Impact of anemia on diastolic function among a sample of Egyptian patients with type 2 diabetes

Anaemia which is common in patients with diabetes has an established role in heart failure. Whether or not anaemia contribute to an increased risk of cardiac dysfunction in patients with type 2 diabetes, needs to be evaluated. Aim of the work: to investigate the effect of anaemia as a risk factor on the abnormal diastolic function in type 2 diabetes. Seventy diabetic patients from Diabetes Clinic, Ain Shams University Hospitals, Cairo, Egypt were investigated for control of blood glucose, haemoglobin level, creatinine clearance and albuminuria. Transthoracic echocardiography and tissue Doppler were performed to study parameters diagnosing diastolic dysfunction. 71.4% of the patients were anaemic. Diastolic dysfunction was more prominent in the anaemic patients as they showed significantly higher LAA, E/A, E/E' [0.35 +/- 0.06 cm2, 1.29 +/- 0.63, 8.7 +/- 0.4, respectively] compared to the non anaemic patients [0.32 +/- 0.06 cm2, p,0.05, 0.99 +/- 0.51, p<0.05, 6.86 +/- 0.18, p<0.001, respectively]. By multivariate analysis haemoglobin showed independent association with E/A even after adjustment for age, BMI, BP, albuminuria and creatinine clearance. Decreased haemoglobin level is a potent independent risk factor of diastolic dysfunction among type 2 diabetic patients. Thus maintenance of haemoglobin level in these patients within normal range improves the degree of cardiac

Clinical and therapeutic aspects of typhoid fever in Upper Egypt

This study included 160 patients [97 males and 63 females, their ages ranged from 3 to 45 years with a mean of 14.66 +/- 7.62 SD] suspected clinically to be typhoid or paratyphoid fevers. They were classified into two groups: Group I, included 93 patients who were blood culture-positive for salmonella and group II, included 67 patients who were culture-negative for salmonella. The criteria of inclusion included patients presenting with fever five days or more with apparent toxemia, headache, coated tongue and with or without splenomegaly. The patients were subjected to full clinical history, general examination, abdominal examination, routine investigations [abdominal ultrasonography, chest X-ray, ECG, urinalysis and stool analysis, complete blood picture, liver function tests and kidney function tests] as well as investigations for the diagnosis of enteric fever, Widal and modified Widal tests to all patients. Serum chloramphenicol level was estimated in 43 patients in group I and in 29 patients in group II and no statistical significant difference was found in the mean level between the two groups. Concerning therapy in the two groups, the response to chloramphenicol was significantly higher in group II in comparison with group I. On the other hand, the resistance to chloramphenicol was significantly higher in group I compared with group II. The responses to antibiotics other than chloramphenicol were similar in the two groups

Bone formation and resorption markers in osteoporosis

This work was done on 47 primary osteoporotic patients and 28 apparently healthy persons of the same age group. A diagnosis of osteoporosis was performed according to radiological examination of the spine. It was concluded that among bone formation markers studied, both total ALP and bone alkaline phosphatase [B-ALP] and propeptide of type I procollagen [PICP] were significantly higher osteoporotic patients than the controls and higher B-ALP in complicated fractured neck femur than non-complicated patients. Meanwhile, bone resorption markers in the form of urinary calcium, pyridinoline [Pyr] and deoxypyridinoline [D-Pyr] significantly increased in osteoporotic patients of both sexes than the controls. Although complicated patients were higher in females than males, the values showed no significant differences between both sexes. At the same time, both Pyr and D-Pyr correlated significantly with each other. Osteocalcin [OC] correlated with Pyr and PICP correlated significantly with urinary calcium. It was also concluded that biochemical bone markers had the advantage of being non-invasive, accurate and possible to perform repeatedly

Choledochal cysts; study of variable presentations, and value of different diagnostic methods

