoni infection in human cases infected with both S. mansoni and Fasdola spv we conducted afield survey involving 6314 individuals from 15 villages. The overall prevalence of schistosomiasis alone was 15.8%, of fascioliasis alone 2.2%, and of combined infection 0.7%. Treatment with 2 doses of TCBZ was given to the 49 cases with combined infection. Eight weeks after treatment, the cure rate was 96% for fascioliasis and was 32.7% for schistosorniasis. All schistosomiasis cases cured had a low intensity infection. Liver function tests done before I treatment and 8 weeks after substantiate the safety of 2 doses of TCBZ given to those with combined infection. Administration of TCBZ should precede praziquantel in treatment of combined infection, however TCBZ cannot be recommended for infection with S. mansoni alone

Hepatic expression of the proliferative marker Ki-67 and cell cycle p53 protein in chronic hepatitis C [a histopathological and immunohistochemical study]

To evaluate hepatic expression of the nuclear proliferative marker Ki-67 and the cell cycle marker p53 oncoprotein in chronic hepatitis C in relation to the advanced stages of liver fibrosis in HCV positive Egyptian patients. Paraffin-embedded liver biopsy specimens were studied from 21 untreated patients with chronic HCV infection. All patients were HCV antibody positive, as determined by a commercially available enzyme-linked immunosorbent assay kit. Patients having other etiologies for chronic liver disease including HBV infection were not included in this study. Liver biopsies were obtained percutaneous. All biopsies were fixed in formalin, embedded in paraffin, and sectioned by microtome with a thickness of 5 ?m. Routine specimen processing involved staining slides with hematoxylin and eosin [5 levels], Masson's trichrome stain [5 levels], for a total of 10 levels per specimen All levels were screened. All specimens were examined by two pathologists, and classified by consensus for all abnormal histological findings. The histological activity index [or histological grade] was determined using Ishak grading scheme22 expressed as a semiquantitative score for portal inflammation [0-4], lobular activity sporadic lytic foci [0-4] and parenchymal confluent necrosis [0-6], and piecemeal necrosis[0-4]. The extent of fibrosis [or histological stage] was determined using Ishak score [0-6]. Steatosis was scored according to Keliner et al 2005, from grade 0 to 3; where S0 = no steatosis or less than 5% [low or medium power evaluation] of parenchymal involvement by fatty changes, S1 [mild] = 5%-33%, S2 [moderate] = >33%-66% and S3 [severe] > 66% of the hepatocytes are involved by fatty changes. Expression of p53 and Ki67 were determined by immunohistochemistry, using avidin-biotin-peroxidase. Liver histology: The studied group [n = 21] involved 16 males and 5 females [male to female ratio 3.3:1]. The histopathological findings of HCV infection, including portal lymphoid infiltration, periportal piecemeal necrosis, lymphocyte infiltration of the lobules, hepatocellular necrosis, steatosis and fibrosis, were studies. The age ranged from 31 to 59 years old with mean of 44.86 +/- 8.74, males 76.2%, females 23.8% .P53 expression was positive in 52.4% and negative in 47.6%. cytoplasmic localization dominated over nuclear expression. Ki 67 was negative in 81% of cases and positive in19% of cases, all cases in stage 6 were positive for p53 while there were no difference in the other stages of fibrosis, and this relation was statistically significant. There was no relation between the grade of necro-inflammation and the expression of p53, and this result was statistically non significant.There was a relation between the percent of steatosis and the expression of p53 as percent of positivity increases with the increase of the percent of steatosis, and this result was statistically significant using independent sample t test and regression test.All negative cases for P53 have negative Ki67 but this rule is not applied on positive cases for P53, and this relation was not statistically significant. There was no relation between the grade of necro-inflammation and the expression of Ki67, and this result was statistically non significant. Hepatic expression of the nuclear proliferative marker Ki-67 and the cell cycle marker p53 oncoprotein in chronic hepatitis C in relation to advanced stages of liver fibrosis in HCV positive patients are expressed in a considerable present of cases which should be cansdidates for follow up for early detection of hepatocellular carcinoma

Factors affecting the clinical picture and prognosis of puffer fish poisoning in Suez city [Egypt] during year of 2008

