Expression of survivin in squamous cell carcinoma and transitional cell carcinoma of the urinary bladder: A comparative immunohistochemical study

PURPOSE: To compare the expression of survivin and its association with clinicopathological criteria in major types of urinary bladder carcinoma, specifically, transitional cell carcinoma with and without squamous differentiation and squamous cell carcinoma. MATERIALS AND METHODS: Immunohistochemical staining for survivin and Ki67 was performed on paraffin-embedded sections of 104 carcinomas: 52 transitional cell carcinoma, 20 transitional cell carcinoma with squamous differentiation, and 32 squamous cell carcinoma. Expression of survivin in >10% of tumor cells was described as altered survivin status. Ki67 staining in >20% of tumor cells was described as a high proliferation index. RESULTS: Altered survivin expression was detected in 60/104 specimens (58%) and was significantly more frequent in transitional cell carcinoma (78%) than in squamous cell carcinoma (38%) or transitional cell carcinoma with squamous differentiation (40%) (p<0.0001). In transitional cell carcinoma but not in squamous cell carcinoma, altered survivin status was associated with higher tumor grade, higher proliferation index, and recurrence. In the whole specimens, altered survivin expression was significantly associated with advanced stage (p<0.001), recurrence (p=0.005), distant metastasis (p<0.001), and death (p=0.001). In the multivariate analysis, altered survivin was an independent poor prognostic factor for recurrence. CONCLUSIONS: Unlike in transitional cell carcinoma, alteration of survivin expression in squamous cell carcinoma occurs less frequently and is not associated with features of tumor aggression or patient outcome. These findings raise a question: are urinary bladder carcinoma patients with squamous cell carcinoma type suitable candidates for survivin vaccine? This is an important question to be answered before approving the vaccine in management.

prevalence of vitamin d deficiency in ancient egyptian population from baharia oasis, the greco roman period

Vitamin D deficiency is considered to be the most common nutritional deficiency andalso one of the most common undiagnosed medical conditions in the world. Vitamin D is naturallypresent only in minor amounts in most foods; the great majority is synthesized by the action ofultraviolet light on chemical precursors in the skin.The manifestation of vitamin D deficiency in sub adults is referred to as rickets, and in adults,osteomalacia . Rickets and osteomalacia are the sub adult and adult expressions of a disease in whichthe underlying problem is a failure to mineralize bone protein [osteoid]. The most common cause ofthis disease is a physiological deficiency in vitamin D. The associated problems include deformedbones. This study aimed to investigate the skeletal remains of ancient Egyptiansfrom Baharia Oasis population for lesions indicative of vitamin D deficiency [rickets andosteomalacia]. The material consisted of 1075 commingled bones [38 sub adults and 1037 adults]. They were recovered from Baharia oasis. The results showed that, there was no evidence of rickets in sub adult group. The prevalenceof osteomalacia in adult Baharia populations was 7.4% ; all were adult males.This result could indicate that this population was subjected to sunlight all over the year and their dietwas rich of calcium and phosphorus. These few cases that were found may be due to mechanical stress during wine andtextile production

Children with isolated growth hormone deficiency: Empty sella versus normal sella.

BACKGROUND: Empty sella (ES) may be associated with variable clinical conditions ranging from the occasional discovery of a clinically asymptomatic pouch within the sella turcica to severe intracranial hypertension and rhinorrhea. The need for replacement hormone therapy in ES, as in other syndromes that may cause hypopituitarism, must be assessed for every single hormone, including growth hormone (GH). AIM: To determine whether or not the presence of ES could allow some changes in the GH responses of the isolated growth hormone deficiency (GHD) patients. MATERIALS AND METHODS: We included a cohort of 59 short stature children and adolescents with isolated GHD. According to computed tomography finding, they were classified into 2 groups: Group 1 included 40 children with normal sella and 19 children with ES in Group 2. All patients received recombinant human growth hormone (rhGH) with a standard dose of 20 IU/m2/week. RESULTS: The baseline results were not significantly different for all variables except weight standard deviation was smaller with statistical significant difference (P = 0.02). We identified no significant differences when comparing both groups, except for height standard deviation (HTSD) after the first year of therapy which revealed significant difference in favor of group 1. When comparing pre- and the two post-treatments HTSD results of the studied cases, all showed significant changes after GH therapy. The results of related variables pre-and post-treatment in both the groups showed significant improvement in all variables of the two groups of the study. CONCLUSION: Our study showed a similar stature outcome in the two treatment groups.

Live donor hepatectomy for liver transplantation in Egypt: lessons learned

To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of [50.1%]. The most frequent complication was infection [21.1%] [intraabdominal collections], followed by biliary leak [18.2%]. Two donors had major complications: one had portal vein thrombosis [PVT] treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely [n=90] with no epidural hematoma despite significantly elevated prothrombin time [PT] and international normalization ratio [INR] postoperatively, reaching the maximum on Day 1 [16.9 +/- 2.5 s and 1.4 +/- 0.2, P < 0.05 when compared with baseline]. Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05 +/- 0.18 mg/dL on Day 1 and 2.3 +/- 0.83 mg/dL on Day 3 postoperatively. Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting

Growth response of Egyptian children with idiopathic short stature during four years of growth hormone therapy.