Twelve patients with different types of choledochal cysts, 4 males and 8 females were included. Age ranged between 7 to 40 years [mean age 25.8 years]. All patients were presented with cholestatic jaundice, and recurrent attacks of cholangitis. Five were cholecystectomized before being referred because of persistent symptoms and jaundice. All patients were evaluated clinically. Also, routine laboratory tests as well as liver profile were done. Ultrasound and CT scan examinations were decisive in one patient only, endoscopic retrograde cholangiopancreatography was decisive in all patients. Type 1 choledochal cyst was found in 6 patients, type 2 in 2, type 4 B in one, and type 5 [Caroli disease] in another one. Associated diseases were: Gall stones in 5, cystolithiasis in 9 and liver cirrhosis in 3. Chronic pancreatitis was diagnosed in one patient. Another patient with Caroli disease had very bad general condition died in liver failure. Six patients were submitted to choledochocystojejunostomy [Roux-en-Y anastomosis], they did well. Another 3 patients were submitted to cystectomy and hepaticojejunostomy. Endoscopic retrograde cholangiopancreatography was the diagnostic procedure of choice

Tumor Markers in malignant liver disease its relation to HBsAg and usefulness of its combined use

Alpha-fetoprotein [AFP], carcinoembryonic antigen [CEA] and serum CA19-9 level were determined in 20 patients with primary hepatocellular carcinoma [HCC] and another 20 patients with metastatic liver disease as well as 20 normal healthy subjects. This was done to determine the usefulness of these markers, its combined use in diagnosis of malignant liver disease and to assess the influence of HBsAg on these markers

Endoscopic cytotechiques in diagnosis of hepatobiliary and pancreatic malignancy

The aim of this work was to represent the report experience with endoscopic cytotechniques during ERCP as well as fine needle aspiration biopsy technique when performed on 30 patients. Twelve patients were diagnosed as bile duct carcinoma, nine patients were diagnosed as pancreatic carcinoma, four patients were diagnosed as papillary carcinoma and five patients were diagnosed as hepatocellular carcinoma. Fine needle aspiration biopsy was positive in 11 out of the 30 patients, there were no false positive results, its sensitivity was 37.7% and specificity was 100%. Brush cytology was positive in 13 out of the 30 patients with no false positive results, its sensitivity was 43.3% and specificity was 100%. Exfoliative bile and/or pancreatic juice cytology was positive in 6 out of 30 patients with no false positive results, its sensitivity was 20% and specificity was 100%. Endoscopic cytotechniques are complementary techniques of high specificity for diagnosis of biliary and pancreatic malignancies. It is recommended to be done in any suspicious case since it adds to the diagnostic yield of conventional ERCP

Study of the role of benzodiazepines in hepatic encephalopathy

A hypothesis implicating the central benzodiazepine receptors [BzR] in the mediation of increased gamma-aminobutyric acid [GABA] neurotransmission in hepatic encephalopathy [HE], has been recently evolved. To investigate the possibility, plasma and cerebrospinal fluid [CSF] benzodiazepine [Bz] immunoreactivity was assayed in 20 patients with schistosomal hepatic fibrosis and clinical evidence of HE who have not taken exogenous Bzs recently. Thereafter, flumazenil [FMZ], a BzR antagonist, was administered intravenously to half of the patients, while the remaining 10 patients received conventional medical [CM] therapy. Also, 10 patients with uremic encephalopathy [UE] had FMZ injections. Although Bz immunoreactivity could not be detected in patients with HE before of after therapy, yet, FMZ therapy resulted in significant improvements in stage to HE, grade of asterixis, psychometric testing, and portal-systemic encephalopathy index. Patients who did not respond at all to FMZ [20%] had HE stage IV.B and died in liver failure. Flumazenil was also not effective in ameliorating UE. Compared with CM therapy, FMZ was superior in producing a significantly more rapid and better clinical response despite the significant decrease in plasma and CSF ammonia and glutamine concentrations after CM therapy. However, no patient regained normal brain function after FMZ therapy. Moreover, the response to FMZ or CM therapy was not correlated with any pretherapy clinical and biochemical parameters. Considering the results of the present study, it can be concluded that BzR-mediated increased GABA-ergic tone has a prominent pathogenetic role in HE, although it is not the sole factor. The amelioration of neuropsychiatric symptoms after FMZ therapy seems to be specific for HE, and of prognostic value. Identification of brain concentrations of Bzs or other substance[s] with BzR binding affinity should be carefully sought

Systemic and portal hemodynamics in patients with schistosomal hepatic fibrosis: relation to sodium retention and ascites formation