Puffer fish is a common form of poisoning throughout Egyptian coastal cities such as Suez city. Puffer fish contains one of the most powerful marine toxins which is called tetrodotoxin. We attract attention of health professional to toxicity of puffer fish and factors affecting the clinical picture and outcome of poisoning which will help for early diagnosis and proper management. The study was carried out nine patients with history of puffer fish ingestion transferred to General Suez Hospital. Diagnosis was made on the basis of recent dietary history and clinical presentation. All cases were clinically examined, investigated and observed from admission to discharge. All patients were treated with gastric lavage, activated charcoal and symptomatic. Accordingly to clinical grading system for tetrodotoxin toxicity, three patients had grade 1 and another three had grade 2 but, three fatal cases had grade 3 and their condition worsened and became grade 4. The onset of appearance of toxic symptoms of puffer fish poisoning was rapid. All investigations for all patients were within normal limits. Clinical manifestations of poisoning were mainly neurological, but the cardiovascular effects were not common in the majority of patients. Toxic manifestations were wide range from mild to severe according to state of preparation and clean of puffer fish. Fatal cases ate gonads and head of fish and the cause of death was respiratory failure. The factors affecting the severity and the prognosis of puffer fish toxicity are the mode or preparation, the clean and the eaten part of fish

Study of IL-10 and Il-18 levels in relation to different stages of liver fibrosis in Egyptian chronic hepatitis C infected patients

Most acute and chronic liver diseases are characterized by inflammatory processes with enhanced expression of various pro-and anti-inflammatory cytokines in the liver. These cytokines are the driving force of many inflammatory liver disorders often resulting in fibrosis and cirrhosis. This work aimed to identify the role of serum IL-10 and IL-18 in the pathogenesis of chronic hepatitis C in different grades and stages of HCV patients and correlate their levels to the necroinflammatory grade and stage of fibrosis. A prospective study on [55] HCV infected patients 43 males and 12 females, their age ranged from 20 to 55 years with a mean of 41.3 year and [20] age and sex matched control [HCV-ve] from National Hepatology and Tropical Medicine Research Institute clinics, from whom consents were taken. The patients included in this study were those originally enrolled on protocol for treatment [interferon + ribavirin] where liver biopsy was required for eligibility of treatment according to the approved protocol. 5ml of blood was collected at the same day of biopsy for assessment of IL-10 and IL-18 levels in blood [ELISA technique]. Serum level of IL-18 was significantly higher in patients with chronic HCV [126.80 +/- 11.76 pg/ml] as compared to control group [45.97 +/- 5.26 pg/ml]; the level was even higher in cases with hepatocellular carcinoma [HCC]. IL-18 levels were significantly higher in patients with early fibrosis than in patients with advanced fibrosis., it was also higher in case with minimal to mild necro-inflammatory grade than in cases with moderate to severe grades, but that difference was not significant. As regards serum IL-10, the level was also higher in patients with chronic HCV [9.24 +/- 1.9 pg/ml] than control group [3.28 +/- 1.81 pg/ml]. Serum IL-10 level was significantly lower in early than advanced stages [P=0.04]. When classifying cases according to necro-inflammatory grade the IL-10 level was lower in minimal/mild cases than moderate /severe cases, but this difference wasn't statistically significant. Serum concentrations of IL-10 and IL18 could be correlated to the histopathological spoilage of the liver as they can predict the stage of fibrosis and hence can be used as indirect markers to assess the severity of liver disease in HCV infected patients. They can also be used as complementary markers in HCC patients

Fetal valproate syndrome in a 2-month-old male infant

Fetal valproate syndrome [FVS] results from prenatal exposure to valproic acid. It is characterized by a distinctive facial appearance, a cluster of minor and major anomalies and central nervous system dysfunction. We describe a 2-month-old male infant with the typical dysmorphic features characteristic of FVS. He had a persistent left superior vena cava draining into a dilated coronary sinus and mild pulmonary hypertension. There was a history of maternal intake of sodium valproate during pregnancy