BACKGROUND: Multiple factors affect the growth response to recombinant human growth hormone (rhGH) in children with idiopathic short stature (ISS). AIM: To evaluate the growth responses of children with ISS treated with rhGH, aiming to identify the predictors of growth response. MATERIALS AND METHODS: We studied 120 cases, 90 males (75%), with a mean age of 13.8±2.7 years and 30 females (25%), with a mean age of 12.3±2.5 years. All patients received rhGH with a standard dose of 20 IU/m2/week. The calculated dose per week was divided into six days and given subcutaneous at night. RESULTS: A significant positive trend was detected in the delta changes of all anthropometric data. For the first year, the growth response was positively correlated to CA and BA delay and negatively correlated to height, weight and IGF-1 SDSs. For the second year, the growth response was correlated positively to first year growth velocity, BA, triceps skin fold thickness SDS and deviation from target height, and negatively correlated to weight, IGFBP3 SDS and target height SDS. For the third year, the growth response was positively correlated to five variables namely target height, 2nd year growth velocity, IGF-1 SDS, weight SDS and triceps skin fold thickness SDS. For the fourth year, growth response was positively correlated to 2nd and 3rd year growth velocity, BA, deviation from target height and weight/ height SDS. CONCLUSION: Our study showed multiplicity of predictors that is responsible for response in ISS children treated with rhGH, and BA was an important predictor.

Pediatric [staff nurses]perspectives on safety practices for medication-use system adoption in critical care units

Medications are a great benefit to patient's lives for relieving pain or curing illness. Medications may be very dangerous if improperly used, moreover medications' safety is one of the highest priorities of nursing practice, a matter of considerable concern for all health team members. Medication errors produce a variety of problems for patients ranging from minor discomfort to substantial morbidity that may prolong hospitalization or lead to death and risk of litigation. Therefore, the aim of this study was to assess the medication safety measures used in every day practice. The study was conducted at the Pediatric Cairo University Hospital. All critical care units of the hospital were included in the study. A convenient sample consisting of all staff nurses [60] who are giving direct care and working three shifts were recruited. The tool used a socio demographic data sheet, and a "Medication Safety Measures Evaluation Tool for Nurses" developed by [American Hospital Association and Institute for safe medication practice 2002] to assess safety of medication in every day practice. It contains 10 domains with a total of [91] items representing safe medication use. The result of the study indicated that there is unsafe use of medication safety measures in majority of dimensions, also there is no significance difference between staff nurses demographic characteristics and unit type from staff nurses perspectives on medication use system safety. The study recommended establishes a clearly defined system and policies for drug ordering, dispensing, and administering. Avoid use of verbal orders whenever possible. Develop an educational program for all medical staff in calculating, prescribing, preparing, and administering medications for children, especially for nurses to develop and maintain pediatric medications knowledge base, and to know how to respond to medication error

relation between perineal length and lacerations during labor

Perineal length is thought to affect the risk of perineal lacerations in vaginally delivered women. To investigate the possible role of perineal length as a risk factor for development of perineal lacerations during vaginal delivery. Correlation descriptive. The study was conducted at El Hlal Elahmar hospitals in Alexandria. A convenience sample of Eighty women with singleton pregnancies who went into spontaneous labor at term during the study period were included in the study. All participants were subjected to general examination, abdominal palpation and vaginal examination was performed to assess cervical effacement/length, dilatation, cervical position, consistency, membranes, liquor, presentation, position, caput, moulding and station. Perineal measurements [to the nearest 0.5 cm] were taken at the beginning of the active phase of labor [effacement of 80-100% and 3-4cm dilatation]. The length of the perineum was determined as the distance between the fourchette and center of the anal orifice. Comparison between women with perineal length 3.5 cm [group II] revealed that women in GI had significantly longer 2[nd] stage of labor and significantly higher frequency of perineal lacerations. Comparison between those with perineal lacerations [PL] and women without in those who didn't have episiotomy has shown that women with perineal lacerations had significantly longer 2[nd] stage of labor and larger head circumferences of the newborn baby. Women with short perineal length are at increased risk of perineal lacerations during vaginal delivery. Other factors associated with increased prevalence of perineal lacerations are prolonged 2[nd] stage of labor and increased neonatal head circumference

Bone age is the best predictor of growth response to recombinant human growth hormone in Turner’s syndrome.

BACKGROUND AND OBJECTIVES: Recombinant human growth hormone (rhGH) is approved for use in children with Turner’s syndrome (TS) in most industrialized countries and is recommended in the recently issued guidelines. We determined the growth responses of girls who are treated with rhGH for TS, with an aim to identify the predictors of growth response. MATERIALS AND METHODS: Fifty-six prepubertal girls with TS, documented by peripheral blood karyotype, were enrolled. All the patients received biosynthetic growth hormone therapy with a standard dose of 30 IU/m2/week. The calculated dose per week was divided for 6 days and given subcutaneously at night. RESULTS: This study showed that rhGH therapy provides satisfactory auxological results. Bone age delay is to be considered as a predictive factor which may negatively influence the effect of rhGH therapy on final height. The growth velocity in the preceding year is the most important predictor of rhGH therapy response. CONCLUSION: These observations help us to guide rhGH prescription, to reduce the risks and costs.