Systemic and portal haemodynamics determined by Doppler ultrasonography were evaluated in 30 patients with schistosomal hepatic fibrosis; 18 of them with and 12 without ascites and in 10 healthy subjects. All patients had significant decreases in systemic vascular resistance increases in stroke volume and cardiac index. These haemodynamic changes might be related to the significant increase in plasma substance-P level, an endogenous vasodilating compound, observed in this work. The development of ascites was associated with significant decreases in urinary sodium excretion and mean arterial blood pressure despite the significant increases in plasma volume and left atrial size. These findings may provide evidence that the initial event triggering sodium and water retention is, probably, an "effective" arterial underfilling as the arterial vascular compartment is disproportionately enlarged. Patients with ascites also had significant increases in portal blood flow volume and with indirect evidence of splanchnic arterial vasodilation forming splanchnic compartmentation which could explain the predilection of the retained fluid to transudate into the peritoneal cavity. It can, therefore, be concluded that a relationship exists between changes in systemic and portal haemodynamics and renal sodium and water retention with subsequent ascites formation. Practical clinical implications for the management of ascites should be further investigated

Incidence of columnar epithelium lined [Barrette's esophagus in schistosomal hepatic fibrosis patients]

This study was carried out on 60 adult patients suffering from SHF. All patients were admitted to the Alexandria Main University Hospital and examined by fiberoptic endoscopy because of different GIT complaints. Esophageal varices were found in 50 patients [83.3%], reflux esophagitis in 34 [56.6%], gastritis in 48 [80%], Barrett's esophagus [by Lugol's iodine] in two patients [3.3%]. Histopathological examination revealed different grades of esophagitis and columnar epithelium lined [Barrett's] esophagus in four patients. From these results, it was concluded that Barrett's esophagus is not uncommon in SHF patients and every patient complaining of clinical manifestation of reflux esophagitis should be examined by fiberoptic endoscopy using [Lugol's iodine] solution as screening test for detection of columnar epithelium lined esophagus

Patterns of pain and fingers prints in congenital heart diseases

Concomitant with recent developments in human cytogenics, there has been a great awareness of the clinical importance of dermatoglyphics in the study of a wide variety of prenatally determined disorders, besides its application in medicological problems. Palm and fingers prints of both h and s were done for 42 patients with different forms of congenital heart disease [CHD] and 20 age and sex matched controls. A higher Whorls/loops index [107.7% and 33.9% respectively] was observed in patients than in controls. Palmar study showed significantly increased vestige pattern in the thenars and hypothenars of both h and s in the patients while arches pattern was significantly increased in the thenars and hypothenars of both h and s in the patients, while arches patterns Were significantly increased in the control group. Axial triradius [t] with significantly higher frequency in patients than controls [55% and 15%, respectively]. On the other h and, there were no significant differences in a-b count between the two groups

Effect of medrogestone on endometrial histology and histochemistry in patients with luteal phase defects

Fifty infertile patients with luteal phase defects were the subject of this study. Progestrone in oil, [12.5 and 25 mg] and medrogestone, [5 and 10 mg] were administered daily, starting 3 days after the probable day of ovulation for 2 consecutive cycles. Endometrial biopsies were subjected to histlogical and histochemical examinations. Secretory endometrial patterns that were in phase were observed in all cases after progestrone therapy. Also, the same patterns were observed in 90% and 70% of case after Medrogestone in 5 mg and 10 mg dosage respectively. Undatable endometrial patterns with early glandular exhaustion and sometimes pseudodecidual reaction were observed with medrogestone therapy. These were detected in 10% and 30% of cases with the 5 mg and 10 mg dosage respectively. Also weak activity of the glandular succinic dehydrogenase was observed on histochemical examination of the undatable endometrial patterns. No Histologic or histochemical differences were noted, when both drugs produce secretory endometrium that was in-phase or 1 day out of phase of the cycle day. It is concluded that oral medrogestone is liable to produce early glandular exhaustion when given to patients with inadequte luteal phase. Such asynchronous maturation may interfer with blastocyst nidation. It can also be concluded that progestrone therapy, albeit inconvinent when administered intramuscularly, is the drug of choice in the treatment of luteal phase defects

