Plasma Levels of Connective Tissue Growth Factor in Children with Congestive Heart Failure

Objectives: Assessment ofplasma level of connective tissue growth factor in congestive heart failure children,assessment of its diagnostic and prognostic role and correlate its level with clinical and echocardiographic assessment of congestive heart failure.Methods: Connective tissue growth factorlevel in the plasma was measured in 40 children; 20 of them have congestive heart failure, and 20 are healthy then,correlated with clinical parameters. Results: The diagnostic and prognostic value of itwas evaluated. Wecompareditslevels in both patientsand healthy children. We found that connective tissue growth factor level was significantly increased in diseased children. Fractional shortening and ejection fraction correlated negatively with the plasma levelof connective tissue growth factor. Heart rate, respiratory rate and calibrated integrated backscatter correlated positively with connective tissue growth factor. Connective tissue growth factorwas significantly correlated with the class of heart failure according to Ross classification.Conclusions: Plasma connective tissue growth factor has a promising diagnostic and prognostic value as a biomarker for congestive heart failure in children with high sensitivity and specificity.

Prognostic Value of Urine Albumen/Creatinin Ratio in Sepsis in Critical Care Patients

Several scoring systems were developed for prognosis and outcome prediction in sepsis.This study aims to evaluate the urinary albumin/creatinine ratio(ACR)as a prognosticp redictorinsepsis.The study included 50 adult septic patient sinapros pectiveobser vational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24h later for ACR1 and ACR2.Admission APACHEIVscoreandthehighestrecordedSOFAscoreoftheirdailyestimationwereconsidered.Thisstudyalsoevaluatedtheneedformechanicalventilation,inotropicorvasoactivesupport,renalreplacementtherapy(RRT),andin-hospitalmortality.InapopulationwithMean±SD51.4±16.3(19-82)yearoldwith34(68%)males,wefoundthattheACR2iscorrelatedwithbothAPACHEIVandSOFAscores(P<0.001).ACR2washigherinpatientswhoneededmechanicalventilationandinotropicorvasoactivesupport[121(21-235)and166.5(89-235)mg/grespectively]comparedto[49(22-120)and56.5(21-211)mg/g],P<0.001inboth.ΔACR,ACR2,increasing AC Rand APACHEIVwerepredictorsofmortality.TheAUCformortalitypredictionwaslargestforΔACR(1),increasingACR(0.985),ACR2(0.963)thenAPACHEIV(0.90).∆ACRandACR2of91.5mg/gand-22was88.2%&100%sensitiveand90.9%&100%specificrespectivelytopredictmortality.WeconcludedthattheurinaryACRmightbeusedasasimpletestforprognosisandmortalitypredictioninsepsis

Relation of breast milk adiponectin level to infant growth

Background: studies on the physiology of breastfeeding revealed the presence of the adipokines as adiponectin in mothers' milk. In full-term neonates, during the first few days of life, serum and plasma adiponectin levels correlate positively with birth weight and length, neonatal adiposity. While, circulating adiponectin levels correlate negatively with the degree of adiposity in children aged between 5 and 10 years

Patient and Methods: in the current cross sectional study patients and their mother were recruited from outpatient clinic in Ain Shams Hospital. Questionnaire was done for maternal age, maternal diseases, gestational age, and mode of delivery, infant sex and type of feeding. Also in this study maternal body mass index and infant anthropometry were calculated and breast milk adiponectin levels were measured at 1[st] week, one month and at six months

Results: maternal body mass index ranges from [19-29]. Infant weight z-score ranges were [-1.77- 1.84], [-1.76-1.9] and [-2.02-1.62] at one week, one month and six months respectively. Infant length z-score ranges were [-1.45-2.72], [1.43-3.01] and [-1.61-1.54] at one week, one month and six months respectively. Breast milk adiponectin ranges were [12.8-38.4 ng/dl], [8.8-30.8 ng/dl] and [5.5-25 ng/dl] at one week, one month and six months respectively

Conclusion: the results of the present study confirm that human milk adiponectin was significantly associated with lower infant WAZ score at one month, with high significant association with lower infant WAZ score at six month. However, not associated with infant weight at baseline

Molecular mechanisms of the anti-obesity potential effect of Moringa oleifera in the experimental model

