Lactoferrinsupplementation for prevention of sepsis in preterm neonate

Background: Sepsis related morbidity and mortality is a concern in neonatal intensive care units [NICUs]specially in preterm and Low birth weight [LBW] infants who are more vulnerable due to immaturity of immune defenses and protective barriers. Lactoferrin is an iron binding glycoprotein presents in mammalian milk and involved in innate immunity. Recent data suggest that bovine lactoferrin[BLF] might prevent late onset sepsis in preterm and LBW neonates

Objective; To evaluate the effectiveness of oral bovine lacoferrin in prevention of neonatal sepsis in Egyptian preterm neonates

Patients of Methods: A randomized clinical trial, double blind, placebo-controlled study was conducted on 135 preterm neonates [born before 37 weeks of gestation] admitted to the NICUs of Ain Shams University and Manshiet El Bakry Hospitals from February 20l3 to January 2015. Infants were randomly sub-divided into two groups: Group 1 consisted of 45 infant received oral lactoferrm supplementation [100 mg/day] within a day of starting feeds for 4 weeks. Group 2 consisted of 90 infants matching group 1 neonates, received placebo in the form distilled water in the same schedule. History and physical examination were carried out laying stress on signs of sepsis, severity [classified according to Tollnerscore], laboratory investigations were done: CBC with blood film [classified according to hematological scoring system], CRP, Blood culture upon admission and on suspicion of sepsis, other cultures and arterial blood gases when clinically indicated. Radiological investigation were done when clinically indicated, Data were analyzed using the Statistical Package for Social Sdences SPSS

Results: Lactoferrin group [45 preterm neonates] with mean gestational age [33.11 +/- 1.81 weeks]. 32 males [71%] and 13 females [29%]. Placebo group [90 preterm neonates] with mean gestational age [33.28 +/- 1.89 weeks], 45 males [50%] and 45 females [50%]. Lactoferrin group showed a significantly lower incidence of late onset sepsis according to Tollner score and Rodwell score and blood cultures [6.7%] compared to placebo group [17.8%]. E coli and Soureuswere the most common organisms found in septic neonates in the current study [28.6% for each]

Conclusion: BLF supplementation would be a suitable preventive tool for late onset neonatal sepsis in preterm neonates

Interplay between matrix metalloproteinase-9 and tissue inhibitor of matrix metalloprotinase-1 in acute asthma exacerbation and airway remodeling

Airway inflammation and remodeling of extracellular matrix are important features of asthma. Matrix metalloproteinases [MMPs] are group of enzymes expressed in the airways with their inhibitor [tissue inhibitor of MMPs [TIMP] and they are the key responsible for extra cellular matrix [ECM] degradation. To clarify the role of MMP-9 and TIMP-1 in asthma exacerbation and airway remodeling. The study included 3 groups, group "A" included 22 patients with stable asthma group "B" included 18 patients during asthma exacerbation and group "C" of 18 healthy volunteer served as control. All groups were matching age and sex. Levels of MMP-9 and TIMP-1 were measured in the induced sputum of the 3 groups. Serum IgE skin prick test and PEFR were assessed. MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio increased in both A and B groups in comparison to control [P < 0.001]. During exacerbation MMP-9 and MMP-9/TIMP-1 ratio showed significant increase for both but TIMP-1 did not show significant change when compared to stable asthmatics. There was significant negative correlation between PEFR and MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio. MMP-9 and TIMP-1 play an important role in pathophysiology of asthma exacerbation and airway remodeling. Clearly, a greater understanding of the pathogenesis of asthma is critical to the development of better therapeutic modalities

Role of hepatic stellate cells in fibrogenesis in a model of pomegranate-treated fatty liver induced by junk food in male albino rats immunohistochemical and electron microscopic study

