Study of cases of children with mesangioproliferative glomerulonephritis attending Alexandria university children's hospital

Objective: the present study was conducted to study files of pediatric mesangioproliferative glomerulonephritis [MesPGN] cases attending Alexandria university children's hospital [AUCH] nephrology clinic during the period from [2001-2012] to identify their clinical presentations, course, complications, management and outcome

Methods: this was a retrospective study of children with MesPGN over the mentioned period. It included 37 patients. Data were collected from the files of all children diagnosed as having MesPGN and included personal characteristics, initial clinical presentation, investigations, renal biopsy reports, complications and treatment

Results: the mean age of disease onset in the studied cases was 4.51 years +/- 3.16. There was no significant difference in gender distribution. The most common presentation of primary MesPGN was nephrotic syndrome, while the secondary MesPGN mainly presented with lupus nephritis. Almost all patients had proteinuria. Hematuria was present in nearly half of the patients. Immunofluorescence studies were done only for 17 renal biopsies, 10 of them revealed deposits for immunoglobulins and 32.4% underwent remission while 10.8% died. Different treatment modalities were used according to the presentation

Conclusion: MesPGN is a heterogeneous disease with a wide range of presentations and its outcome varies accordingly, so it can't be considered a special entity like FSGS

Duplex-guided percutaneous transluminal balloon angioplasty of superficial femoral artery

The standard technique of balloon angioplasty of superficial femoral artery requires contrast arleriography and jluoroscopy. We attempted to perform this procedure with duplex guidance to avoid the use ofnephroloxic contrast material and eliminate radiation exposure. Materials and From October 2009 to December 2011, 48 patients [64.6% male] with a mean age of 68 +/- 8 years [range, 55-92 years] underwent balloon angioplasty of short [<4 cm in length], easily visualized superficial femoral artery stenotic/occluded lesions under duplex guidance. Diabetes, smoking, hypertension, renal insufficiency [serum creatinine level >L5 mg/dl], and hyperlipidemia were present in 33.3%, 66.7%, 41,7%, 54.2%, and 62,5% of patients, respectively. Disabling claudication was the indication far the procedure in 68.8% of cases, and critical limb ischemia was the indication in 31.2%. Based on color-coded duplex examination, patients were assigned into two groups. Group I included 30 cases [62.5%] with arterial stenoses, whereas Group II included 18 cases [37.5%] with arterial occlusions. The ipsilateral common femoral artery was cannulated under direct duplex visualization. Still under duplex guidance, a guidewire was directed into the superficial femoral artery, across the diseased segment, and parked at the tibioperoneal trunk, The diseased segment was then balloon-dilated. Balloon diameter and length were chosen according to arterial measurements obtained by duplex scan, Hemodynamically significant defects causing diameter reductions greater than 30% and peak systolic velocity ratios greater than 2 were stented with self-expandable stents under duplex guidance. Completion duplex examinations and ankle brachial indices were obtained routinely before hospital discharge. Whereas, the overall technical success rate was 95.8% [46/48 cases], it was 100% [30/30 cases] in Group I, and 88.9% [16/18 cases] in Group II. There was no statistically significant difference in technical success between the two groups [P value = 0.1]. Hemodynamically significant residual defects that required stenting were documented in 6 [13%] of the 46 successfully cannulated cases. There was no statistically significant difference regarding the need for stenting between the two groups [P value = 1]. After successful DGBA, the PSV [in 30 patients] decreased significantly from a mean of 419 +/- 27 cm/sec to 111 +/- 20 cm/sec [P value <0.0001], and the PSV ratio decreased significantly from a mean of 7.4 +/- 1.2 to 1,2 +/- 0,2 [P value <0,0001]. On the other hand, the ABI [in 46 patients] increased significantly from a mean of 0.5 +/- 0.1 to 0.9 +/- 0.1 [P value <0.0001]. The overall 6-month survival and limb salvage rates were 100%, The overall 6-month patency rate was 91.3% [42/46 cases]. There was no statistically significant difference regarding the patency rate between the two groups [P value = 0.1]. Duplex-guided balloon angioplasty and stent placement is a safe, effective alternative to the standard fluoroscopy guidance for the treatment of short, adequately visualized SFA stenotic/occluded lesions. It offers multiple advantages, including guidance of the arterial access, precise selection of the balloons and stents, and confirmation of the adequacy of the technique by reliable hemodynamic and imaging parameters

Serum interleukin-10 level and microinflammation in vascular access failure in Egyptian children on hemodialysis

Vascular access [VA] dysfunction is a major clinical complication in the hemodialysis [HD] population and has a direct effect on dialysis outcome. Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing HD. interleukin10 [IL-10] and C-reactive protein are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular access failure and IL-10 level and explore the role of microinflammation in the VA dysfunction in pediatric patients on maintenance HD. Forty children receiving maintenance HD with arteriovenous fistula [AVF] in place or an artificial graft [AVG] or tunneled permanent catheter [TPC] were included for this study. They were divided into two groups: group 1 [n=26], children with good vascular access and group 2 [n=14] children with vascular access failure. Twenty healthy children were matched as controls for serum IL-10 and high sensitivity C-reactive protein [hs-CRP] levels. Clinical and laboratory data including serum IL-10 and hs-CRP levels were compared. Female gender, hypoproteinemia, and hypercholesterolemia were associated with vascular access failure. Serum IL-b in group 2 was significantly higher than those in group 1 and in controls [[45.68 +/- 29.62] pg/mi vs [31.07 +/- 22.01] pg/mi and [12.70 +/- 9.76] pg/mI, p<0.05, and p<0.001, respectively]. Serum hs-CRP in group 2 was significantly higher than those in group I and in controls [[5.27 +/- 5.44] mg/L vs [2.32 +/- 2.30] mg/L and [1.36 +/- 0.67] mg/L, P<0.01 and P<0.005, respectively]. Moreover, serum hs-CRP level was negatively correlated with IL-10 levels [r=-0.36, p=0.01].Also, serum hs-CRP level was negatively correlated with serum albumin [r=-0. 78, p=0.04], serum cholesterol [r=-0.91, p=0.002] and fractional shortening percentage on cardiac echo [r=-0.36,p=0.01]. Multiple regression analysis confirmed AVG and TPC, uremic cardiovascular disease, vascular access duration and WBC as factors independently influencing CRP levels. Patients with VA dysfunction have significant higher levels of serum IL-10 and hs-CRP. An altered immune response and microinflammation might contribute to vascular access failure. AVG and TPC have a higher degree of chronic inflammation than AVF