Objective: To elucidate the molecular mechanisms of the potent anti-obesity effect of Moringa oleifera Lam. (M. oleifera) ethanolic extract and to clarify the link between these mechanisms and the associated metabolic and vascular risks in the experimental model of visceral obesity. Methods: M. oleifera ethanolic extract was orally administered at 600 mg/kg body weight in obese female rats daily for 12 weeks. At the end of treatment, body weight was deter-mined, and the atherogenic index, coronary artery index, glucose level, insulin resistance status, liver and kidney functions were assessed. Also, the mRNA of leptin, adiponectin and resistin in visceral adipose tissue was determined by quantitative real time-PCR. Results: The results showed that M. oleifera extract down-regulated mRNA expression of leptin and resistin, while it up-regulated adiponectin gene expression in obese rats relative to untreated obese control counterparts. This amelioration of genes expression was paralleled by a reduction in body weight and improvement of the atherogenic index and coronary artery index, as well as glucose level and insulin resistance value without adverse effects on liver or kidney functions, versus the untreated obese control ones. Conclusions: It is reasonable to assume that the anti-obesity, anti-atherogenic and anti-diabetic properties of M. oleifera are mechanistically achieved via working directly on the adipokines of the visceral adipose tissue. Therefore, M. oleifera may be a good thera-peutic candidate for the symptoms of metabolic syndrome.

Irreducible dislocation of the hallucal interphalangeal joint: a rare case report and literature review

A 47-year-old male presented to emergency department with dislocation of hallucal interphalangeal joint of the left great toe. A trial of closed reduction under local anesthesia was attempted but failed. An emergency open reduction of the irreducible dislocation of hallucal interphalangeal joint was done with stabilization by K-wire. We report this unusual case of rare injury and review the relevant literature

[Value of magnetic resonance spectroscopy in diagnosis of patients with focal brain lesion]

Objective: To describe the spectrum of Magnetic Resonance spectroscopy in focal brain lesions and determine its diagnostic accuracy in comparison to conventional MRI using histopathology as gold standard in differentiating various types of focal brain space occupying lesions. New line.

Patients and methods: 52 patients [21 males and 31 females] with single focal brain space occupying lesion diagnosed by post contrast CT or MRI are included in this study. Complete clinical evaluation, MRI, and MRS examination were performed for all these patients before surgical biopsy and/or resection. Correlation of all these findings was done with histopathology obtained in all these patients

Results: The most important markers in differentiating and grading various types of single focal brain space occupying lesion were choline level and choline/N-acetyl aspartate ratio. There is statistically significant difference between mean of Cho/NAA in high grade glioma as it was 23.13 and low grade glioma where mean of choline/NAA was 6.21 [P value = 0.02]. Lipid and lactate peaks were more frequent in high grade tumors and lipid peak together with Choline/N-acetyl aspartate ratio could differentiate between metastasis and metastasis with delayed radiation necrosis. Alanine peak appear to be pathognomonic for meningioma. Perilesional MRS metabolites could detect actual histopathological [subclinical] extension and so differentiate between high grade and low grade tumors and between high grade tumors and metastasis

Conclusion: MRI+MRS is more sensitive than MRI alone in diagnosis, differential diagnosis, and grading of focal brain space occupying lesion. MR spectroscopy could differentiate various types of focal brain space occupying lesion with sensitivity of 92.3% while sensitivity of MRI alone was 76.9%

Cortical excitability in amyotrophic; lateral sclerosis

The primary purpose of this study was to provide insight into the central changes that occur in amyotrophic lateral sclerosis with a view to pointing out that these could contribute to symptoms, Seventeen patients with definite ALS and 17 control healthy volunteers were included in the study. Clinical examination, amyotrophic lateral sclerosis severity score [ALSSS] and transonic magnetic stimuli investigations including measurement of resting and active motor threshold [RMT, and AMT], motor evoked potential [MEP], input-output curve, contralateral silent period and transcallosal inhibition [CSP and TI] were measured for each participant. There were no significant differences in RMT or AMT in either hemisphere between patients and the control group. Despite this there was a significant negative correlation between ALSSS and RMT, and AMT meaning that increased seventy was associated with higher thresholds. MEPs were significantly smaller in ALS patients in comparison to the control group [P=0.03]. There was a significant decrease in the slope of the I/O relationship of MEP amplitude to TMS intensity in patients group in comparison to controls. ALS patients had a significant prolongation of CSP and TI for both hemispheres. There was a tendency for there to be a significant negative correlation between left TI and ALSSS [P= 0.051]. Measurements of cortical motor excitatory and inhibitory changes in ALS confirm the presence of hypoexcitability and GABAb dysfunction, that was correlated with the severity of ALS

Amelioration of carbendazim-induced testicular dysfunction by vitamin E and pumpkin seed oil in rats