Hepatic fibrogenesis is a common result of liver injury. It is believed to be a critical factor that leads to hepatic failure. A critical event in fibrogenesis is activation of hepatic stelate cells [HSCs]. The aim of this investigation was to study the role of HSCs in figrogenesis in a model of pomegranate juice [PJ]-treated fatty liver induced by junk food using immunohistochemical and electron microscopic study. Thirty young male albino rats were divided into control [1] and experimental [II] groups. Group II was further divided into two subgroups: II-a [junk food] and II-b [pomegranate juice + junk food]. After 8 weeks, blood samples were collected for detection of leptin and tumour necrosis factor alpha TNF-alpha. Then half of the liver samples were processed for light microscopic examination, whereas the other half were prepared for electron microscopic examination. Praffin sections were stained using H and E, glial ibrillary acid protein, alpha -smooth muscle actin, TNF- alpha, and transforming growth factor -beta-1 TGF-beta1. Morphometric and statistical studies for assessing immunoexpression were carried out. HSC's markers glial fibrilar acid protein and alpha -smooth muscle actin and cytokines TNF- alpha and TGF- beta1 in subgroup II-a showed strong positive immunoexpression. Electron microscopic study showed activated - HSCs containing granules and collagen fibrils. Proliferative and myofibroblast -HSCs were also seen in the same group. Subgroup II-b showed a nonsignificant increase in immunoexpression of HSC s markers and cytokines. However, only activated -HSCs were seen. Immunoexpression of HSC markers and cytokines may be used as an indicator for liver fibrosis. Presence of different types of HSCs in fatty liver explains their role in fibrosis. Further experimental and clinical studies directed toward inhibiting the activity of HSC may delay or prevent liver fibrosis occurs in many pathological conditions

clinical utility of LPL and ZAP-70 expression in assessment of prognosis in patients with B-cell chronic lymphocytic leukemia

It was found that B-CLL patients with unmutated immunoglobulin heavy chain variable region [IgVH] have poor prognosis and clinical outcome. The difficulty of performing the mutation status of IgHV in the routine diagnostic workup of B-CLL patients, prompts the search for surrogate markers particularly gene expression profile in B-CLL cells. To investigate the role of LPL and ZAP-70 expression in assessment of prognosis and survival in a group of B-CLL patients and correlate the results with other prognostic variables. The study included 47 B-CLL patients who were subjected to clinical staging which was done by Binet and Rai scoring systems. The expression of LPL and ZAP-70 was measured by real-time quantitative PCR [RQ-PCR] and flow-cytometric analysis respectively. The patients were followed over 24 months for proper estimation of treatment free survival [TFS] and disease free survival [DPS]. The results of our study showed positive LPL and ZAP-70 expression in 46.8% and 48.9% of B-CLL patients respectively. There was significant correlation between LPL and ZAP-70 positive expression in our patients [p<0.0001]. The positive expression of both genes is associated with advance in clinical staging with significant correlation between LPL and ZAP-70 positive expression and shortening of the TFS and DPS and subsequent classification of most of the LPL+ and ZAP-70+ cases as patients with poor prognosis. Our study showed that expression of LPL and ZAP-70 has a significant role in determining the prognosis in B-CLL patients, being positive expression of LPL and ZAP-70 is associated with poor prognosis with shortening of TFS and DPS. Also, both genes expression is of great value in selection of B-CLL patients in early clinical stages that are in need to start chemotherapy to avoid progression to aggressive forms of the disease

Do survivin and HER-2/neu play a role in rheumatoid arthritis?

Rheumatoid arthritis [RA] is an inflammatory joint disease characterized by hyperplasia of synovial tissue and pannus formation growing invasively into the cartilage, followed by cartilage and bone destruction. In RA, the proliferation of synovial fibroblasts and their invasive growth are due to impairment in the regulation of the cell cycle. Survivin belongs to the apoptosis-inhibiting proteins [IAP] family and regulates the inflammatory and destructive process inside the joints of patients with RA. RA Synovial Fibroblasts [SFs] over express the ErbB2/HER2 member of the epidermal growth factor [EOF] receptor family relative to normal fibroblasts. The aim was to study the role of survivin and HER-2/neu in the pathogenesis of RA and the association between their level and the presence of erosion in RA patients and evaluation of the possible influence of the ongoing treatment on their serum level. In this study, serum survivin and serum HER-2/neu levels were measured in 35 erosive and non-erosive RA patients and compared with age and sex matched healthy population. There was a statistically significant difference in serum HER-2/neu between RA patients and controls and also between RA patients treated with methotrexate and those treated with methotrexate and others. There was a statistically significant difference in the serum level of survivin between erosive and non-erosive RA patients

Serum resistin as a biomarker for hepatic state in HCV infected patients and its relation to insulin resistance