Assessing the disposition of the undergraduateuniversity nursing students toward critical thinkingat Faculty of Nursing El Minia University

This study aimed to assess critical thinking dispositions of the four academic year's undergraduate nursing students. A cross sectional descriptive design was utilized in this study. Sample of 347 nursing students who were completed 1st, 2nd, 3rd, 4th year of baccalaureate nursing program were assessed at the beginning and at the end of their academic year, Faculty of Nursing, El Minia University. The California Critical Thinking Dispositions Inventory [CCTDI] by Facione [1992] was used after translation into Arabic to measure the key theoretical aspects of the overall dispositional dimension of critical thinking. Results of this study revealed that, in the majority of sub-scales of CCTDI students showed an ambivalent disposition toward critical thinking, a statistical significant differences were found in relation to all dispositional level characteristics; the Mean and SD were low at the end of academic year than at the beginning of the academic year, the third academic year students have the highest mean score in the dispositional level characteristics [truth-seeking] ,the first academic year have the highest mean score regarding to all dispositional level characteristics except in [truth-seeking] while the fourth academic year have the lowest mean scores in all dispositional level characteristics and the females nursing students have a slight increase in mean scores in all dispositional level characteristics than males nursing students. In conclusion of the study finding the need for critical thinking in nursing has been accentuated in response to the rapidly changing health care environment. Nurses must think critically to provide effective care whilst coping with the expansion in role associated with the complexities of current health care systems. It is considered recommended that nurse educators must try new teaching approaches and to establish those teaching strategies that are most effective in promoting critical thinking [CT] among students and nursing teacher should modeling positive critical thinking dispositions as well as students nurse could act as role models for each others

study on the ages of union of epiphyses at the elbow, wrist, hand, knee, ankle, and foot regions in a sample of Egyptian population in the East of Delta on the beginning of the 21st century

In the present work, 765 X-ray photographs for males and 450 for females from a sample of clinically healthy Egyptian population in the east of Delta, in the age range of 9-25 years, were examined for epiphyseal union in the regions of the elbow, wrist, hand, knee, ankle, and foot. The epiphysis was considered united if there was complete obliteration of the diaphyseo-epiphyseal space, and non- united if there was no or partial obliteration of diaphyseo- epiphyseal space. The results showed that epiphyseal union occurs over a range of 4-6 years in males and 4-5 years in females, and the union was 1-2 years earlier in females than in males. Comparison of results of the present study with results of other studies performed earlier or in other localities demonstrated the existence of differences in age timing and sequence of union of the studied epiphyses. The differences were more marked on comparing the present study with a study performed on Bengalis than with a study performed on Caucasians. This raises the importance of developing and updating the standards of ages of epiphyseal union for each locality to achieve more accuracy of age estimation by examining bone epiphyses. Examining more than one epiphysis for age estimation is also recommended

Lead enhances neutrophil apoptosis in albino rats

The present work was conducted to study the effect of lead, after in vivo and in vitro exposure, on neutrophil apoptosis in albino rats. For the in vivo study, adult female albino rats, with body weight range of 150-250 g, were randomized into test and control groups, 20 rats/group. Test groups were treated with lead acetate solution in distilled water by intraperitoneal injection at two dose levels [20 mg/kg body weight or 40 mg/kg body weight for either 4 weeks or 12 weeks for each dose level]. Control groups were treated with distilled water by intraperitoneal injection for either 4 weeks or 12 weeks. For the in vitro study, neutrophil cultures were prepared from 20 rats and each test culture was divided into two subdivisions and incubated for 24 hours with lead acetate at 2 concentrations, 20 or 40 mmol/ml cell culture. Control cultures were prepared from other 20 rats. Apoptosis was assessed morphologically by light microscope using Giemsa stain, fluorescence microscope using acridine orange stain and by assessment of DNA fragmentation by agarose gel electrophoresis

Lead modulates T lymphocyte functions in albino rats

The present work was performed to study the effects of subchronic and chronic in vivo exposure to lead on some parameters of T lymphocyte functions; namely, interferon-gamma [IFN-gamma] production and mitogen blastogenesis in albino rats. Adult female albino rats, with body weight range of 150-250 g, were randomized into test and control groups, 20 rats/group. Test groups were treated with lead acetate solution in distilled water by intraperitoneal injection at two dose levels [20 mg/kg body weight or 40 mg/kg body weight for either 4 weeks or 12 weeks for each dose level]. Control groups were treated with distilled water by intraperitoneal injection for either 4 weeks or 12 weeks. The results showed that lead exerted immunomodulatory effects on the studied immune parameters. It decreased gamma-IFN serum levels and enhanced blastogen transformation of lymphocytes in a dose and time-dependent manner. These results showed that lead differently affects T cell subpopulations. Dysregulation of the immune function may be the end result