Carbendazim, a carbamate fungicide, is one of the most widespread environmental contaminant of major concern to human and animal reproductive health. The present study was undertaken to investigate the ameliorating effect of vitamin E and Pumpkin seed oil on carbendazim-induced testicular toxicity in male rats. Safety profile of vitamin E and pumpkin seed oil was firstly examined on normal rats and found to be safe on all the examined parameters. Adult Sprague dawley male rats were used in this study. Carbendazim [100 mg/ kg] was administered alone or combined with either vitamin E [200 mg/ kg] or pumpkin seed oil [40 mg/ kg] for 48 successive days. Carbendazim exposure significantly reduced the weights of testes, prostates and seminal vesicles. Also, serum testosterone, sperm count, motility and viability were diminished. The incidence of sperm abnormalities and testicular cholesterol content, were markedly elevated. In addition, carbendazim caused oxidative stress as observed by elevation of malondialdehyde [MDA] and lactate dehydrogense [LDH]. The antioxidant system including superoxide dismutase [-SOD], glutathione peroxidase [GSHPX] and glutathione [GSH] were also reduced. Carbendazim also produced marked histopathological changes including degeneration of most seminiferous tubules with absence of spermatogenic series in tubular lumen in the testis. Co-administration of either vitamin E or pumpkin seed oil with carbendazim significantly ameliorated most of these deleterious effects where weights of testes, prostates and seminal vesicles were regained. They also elevated serum testosterone level, sperm count, sperm motility and sperm viability. Furthermore, administration of vitamin E and pumpkin seed oil with carbendazim reduced the incidence of sperm abnormalities and nearly normalized the testicular cholesterol content, They also reduced the oxidative stress caused by carbendazim which was associated with normal histopathological features of the testis

Spinal compression by brown tumor in two patients with chronic kidney allograft failure on maintenance hemodialysis

Brown tumors with non-neoplastic process are noticed in patients with end-stage renal disease suffering from a severe form of secondary hyperparathyroidism. Herein, we report a patient with chronic kidney allograft failure returned back to hemodialysis who experienced manifestations of cauda equina compression secondary to a lumbar brown tumor. Also, we had another patient on hemodialysis with a demineralized lesion affecting the cervical vertebrae. Although brown tumor is a rare complication, these two cases highlighted the importance of neurological symptoms in uremic patients. Spinal decompression surgery, in order to alleviate pressure on neurological structures, together with subtotal parathyroidectomy, were highly indicated

Laparoscopic management of hepatic hydatid cyst

The aim of this study was to describe in detail the laparoscopic treatment of patients with liver hydatid cyst. Twenty patients with 30 liver hydatid cyst were considered for laparoscopic treatment from May 2004 and July 2007. A laparoscopic surgical technique was used in all cases. The method involved treatment of the residual pericytic cavity and removal of the contents of the cyst. The operating time [range 40-120]. Complications were observed in 2 patients [10%] after surgery, 18 patients [90%] were followed-up for means of 14 months [range 6-30]. No recurrence was found in any of the cases. The mean post operative hospital stay was 6-10 days [range 6-15]. This laparoscopic hepatic hydatid surgical technique is a safe and effective method of treatment in selected patients. It can be a useful alternative for treating patients with liver hydatidosis

Common channel length predicts outcomes of bilio pancreatic diversion alone and with the duodenal switch surgery

The optimal common channel [CC] length for malabsorptive weight loss surgeries is unknown even though these surgeries were developed in 1970s [Biliopancreatic diversion [BPD] and 1990s [Biliopancreatic diversion with aduodenal switch [BPDPS]. I hypothesized that the length of the CC correlates with a successful weight loss result. It is retrospective study to evaluate 3 groups of patients based on the length of the CC, with follow-up evaluation for two year. I reviewed all patients who had either an open BPD or a BPDDS from January 2005 to March 2007. Group I comprised 15 patients: their preoperative mean body mass index [BMI] was 53.9 kg/m2, 73.3% of patients had a BMI more than 50, and the CC length was 100 cm. group II comprised 15 patients, their preoperative mean BMI was 54.25 kg/m2, 73.3% of patients had a BMI more than 50, and the CC length was 75 cm. Group III comprised 15 patients: their preoperative mean BMI was 60 kg/m2, 84% of patients had a BMI more than 50, and the CC length was 50cm. The mean weight loss in group I was 45 kg [44% mean excess weight loss]. The mean weight loss in group II and III was 55.8 and 62 kg, respectively, [a 54% and 57% mean excess weight loss, respectively] [all P < .05 by analysis of variance]. The length of the CC contributes significantly to successful excess weight loss in BPD and BPDDS patients. In general, the length of the CC should not exceed 100 cm