Patients with chronic liver disease display disturbances of glucose metabolism which is more prevalent among patients with chronic HCV compared with those with other liver diseases and the general population, irrespective of whether cirrhosis is resent. Insulin resistance, a "prediabetic" abnormality of blood sugar, is a specific feature of chronic hepatitis C virus [HCV] infection. To evaluate the clinical utility of the adipokine hormone resistin a potential mediator in inflammatory processes as a biomarker of disease progression in HCV infected patients and to assess if it is involved in the pathogenesis of insulin resistance. The study included 60 HCV infected patients and 20 healthy subjects as control. All cases were recruited from Kasr El Ani Hospital. They were classified into 3 groups; group [I]: Included 20 cases of HCV infected patients with no liver cirrhosis; group [II]: Included 40 cases of HCV infected patients with liver cirrhosis, it was subdivided into three subgroups according to Child-Pugh classification which were [IIa]10 cases, [IIb] 15 cases and [IIc] 15 cases and group [III]: Control group included 20 healthy subjects who were matched with the studied patients as regard age, sex and body mass index. Abdominal ultrasonography, upper endoscopy [for patient groups only], liver function, complete blood picture, erythrocytes sedimentation rate [ESR], C-reactive protein [CRP], blood sugar, fasting insulin, fasting C-peptide with calculation of insulin sensitivity [IS] by the quantitative insulin sensitivity check index [QUICKI] and serum resistin levels were done for all participants. Serum resistin level showed statistically highly significant elevation in HCV infected patients compared with the matched control group [p<0.001] and also its level showed statistically significant differences in subgroups of group [II] being higher in patients presented with complication of liver cell failure [p<0.01]. Its serum level was inversely correlated with the hepatic synthetic function including albumin [r=-0.476, p<0.001] and prothrombin concentration [r=-0.346, p<0.001]. Also, a positive correlations between resistin and biomarkers of inflammation including CRP [r=0.305, p<0.004] and TLC [r=0.268, p<0.01] and insulin resistance parameters [C-peptide r=0.285, p<0.01] were detected, while resistin was inversely correlated with insulin sensitivity [QUICKI] [r=-0.289, p<0.05]. This study demonstrates that serum resistin level is elevated in patients with HCV related chronic liver disease and might be used as a biomarker for the clinical progression of the disease. The correlation of resistin to the insulin resistance [IR] present in such patients, may suggest its possible role in the pathogenesis of insulin resistance

radiographic assessment of craniofacial growth pattern changes in children with chronic renal failure [by digital cephalometric study]

The purpose of the present study to evaluate the craniofacial growth changes in patients with chronic renal failure using a digital cephalometric analysis system. This study was carried out on 24 children [ 12 male and 12 female] with chronic renal failure aged between 6-9 years. The results were compared with control group of 24 normal subjects [12 male and 12 female] having the same age. For each subject in the study a lateral cephalogram was taken. Each cephalogram was scanned, traced and analyzed using a digital cephalometric system program. The data of the digital analysis were collected, tabulated and statistically analyzed. In conclusions: the children who suffered from chronic renal failure had several changes in craniofacial growth pattern in comparison with normal children with the same age group. Also, digital cephalometric radiographic assessment is an accepted method for evaluation the craniofacial growth pattern

Quantitative assessment of effect of serum-coated and non-coated bioactive glass on regeneration of bony defects by radiographic evaluation

This study was designed to compare between serum-coated bioactive glass with non-coated type in stimulation of regeneration of bony defects and to assess radiographic changes after implantation of bioactive glass material in cystic defects by digital radiography and quantitative computed tomography. The study was performed on 12 adults healthy male patients of age ranging from 20-50 years, those patients were complaining of intra bony cysts of approximately 2-5 cm in diameter. Patients were categorized into two groups, group A included 6 patients in whom bioactive glass particles mixed with the patient serum were applied after cyst ennucleation to fill the intrabony defect. Group B included 6 patients in whom bioactive glass particles mixed with normal saline solution were applied. All patients were subjected to IDDR, panoramic and Q.C.T. radiographic evaluation. Measurement of density of the intra-bony graft at IDDR were taken in the post -operative follow-up periods at immediate, four, eight and twelve weeks were corresponding to density measurements at quantitative C.T. for two groups. The results were recorded, tabulated, compared statistically. From our study we can conclude that quantitative C.T. and ID DR radiography methods are very efficient methods in measuring bone density changes in healing osseous defects. Also, serum-coated bioactive glass enhances rapid bone tissue healing than non-coated type