Role of vitamin-E on rat liver-amiodarone: an ultrastructural study

Amiodarone, a class III antiarrhythmic drug, has been found to be effective in the management of patients with life-threatening ventricular arrhythmias. The aim of this study was to test whether the co administration of vitamin-E with amiodarone can reduce amiodarone-induced liver damage. Twelve male albino rats were divided into three groups [ml vegetable oil/day by oral gavages daily for 2 weeks and were used as control group. The rats of the second group received 5.4 mg amiodarone/100 gm rat dissolved in vegetable oil daily by oral gavages for 2 weeks. In the third group, the rats received 5.4 mg amiodarone and 5 mg vitamin-E/100 gram rat dissolved in 2 ml vegetable oil by oral gavages daily for 2 weeks. Two weeks after treatment, the rats were sacrificed and liver specimens were immediately taken and processed for transmission electron microscopic examinations. Sections from the rat liver receiving amiodarone examined by electron microscopy showed disrupted hepatocytes with increased vacuolations. Degenerated organelles and disrupted nuclei were observed. The microvilli of bile canaliculi were disrupted and the hepatocytes showed increased lipid contents. Both endothelial cells and Kupffer cells were damaged. Phospholipids inside the mitochondria showed a loss of cristae. Sections from the liver of rats received amiodarone and vitamin-E showed lesser effects, especially in depositions of phospholipids in the mitochondria and the whole organelles and the nucleus showed minor damage in comparison to the previous group. Milder hepatotoxic effects are seen in rats administered amiodarone and vitamin E simultaneously suggesting that vitamin-E may play a role in amelioration of the effects of amiodarone

Effect of Helicobacter pylori eradication on platelet count in patients with chronic idiopathic thrombocytopenic purpura

This study was carried out on 40 patients [14 men and 26 women] have Chronic Idiopathic Thrombocytopenic Purpura [cITP]; their ages ranged from 48 to 70 years in males and 46-62 years in females, mean age +/- SD[5 7.5 +/- 11.4 and 56.6 +/- 8] years respectively among those referred from the Outpatients clinic and inpatients Department of general and Tropical Medicine Departments, Faculty of Medicine, Al-Azhar University Hospitals, from April 2007 to July 2009 . Results showed: Of 40 cITP patients, H.pylori infection was found in 25 [62.5%] patients were noted between infected men [6 infected versus 8 uninfected] and women [19 infected versus 7 uninfected], no significant differences were found as regards ; age and gender, clinical factors between the responders amid the non responders. The eradication of H.pylori was achieved in 76.9% [10 of 13] of these patients. The platelet recovery was significantly different between the eradication group 61.5% [8 of 13] and the non-eradication group [zero% . 0 of 12].The eradication of H. pylori infection in patients with cITP was associated with a platelet response in 46.1% [6 of 13] in the eradication group [4 Complete Response and 2 Partial Response] and zero% in the non-eradication group [P<0.01]. The platelet response was also significantly more common in patients with infection sustained by CagA-positive strains of H .pylori [P=0.04]. H. pylori virulence factors and the urease activity were not associated with the response. cITP H. pylori positive patients showed significantly lower platelet counts compared to H. pylori negative patients. H. pylori eradication in patients with cITP is effective in increasing platelet count. The titers of anti-CagA antibodies in the responders were significantly higher than those in the non responders [p=0.04]

Modulation of gonadotrophin release from pretreated male camel pituitary cell culture with inhibin and both calcium agonist and antagonist

The present study was conducted to identify the modification carried out by both calcium agonist [Cacl2] and antagonist [VHcI] and inhibin like material [OTLP4] on the GnRH stimulated release of FSH and LH from male camel pituitary cell culture collected during breeding and non breeding seasons. The data obtained showed that 100 and 200 ul/ ml of GnRH was able to release both FSH and LH from pituitaries collected during the year. OTLP4 as an inhibin-like preparation was able to block FSH release from the pituitary especially during non breeding season. Calcium chloride pretreatment has a pronounced effect on LH release without any effect on FSH. The higher dose of calcium chloride unable to release LH from pituitaries collected during breeding season and it may be due to the calcium desensitizing effect. VHcl has a potent effect in blocking LH release to the media by all doses used. The blocking effect on FSH was obtained only when VHcI was used in a higher dose. The use of VHcl in the field for treatment of cardiovascular diseases and its effect on male reproduction need further in vivo investigation