Adrenal cystic masses: report of ten cases and suggested algorithm for therapy

Purpose: To report our experience in diagnosis and treatment of adrenal cysts in 10 cases. Patients and Over 7 years period adrenal cysts have been diagnosed in 10 patients [7 males and 3 females]. Their ages ranged between 25 n 68 years. Eight cases were between 50 and 68 years. Six cysts were detected incidentally during imaging work-up performed for extra-adrenal complaints. Three cases presented by flank pain and only one had severe hypertension. Diagnosis was made by ultrasound [US] in all cases and confirmed by computed tomography [CT] in six cases. The longest diameter of the cysts ranged from 3 to 12 centimeters. The right side was affected in 8 cases and the left side in 2 cases. All cases had unilateral cysts. Biochemical work up included determinations of serum electrolytes, lipids and hormonal study. Adrenal ultrasound-guided FNAB was performed in all cases. Six cases had simple non-functioning adrenal cysts, two had infected adrenal cysts one had cystic pheochromocytoma and one had adrenal carcinoma. Surgical adrenalectomy was performed in three patients [30%]. The indications for operation were pheochromocytoma in one patient, symptomatic adrenal cyst with diameter greater than 5 cm in another one, and adrenal carcinoma in a third patient. Imaging characteristics suggestive of malignancy were found in only one proved to have adrenal carcinoma. Cysts recurred in five cases after FNAB. Small, asymptomatic, non-functional cysts with benign characteristics may be treated conservatively with regular follow-up by US or CT. Symptomatic benign nonfunctioning adrenal cyst may be managed by aspiration alone. If the cyst recurs and is asymptomatic, it may observed. If a symptomatic cyst recurs, it may be reaspirated or excised. Malignant adrenal cysts should be treated by adrenalectomy

Studies on SLE: Correlation between immunological and electroencephalographic changes

Systemic Lupus Erythematosus [SLE] is :m autoimmune disease characterized by n ihisystem involvement. Nervous system ivemen,t in SLE can present with diverse airologic or psychiatric symptomatology. study was done on fifty patients with vi.. They were divided into 2 groups:Group included twenty five patient with active / K Group II included twenty five patients i non active SLE. the following were for each patient: Complete history, full .ail examination , complete blood count ' HH! urea, creatnine, ANA, anti DNA, anti :[1 JSSA], anti LA [SSB] , anti SM, anti All, LAC, and conventional EEG. i EG findingsamongbothgroups :d that the EEG was normal in 12 % of .ills and abnormal in 88 % of patients long group I. The generalized epileptic

Comparative study of thoracoscopic versus open surgical approach for upper dorsal sympathectomy

Upper dorsal sympathectomy has been performed for a wide variety of indications, the most common of which is palmer hyperhydrosis. With the development of video-assisted thoracic surgery, its application has extended to include thoracoscopic sympathectomy. In the present study we describe our experience with this recent technique and evaluate its results in comparison with the standard open surgical supraclavicular approach. Forty-five cases of thoracoscopic sympathectomy lucre studied in comparison with 20 cases of open supraclavicular sympathectomy performed for various indications. The two groups were well matched regarding age, sex, side of surgery, and indication for the procedure [p>0.05]. Relief of symptoms was achieved in 42 patients [93.3%] in the thoracoscopic group versus 18 patients [90%] in the open surgical group [p>0.05]. Recurrent hyperhydrosis occurred in one patient in the thoracoscopic group six months after the procedure. No perioperative deaths or major complications were encountered in either group. Horner's syndrome occurred in three patients in the thoracoscopic group and in two patients in the open surgical group [p>0.05]. Minor complications included surgical emphysema [one patient], and intercostal neuralgia [one patient] in the thoracoscopic group. In the open surgical group, minor wound complications [hematoma, ehylous discharge] occurred in two cases. The mean operative time was significantly shorter for time thoracoscopic technique compared to the open surgical procedure [32.9 +/- 11.6 mm. versus 73.3 +/- 33.3 min, p<0.0001]. The mean hospital stay was also significantly shorter for the thoracoscopic group compared to the open surgical group [1.12 +/- 0.4 days versus 2.81 +/- 2.5 days, p<0.0001]. In conclusion, time present study supports the superiority of the thoracoscopic approach for upper dorsal sympathectomy. Its technical ease, increased patient acceptance, minimal morbidity, and excellent results make it the approach of choice for this procedure

Role of tongue guard in treatment of tongue thrust habit

This study included 15 patients complaining of anterior open bite due to tongue thrust with or without persistent thumb-sucking habit. Their age ranged from 9 to 12 years. Treatment was performed through [upper removable appliance] Hawley retainer with tongue guard and short labial arch. The appliance was kept in place for average time 18 months, till the complete eruption and growth of upper anterior teeth and alveolar process. The idea of the treatment depends on the psychosomatic medicine basis, in which the habit has to be stopped without any force, in order to prevent the neurotic symptoms or personal changes, which can be developed by the child in case of forcible cessation of the habit. This hypothesis can be performed by convincing the child to thrust against the tongue guard instead of the teeth, so as to treat the child without spoiling his pleasure in thrusting. All the cases were successfully treated without any recurrence of the habit. Tongue thrust habit might develop and continue into the mixed dentition stage. In many cases if the habit continues to the mixed dentition, a malocclusion might be developed