Radiogeometric evaluation of the dentofacial changes and their relationship to the temromandibular joint and dentition after adenoidectomy in children

The present study was conducted on sixteen children with age ranging from 6-12 years to evaluate the dentofacial changes and its relationship to the tempromandibular joint and dentition before and after adenoidectomy. Hence, this study was performed by using lateral cephalometry with a special constructed computer program in order to assess the skeletal angular, linear and dental measurements. Also, using scanora multimodal system and special geometric method in order to assess condylar position and condylar displacement, Children were divided into two groups, group 1 contained 8 children which suffered from adenoids [this group subdivided into group 1a before adenoidectomy and group 1b after adenoidectomy by 1 year] and group 2 contained 8 normal children. From our study it can conclude that the cephalometric radiograph is a valuable in diagnosis and treatment of skeletal deformities. Also, scanora multimodal system is a useful diagnostic images of high quality and sharpness rendering with any geometric method measurements more precise

Effects of laser and flouride on the acid resistance of human dental enamel of primary molars andpremolars

The chief goal of this study was first to assess the effect of CO[2] laser and /or acidulated phosphate fluoride treatment on caries initiation and progression in human dental enamel. Second was to compare the acquired acid resistance induced in primary molars and premolars following C02 laser and /or fluoride treatment. The evaluation was carried out by microdensitometric direct digital analysis and scanning electron microscopic examination [SEM]. The study included 84 freshly extracted sound human teeth, 28 primary molars and 56 premolars of [28 patients]. Primary molars were sectioned into fourths and premolars into halves to represent 28 cases. Each case contains 4 specimens; one specimen was immersed in 1ml solution of acidulated phosphate fluoride [APF] for either 5min. or 10 min., the second specimen was subjected to CO[2] laser irradiation, which was applied with a drop of water at either 2 or 3 watts for 4 seconds period. The third specimen was treated with laser beam [2 or 3 watts) followed by fluoride treatment [5 or 10 min.]. The last specimen was the control. Finally all specimens were immersed in acidified gel. The gel was renewed after one week. Specimens were removed after wo weeks, rinsed well under running water and dried. Measurements of change in enamel density before and after treatments in all prepared specimens which radiographed using digora unit were recorded. The results revealed that treatment of teeth with either fluoride or laser could increase their resistance to the acid attack. Combined treatment with laser and fluoride was better than either alone. SEM examination confirmed the previous results

Conclusion: The use of laser or fluoride could increase resistance of the tooth to acid attack. Direct digital radiography has proved to be a valid method in density measurements

Evaluation of low intensity laser irradiation in treatment of induced osteoporosis

The present study was conducted on forty two adult albino rats attempt to evaluate the effect of LILI on the degree of radiographic bone density by using the Digora soft ware, histopathological bony changes and surface area measurments of bone repair through the image analyzer computer system. From those Forty -two rats, only sixth rats were maintained on normal diet as normal control group, the remaining thirty sixth rats were received the osteoporosis induced diet so, eighteen rats were subjected to LILI application on the lower jaw while the other eighteen rats were not subjected to laser therapy and were used for comparison with the lased animals and also with normal control group. The correlation between statistical analysis of radiographic bone density evaluation and surface area measurements of both lased and non-lased groups assured the findings of this study that the laser treated animals showed accelerated healing and bone deposition compared to non lased groups

relationship between nurse-physician collaboration and nurses' job satisfaction

Today, health care facilities imperative is providing quality patient care with cost effectiveness. In recent years, intensive care units have been exposed to increased workloads because of rapidly expanding medical technology, increasing job complexity and ethical dilemmas associated with it. That is why physicians and nurses play major roles in delivering health care, and this collaboration is vital. The nurse physician collaboration includes mutual respect, shared planning, decision-making, problem solving, goal setting, responsibility, co-operation and co-ordination. Nurse-physician collaboration also has been proposed as crucial for increasing staff satisfaction and retention of critical care nurses. Because nursing is an increasing important core component of the health care system, nurses' workplace well-being is a critical issue. The study aims to determine the relationship between nurse-physician collaboration and nurses 'job satisfaction. The data was collected from 98 ICUs staff nurses at Mansoura University Hospitals. Two tools for data collection, nurse-physician collaboration decision-making questionnaire and job satisfaction questionnaire were used. The results revealed that there is a positive statistical correlation between nurse-physician collaboration and nurses' job satisfaction. The nurse-physician collaboration score not exceed 44.72% in ICUs. Yet, nurses reported the lowest overall level of job satisfaction 54.33% in their work setting. Thus, it is recommended that system imposed by organization should be included information and experiences opportunities concerning the importance of collaboration for the two professions medical and nursing through rounds, patient care seminars, and development of joint patient care plans