Evaluation of serum cartilage oligomeric matrix protein [Comp], soluble tumour necrosis factor receptor-II[sTNF-RII] and interleukin-6 [IL-6] levels in relation to serum estradiol, functional and radiologic findings in postmenopausal females with knee joint osteoarthritis

To evaluate the possible relation between serum levels of cartilage oligomeric matrix protein COMP, sTNF-RII, IL-6 and estradiol in post-menopausal females with clinically and radiologically documented osteoarthritic changes in the knee joint. Twenty post-menopausal females [PMOA] -with clinically and radiologically documented knee joint osteoarthritis were compared to a control group of ten post-menopausal females [control group [I]] and ten pre-menopausal females [control group [2]] "who were clinically and radiologically free of knee joint osteoarthritis. To all the studied subjects, a complete clinical examination was performed, including body mass index calculation, as well as scoring .systems for functional assessment of joint. Plain X-ray of both knee joints was performed. Serum samples were obtained for analysis of urea, creatinine, uric acid, total calcium, inorganic phosphates, C-reactive protein, rheumatoid factor COMP, sTNF-fUI, IL-6, and estradiol levels. The mean serum estradiol values in the PMOA, and control group [I] were significantly lower than their corresponding value in control group [2], and slightly lower in the PMOA than control group [1]. The mean serum COMP value was slightly higher in the PMOA group than its corresponding value in control group [1], and both mean sera values were significantly higher than their corresponding mean value in control group [2]. The mean serum sTNF-RII value was significantly higher in the PMOA group than its corresponding values in control group [1] and control group [2]. As regards mean serum IL-6 value, it was significantly higher in control group [1] than its corresponding values in the both PMOA and control group [2]. Based on ROC curve analysis in PMOA and control group [1], both serum COMP and sTNF-RII yitld a diagnostic specificity of 90% each, while the diagnostic sensitivity was 45% and 50% respectively. By using the combined approach, we were able to increase the diagnostic sensitivity of serum COMP and sTNF-RII to 90% and 83% respectively. On the other hand, the receiver operating characteristics [ROC] curve analysis of the same parameters in PMOA and control group [2], revealed a diagnostic sensitivity of 100% for each of serum COMP and s TNF-PJI as well as a diagnostic specificity of 90% for serum COMP and 70% for sTNF-RII. The fact that radiographic evidence of OA usually appears in advanced stages of the disease led to the need of identifying possible serum biochemical markers that could reflect the joint tissue status. From the above mentioned results, it could be concluded that the combined measurement of serum levels of the biochemical markers COMP and sTNF-RII may be used in identifying osteoarthritis in post-menopausal females. Furthermore, menopausal state per-se could play a role in the limitation of the diagnostic sensitivity of either of the two parameters if one of both analytes was chosen alone for measurement

Evaluation of some platelet functions and platelet membrane glycoproteins in uremic, hemodialysis and renal transplant patients

The hemostatic defect of chronic renal failure [CRF] is well recognized. Increased bleeding has been attributed to platelet dysfunction. However, the available reports are controversial. To study platelet aggregation and glycoprotein receptors' [GP] expression in a well identified population with CRF. 25 patients with advanced CRF on conservative treatment [CRF group], 25 patients on regular hemodialysis [HD group], 25 renal transplant patients [Tx group], and 20 age-, race- and sex-matched healthy controls [control group] were subjected to complete physical examination, complete blood count, bleeding time [BT], renal functional parameters and other necessary laboratory tests, in addition to estimation of platelet aggregation in response to adenosine 5-diphosphate [ADP] and ristocetin as well as GPIb, GPIIb, and GPIIIa receptors' expression using fluorescein isothiocyanate-conjugated monoclonal antibodies CD42b, CD41 and CD62, respectively and a flow cytometer. BT was prolonged in both CRF and HD groups [P<0.001], and was not attributed to a decrease in platelet count. Both CRF and HD patients had similar, but significantly decreased maximum percentage of platelet aggregation induced by either ADP or ristocetin compared with Tx and healthy control groups [P<0.001]. GPIb expression was significantly decreased in the CRF group than the Tx and healthy control groups [P<0.05], while HD group showed non significant difference when compared with CRF, Tx or control groups. GPIIb and GPIIIa showed a highly significant decreased expression in both CRF and HD groups compared with Tx and healthy control groups [P<0.001], with no significant difference in between both uremic groups. An inverse correlation was observed between serum creatinine and GPIIb [r=-0.641, P=0.023] and GPIIIa [r=-0.545, P=0.031] receptors' expression in CRF patients versus no correlation in HD patients. The results of the studied parameters in Tx group were comparable to healthy controls. Uremic patients have decreased platelet aggregability and decreased GP receptors' expression [mainly GPIIb and GPIIIa], denoting that platelet dysfunction is at least partially contributing to their hemorrhagic problem. The observed defects were not corrected by regular HD. Renal transplantation seemed to be a better choice