Effect of endotoxin on ovulation, implantation and early foetal development in rabbits

Salmonella entritidis endotoxin given in a dose of 1 ml/kg [= 20 ug/kg] intravenously to female rabbits five hours after chotionic gonadotropin administration caused significant reduction in the number of ruptured follicles. The simultaneous administration of the same dose of endotoxin with 2 mg/kg indomethacin intra-muscularly did not reverse the effect of endotoxin on ovulatory process. To study the effect of endotoxin on implantation and early foetal development, it was given in a dose of 0.25 ml/kg [= 5 ug/kg] intravenously on day 4 of gestation and this resulted in failure of implantation. On combining endotoxin and indomethacin, the effect of endotoxin on implantation was not reversed. Endotoxin administration on day 8 of gestation produced a lethal effect on most of foetuses and regression of associated placentae. When indomethacin was combined with andotoxin on day 8 of gestation, the immediate lethal action was inhibited as evidenced by presence of most implantations at the time of autopsy on day 14. Nevertheless, most foetuses died after indomethacin treatment. Administration of indomethacin alone on day 4 of pregnancy did not reduce the total number of foetuses, but foetuses and placental tissues were smaller than controls. However indomethacin given on day 8 of pregnancy resulted in a large number of post implantation mortalities. The results are discussed and it was recommended that: First: Women desirous of becoming pregnant or pregnant women early in their gestation should be advised not to use the analgesic agent indomethacin particularly prior to ovulation and during the luteal phase of the menstrual cycle. Second: If a lady is suffering from a disease caused by an endotoxin producing organism she must use a contraception to prevent her from becoming pregnant and if she is already pregnant, gestation must be terminated

Intraoperative imprint cytology: a rapid method of breast biopsy diagnosis

One hundred fresh breast tissue biopsies obtained from patients with possible neoplastic disease were examined by the technique of intraoperative imprint cytology and were compared with their corresponding histologic sections [frozen and paraffin]. In 95% of the cases, there was a good agreement between the histologic and cytologic diagnoses. Certain morphologic observations, such as cellular density, atypia and intracytoplasmic inclusions, were noticed in the cytologic imprints of malignant lesions that are believed to be of help in differentiating between benign and malignant breast lesions. The results have shown that imprint cytology of breast lesions is a useful intra-operative diagnostic tool that may serve to minimize the error of subsequent histologic methods of diagnosis

Infective gangrene of the breast complicating diabetes mellitus: a case report

A case of infective gangrene of the breast complicating diabetes mellitus is reported. This rare complication of diabetes was successfully treated by simple mastectomy after control of the diabetic state

Histopathologic studies of the decidua in induced and spontaneous abortion

Histologic and histopathologic studies of the decidua early in gestation were carried out in 20 cases of induced abortion and 140 cases of spontaneous abortion. Decidual necrosis and vascular changes were demonstrated in cases of spontaneous abortion. The results observed were discussed. It is generally believed that the decidual necrosis observed in cases of spontaneous abortion was secondary to ischaemia resulting from obliterative changes in the decidual blood vessels. These vascular changes are believed to be the result of an antigen antibody reaction and this gives support to the immunological theory of spontaneous abortion. On the other hand, decidual necrosis will interfere with early histotrophic embryonal nutrition

Histopathological and histochemical observations on the endometrium in bilharzial patients

The endometrium of 40 patients with genital and/or extragenital bilharziasis and that obtained from 40 healthy women of comparable age and parity were examined histologically and histochemically for glycogen and enzymes. Bilharzial patients showed no bilharzial endometrial affection. However, in 7.5% of these subjects, there was persistent anovulation while all healthy women were ovulating. Luteal phase defects, evaluated by his-tological dating of endometrial biopsies, were present in 12.5% of bilharzial patients compared with 5% incidence in healthy women. Histochemical alterations in glycogen and the enzymes [succinic dehydrogenase, non-specific esterase, alkaline phosphatase and acid phosphatase] were observed in these women with corpus luteum insufficiency. It is believed that the increased incidence of anovulation and of corpus luteum insufficiency, with endometrial histochemical alterations, are partly resposible for the higher incidence of female infertility among the bilharzial population, reported by some authors; and observed in the present investigation