[Knowledge of patients with type 2 diabetes about their condition in Sousse, Tunisia]

We assessed the knowledge of 404 type 2 diabetic patients about their condition in order to evaluate the quality of diabetes education in primary health care units in Sousse in 2003. We found that knowledge was satisfactory in only 59% of the patients. Their knowledge about the definition of diabetes and its pathophysiology were the 2 main areas where knowledge was lacking: the proportion of correct answers were 62.6% and 50.3% respectively. More attention should be paid to educating diabetic patients within the chronic disease care national programme

[Attitudes of teachers to tobacco smoking]

We aimed to evaluate the attitudes of teachers to tobacco smoking in Kalaa Kebira [a semi-urban region in the Tunisian Sahel]. Data from 358 of 402 teachers surveyed were obtained using a self-completed questionnaire. The mean age of the teachers was 35.7 [SD 7.9] years. The prevalence of smoking was 29.3% [51.6% of men and 3.6% of women], and 79% of smokers were addicted to nicotine according to the Fagerstrom test. About 50% of the teachers were badly-informed about the dangers of smoking and 75.2% of smoking teachers did not refrain from smoking in front of their pupils. The lack of knowledge of teachers limits their role as a model and information source in the anti-tobacco struggle. It is essential to draw up an education programme for the teaching staff

In vitro effect of propolis versus Wheat germ agglutinin on growth and adherence of an Egyptian Giardia lamblia trophozoite strain

Giardia is a common human parasite that can cause significant morbidity especially in children in developing countries where it may lead to malabsorption syndrome. Many subjects have difficulty in tolerating the drugs and others may develop drug resistance; however, natural medicine has great potential to influence the course of giardiasis. In a trial to improve the current chemotherapy of Giardia infection, the pesent study was done to evaluate the in vitro effects of both ethanolic extract of propolis [EEP] and wheat germ agglutinin [WGA] on growth and adherence of Giardia trophozoites of El-strain in Trypticase Yeast extract Iron.-serum [TYI-33] culture medium. The results showed that the parasite growth inhibition varied according to incubation times. EEP inhibited trophozoite growth by 90.7% in a dose of 250 [micro]g/ml, on increasing its dose to 500 [micro]g/ml, the inhibitory effect increased to 100% after 72 hour, giving better results than that obtained by the standard drug metronidazole [MTZ] not only on parasite growth but also on its adherence. WGA in a concentration of 100.g/ml inhibited parasite growth by 56.7% after 72 hour compared to 83.3% obtained by ME, while its inhibitory effect on parasite adherence was the same as that obtained by MTZ. Our results showed a promising effect of using propolis or WGA in treating Giardia infection naturally either alone or through combination approach utilizing both nutritional interventions and phototherapeutics agents

Major histocompatibility complex antigens class II in childhood nephrotic syndrome

HLA class II antigens [DR, DQ] were studied in 24 nephrotic children using the microlymphotoxicity method. Twelve patients were steroid sensitive, and the other 12 were steroid resistant Renal biopsy was done in all the steroid resistant cases. HLA-DQ4 antigen was significantly higher among all nephrotic children [33% vs. 8% in controls, X[2c]= 3.97, P<0.05], relative risk was 5.5 [P<0.05] and etiologic fraction was 0.27. In the steroid sensitive group, HLA-DQ2 antigen was 75% vs. 33% in controls [X[2c]= 5.08, P<0.05]. The relative risk was significant and indicates that patients having DQ2 are 6 times more likely to respond to steroid therapy than those without the antigen. In the steroid resistant group, frequencies of HLA-DR9, DR12 and DR14 were increased, pointing to linkage of these antigens and resistance to steroid therapy. HLA-DR12 was 33% in patients vs. 4% in controls, [X[2c] = 4.21, P<0.05]. The relative risk of DR12 was 11.5 indicating that nephrotic patients having DR12 antigen are 11.5 times more liable to be steroid resistant. Our results support the important role of HLA antigens in the pathogenesis of NS, and shed light on the importance of HLA markers as prognostic factors in childhood nephrotic syndrome

Normal anatomy of paratracheal lymph nodes: a cadaveric study

The paratracheal lymph nodes, [syn. recurrent laryngeal nodes, latero tracheal chain] are placed along the recurrent laryngeal nerve. Study of the normal anatomy of paratracheal lymph nodes was carried out on ten fresh cadavers immediately after autopsy examination. The number, size and commonest level of the nodes as well as the relation to the recurrent nerve were studied. The study showed that the majority of paratracheal nodes are