Profile of Egyptian patients with mucopolysaccharidosis

Mucopolysaccharidoses [MPS] are chronic progressive lysosomal disorders [Six distinct types] which are inherited as autosomal recessive except MPS II which is inherited as X-linked recessive disorder This study is designed to investigate a group of Egyptian patients with MPS biochemically using screening test by electrophoretic separation of glycosaminoglycans and enzymatic assay in order to establish the diagnosis of the disorder and its subtypes, to prepare patients for enzyme replacement therapy. Also this will help in proper genetic counseling and prenatal diagnosis. Establishing a reliable rapid screening test for MPS is another aim of the study. The present study included 20 index cases suspected clinically as mucopolysaccardioses at the Medical Genetics Center, Ain Shams University [ASUMGC].They were subjected to full history taking, thorough clinical examination, family pedigree construction, skeletal survey, abdominal ultrasound and echocardiography, quatitative assay of glycosaminoglycans [GAGs] by diemethylmethlene blue [DMB] is done. The level of urinary GAGs by two dimentional electrophoresis [DMB] test was high in all patients tested. After that the patients were subjected to 2-DEP to determine the pattern of GAGs for probable type of MPS. 11 cases [55%] showed big dermatan sulfate spot [Type I, II or VI]. Seven cases [35%] showed hepran sulfate spot [Type III], 2 cases [10%] showed keratan sulfate spot [Type IV]. Finally patients were subjected to enzyme analysis specific for each type of MPS to confirm diagnosis. Reaching a specific diagnosis is of importance for genetic counseling and prenatal diognosis which is possible for all types of MPS. Prenatal diagnosis was done by 2-DEP of the amniotic fluid for four mothers of affected patients of MPS. One fetus was proved to be affected with MPS III. Another fetus was affected with MPSII. The others fetuses were normal

Study on evaluation of the persistent elevation of C-reactive protein as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on hemodialysis

The average age of dialysis patients is increasing each year, reflecting the aging of the population in general. Hemodialysis [HD] patients suffer from a chronic inflammation. They are at increased risk of cardiovascular disease. To evaluate the persistent elevation of C reactive protein [CRP] as a predictor of cardiac hypertrophy and dysfunction in elderly patients maintained on HD. Quantitative determinations of serum high-sensitivity C reactive protein [hs-CRP] by ELISA were done in the 3 studied groups; Group A: included 30 selected end stage renal disease [ESRD] elderly patients maintained on regular HD at the Main Alexandria University Hospitals. Their mean ages were 68.50 +/- 5.20 years [15 males and 15 females]. Group B: included 20 age-matched elderly healthy individuals. Their mean ages were 69.10 +/- 6.42 years [10 males and 10 females]. Group C: included 10 healthy adult individuals. Their mean ages were 34.20 +/- 4.85 years [5 males and 5females]. Doppler Echocardiography was done to all subjects with estimation of ejection fraction [EF%], fractional shortening [FS%], and left ventricular mass index [LVMi] as well as E/A and El/Al ratios. In elderly HD patients, hs-CRP showed statistically significant higher levels than those of groups B and C with significantly higher values in group B than group C [F=19.85, p=0.001]. By using echocardiography, LVMi showed statistically significant higher values in group A than the other 2 groups with no significant difference between them [F=0.854, p=0.01], whereas FS and EF percentages showed no significant differences between the 3 studied groups. Both E/A and El/Al ratios showed statistically significant lower values in group A than groups B and C [x[2]= 13.33 and 12.38, p= 0.00] and 0.02 respectively]. Correlation study showed a significant negative correlation between serum hs-CRP levels and serum albumin, EF% and E/A ratio. On the other hand, serum hs-CRP levels had a significant positive correlation with serum urea, erythrocyte sedimentation rate [ESR] and LVMi. In elderly patients maintained on HD, the persistent elevation of CRP, which reflects chronic inflammation, had a high impact on the occurrence of left ventricular hypertrophy [LVH] and dysfunction. These data lend support to the hypothesis that inflammation plays an important role in the pathogenesis of cardiovascular diseases in these patients

