Role of anterior segment optical coherence tomography in the diagnosis of subclinical keratoconus in comparison with the pentacam

Background: The most common ectatic disorder is keratoconus which is characterized by bilateral and progressive corneal thinning. Role of the pentacam has been well established for screening form fruste keratoconus in ophthalmology practice. While for anterior segment OCT it can detect the characteristic abnormal corneal thinning in patients with keratoconus using its pachymetry maps

Aim of the Work: was to detect how much anterior segment OCT can approach the pentacam's well established efficacy in diagnosis of early keratoconus among the highly myopic astigmatic patients

Patients and Methods: This prospective, non-randomized population study followed the tenets of the Declaration of Helsinki, and the protocol was reviewed and approved by the Ophthalmology Department of Ain Shams University. An informed consent was signed by the patients before inclusion. We selected 40 eyes of twenty-three healthy young volunteers with high myopic astigmatism for the study from patients who attended the outpatient clinic of Maghraby Eye Hospital at the period of November and December 2017

Results: This study included 40 eyes of healthy young adults [22 females, 18 males] with high myopic astigmatism [-4.038 D+/- 1.194]. The mean age +/- SD was 24.1 +/- 5.702 [range: 16-31 years]. Statistically highly significant differences were observed in all measured cases between Pentacam and Anterior Segment OCT [p<0.01]. So the OCT corneal pachymetry mapping seems promising for evaluating corneas as in cases of early keratoconus

Conclusion: The OCT corneal pachymetry mapping with its fast acquisition time seems promising for evaluating highly astigmatic corneas, as in early keratoconus

Fever of unknown origin: 98 cases from Saudi Arabia

Fever of unknown origin [FUO] is mainly secondary to infectious, neoplastic or inflammatory diseases. To increase the body of knowledge on this diagnosis in the region, we collected information on all patients admitted to our institution with FUO in a 13-year period. We conducted a retrospective chart review of all immunocompetent males and females aged 13 years and older admitted between January 1995 and June 2008 who fulfilled the criteria for FUO. Data collection included demographics, laboratory investigations, imaging studies, procedures and discharge diagnoses. For true FUO, we recorded the duration of follow-up and the outcome. The 98 patients who met the criteria included 44 males and 54 females with a mean [SD] age of 41.3 [18.5] years and range of 14 to 85 years. The most frequent diagnostic etiology was infectious in 32 [32.7%]. Seventeen [17.3%] patients were undiagnosed or had true FUO. Of 9 patients followed up, 8 recovered and 1 expired. The mean duration of follow-up was 20.6 months [range, 0-168 months]. Infectious diseases, especially TB, continue to be the leading etiology of FUO in our area. Our data did not identify any predictor of certain FUO diagnoses except for older age and neoplastic etiology. True FUO patients generally did well. Reporting local experience is important in guiding clinicians about the epidemiologic patterns of FUO in their regions

Plasma and ascitic fluid level of calprotectin in chronic liver disease: malignant and non malignant

Calprotectin was widely investigated in alcoholic liver disease and proved to be a new prognostic marker of survival independent of the severity of liver disease as well as marker of malignancy. However it was not widely investigated in other causes of liver cirrhosis. Of the present work was to study the level of calprotectin both in plasma and ascitic fluid in patients with hepatitis C [HCV] related chronic liver disease with and without malignancy, and to find out whether one or both of them correlate with the severity of liver damage and presence of malignancy. This study was conducted at the Faculty of Medicine, Alexandria University and the National Liver Institute, Menoufiya University. Thirty patients with Hepatitis C related liver cirrhosis were recruited. Fifteen of these patients suffered from concomitant hepatocellular carcinoma [HCC] diagnosed by elevated alpha foeto-protein [AFP] and one imaging technique OR by two imaging techniques in the case of normal AFP. Calprotectin was significantly elevated in patients with cirrhosis and cirrhosis/HCC than in controls [p=<0.01]. However there was no significant difference in the levels of plasma or ascitic calprotectin between the cirrhotic group and the group with HCC. There was no correlation between plasma and ascitic calprotectin levels. Ascitic calprotectin correlated significantly with bilirubin, and markers of synthetic liver function [p=<0.05], but plasma calprotectin correlated only with prothombin activity [p=<0.05]. In patients with spontaneous bacterial peritonitis, ascitic calprotectin was significantly higher in patients having this complication [879.8 +/- 67.5] than patients without SBP [534.2 +/- 59.3 [p<0.01] and a highly significant correlation was found between ascitic calprotectin and total leucocytic count in ascitic fluid [p=<0.01]. Calprotectin is elevated in HCV-related cirrhosis but not further elevation with the occurrence of hepatocellular carcinoma. Ascitic calprotectin correlated with the degree of hepatocellular injury and was significantly higher in patients with SBP. Further studies are warranted to establish a role of plasma calprotectin for the risk assessment of infectious complications secondary to bacterial translocation in patients with HCV- related liver cirrhosis

Macrophage inflammatory protein 1 - alpha [MIP -I]: its pathogenetic role in some connective tissue diseases

This study aimed to measure serum level of macrophage inflammatory protein 1- alpha [MIP-la] in some connective tissue diseases as rheumatoid arthritis [RA], systemic lupus erythematosus [SLE] and systemic sclerosis [SSc] in order to clarify its possible role in their immunopathogenesis. Fifteen RA patients [group I], 15 SLE patients [group II], 10 SSc patients [group III] and 10 healthy controls [group IV] were participated in this study. A full history taking, thorough clinical examination and routine rheumatological profile investigations were done. Serum MIP-1-alpha was measured in all patients and control groups using ELISA technique. In conclusion, the higher level of serum MIP-1-alpha in RA, SLE and SSc patients could reflect its immunopathogenetic role as an important stimulator of T cells, monocyte macrophage as well as its variable pro-inflammatory activates

Serum adrenomedullin level in rheumatoid arthritis compared with systemic lupus erythematosus

This study was conducted to measure the level of serum adrenomedullin [AM] in rheumatoid arthritis [RA] and systemic lupus erythematosus [SLE] to find out its role in their pathogenesis and its correlation with clinical and laboratory parameters of disease activity. Twenty-five RA patients [group I], 15 SLE patients [group II] and 10 healthy controls were included in this study. They were subjected to full history taking, thorough clinical examination and CBC, ESR, RF, ANA, Ant ds DNA investigations and measurement of serum adrenomedullin level with ELISA. An assessment of disease activity was done using Duke score for RA patients and SLE-DAI score for SLE. From the results obtained, it was concluded that serum level of AM was elevated in both RA and SLE [more in RA than SLE] patients and it was correlated with the disease activity parameter RA [only with ESR in SLE]. These findings emphasized that AM is involved in the pathogenesis of RA and SLE