Study of N-acetyl-beta-D-glucosaminidase in elderly patients with iron deficiency anaemia

Little is known about renal tubular function in elderly patients with iron deficiency anaemia. To investigate renal tubular function in these patients. To achieve this aim, we compared renal tubular function in 30 asymptomatic non smoker elderly patients [over 65 years] having iron deficiency anaemia [group I] with 15 healthy age and sex matched controls [group II]. Based on their ages, group I patients were subdivided into 2 subgroups; group Ia consisted of 15 iron deficiency anaemia patients >/= 65 - 70 years while group Ib consisted of 15 iron deficiency anaemia patients above the age of 70 years. These patients were diagnosed during routine check up. Patients with known cardiac, hepatic, or renal diseases as well as cancer or other comorbid conditions were excluded from the study. Blood and urine samples were obtained for haematological and biochemical analysis. Urinary N-acetyl-beta-D-glucosaminidase [NAG], as an index of renal tubular function, was estimated by spectrophotometry. Mean urinary NAG levels were significantly higher in iron deficiency anaemia patients of both age groups than in controls [F=85. 77, p<0.001] with significantly higher mean values observed in group Ib than in group Ia patients. No statistically significant difference was observed between mean urinary NAG values in males [19 patients] and females [11 patients] [t= 0.56, p= 0.46]. In elderly iron deficiency anaemia patients of both age groups, urinary NAG values showed statistically significant negative correlation with haemoglobin levels [r=-0.673 and -0.811 at p=0.006 and <0.001 for groups Ia and Ib respectively] and were positively correlated with age [r=0.838 and 0.780 at p<0.001 and <0.001 for groups Ia and Ib respectively]. No correlation was detected between urinary NAG and haemoglobin values in either males or females [r=-0.433, p=0.064 for males and r=-0.077, p=0.821 for females]. There was no correlation between urinary NAG and serum iron, total iron binding capacity [TIBC] or serum ferritin in elderly iron deficiency anaemia patients of both age groups [r=-0.136, 0.328 and -0.070 at p=0.63, 0.232 and 0.805 respectively for group Ia] and [r=-0.229, -0.333 and 0.107 at p=0.414, 0.225 and 0.704 respectively for group Ib]. Elderly patients even with asymptomatic iron deficiency anaemia have impaired renal tubular function. Anaemia may be a contributing factor for renal impairment in such patients that is why it should be early diagnosed and treated even if no clinical disease is immediately apparent

Topical immunosuprressives in ocular surface disorders

To evaluate the effect of topical immunosuppressives in ocular surface disorders. Cyclosporine A 0.05% eye drops was added to the regimen of the treatment of 30 eyes with different ocular surface disorders. Follow-up period was 6 months. Marked improvement in eyes with dry eye and resistant corneal ulcers at the end of the follow-up period. Topical immunosuppressives [cyclosporine A eye drops, 0.05%] has a curative effect on most of the ocular surface disorders

Prediction of visual acuity improvement after intravitreal, triamcinolone acetonide injection in cases of diffuse diabetic macular edema

This study aims at identifying which factors affect the visual improvement following intravitreal triamcinolone acetonide [IVTA] injections. This is important in order to avoid injection of cases with expected poor improvement. 62 eyes with diffuse- diabetic macular edema of 48 patients were received IVTA injections of 4 mg. Visual acuity assessment, Fluorescein angiography and measurements of macular thickness by Optical Coherent Tomography [OCT] were done before and 3 months after injection. The data are collected and statistically analyzed. Visual improvement was found to he affected by the pre- injection macular thickness, macular ischemia, duration of visual loss, previous laser treatment. Age of the patient did not show significant influence on the degree of improvement of vision. The effect of IVTA can be expected by meticulous preoperative assessment. This is important in order to avoid useless injections