Anti-cyclic citrullinated peptide [anti-CCP] antibodies in juvenile rheumatoid arthritis children

To determine if anti-cyclic citrullinated peptide antibodies [Anti-CCP] can be detected in sera of with juvenile rheumatoid arthritis [JRA] patients and to study its clinical significance. Serum anti-CCP antibodies were measured with ELISA technique in 20 JRA patients. Thirty adult RA patients and 20 apparently healthy children were also included in the study. Correlations between anti-CCP, disease characteristics, medication and radiological damage were also determined in JRA patients. Anti-CCP was positive in 10% [2/20] of JRA patients and in about 67% [20/30] of adult RA patients while it was not detected in healthy children. The two JRA patients were girls with seropositive [IgM-RF] polyarticular subtype. There was a statistically significant difference in radiological damage and rheumatoid factor seropositivity between anti-CCP positive and negative JRA patients. On the other hand, disease duration, antinuclear antibody positivity and medication did not differ statistically between the previous two groups. Anti-CCP antibodies can be detected in the sera of JRA patients but less frequently present than adults with RA. Anti-CCP antibodies are exclusively present in the subset of seropositive polyarticular JRA

Assessment of fatigue in ankylosing spondylitis patients: clinical and self-reported measures

Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis [AS]. However, fatigue has been reported as the major complaint of AS patients. To evaluate fatigue as a potential independent domain in comparison to the conventional ones and to evaluate the sensitivity to change after non-steroidal anti-inflammatory drug [NSAID] therapy. Twenty patients were selected as having painful AS [modified New York criteria 1984]. The following variables were recorded at baseline and after six weeks of NSAID therapy: pain [VAS], function [Bath Ankylosing Spondylitis Functional Index], patient's global assessment [VAS], inflammation [night pain], morning stiffness, metrology [Schober test, finger-to-floor] and fatigue using 0-100 VAS scale. Analysis consisted of the prevalence of fatigue [VAS value of at least 50mm] and the sensitivity to change, by calculating the standardized response mean [mean change / S.D. change] [SRM] between before and after NSAID therapy. Fatigue was considered important in 14 patients [out of 20: 70%]. The information provided by pain, function and global assessment explained only 44% of the variability of the variable "fatigue" [similar analyses considering "pain" on the one hand and "function" on the other hand as the dependent variables showed an R value of 34 and 60%, respectively]. The NSAID treatment effect [SRM] was higher for the variables "pain" and "function" [0.76 and 0.71 respectively] than for "fatigue" [0.34]. This study strongly suggests that fatigue should be considered as an independent domain to be systematically evaluated in AS patients and that conventional therapy such as NSAIDs have a lower effect on fatigue than on pain or functional impairment

Evidence of cerebral hypoperfusion with [99m]tc HMPAO SPECT in Egyptian scleroderma patients

The aim of this study was to investigate regional cerebral blood flow [rCBF] with 99mTc-hexamethyl-propylenamine oxine [HMPAO] single photon emission computed tomography [SPECT] in a group of 22 patients affected with systemic sclerosis [SSc]. The SPECT findings were correlated with clinical data and MRI whenever possible. The study was conducted on 22 Egyptian SSc patients in comparison to ten healthy age-matched controls. Subjects affected with concomitant diseases that might interfere with the interpretation of the SPECT results were excluded. SPECT findings were correlated with clinical data, magnetic resonance imaging [MRI] of the brain and magnetic resonance angiography if available. Twelve SSc patients [54.5%] showed cerebral hypoperfusion, focal in 8 [66.7%] patients and diffuse hypoperfusion in 4 [33.3%] patients at the SPECT analysis. MRI was available in 15 patients and was shown to be altered in five of them [33.3%]. Magnetic resonance angiography [MRA] was normal in those five patients except one. No significant differences were found between the group of SSc patients showing hypoperfusion and those showing a normal SPECT scan regarding age, the duration of disease and damage of other organs typically involved in the disease. Focal or diffuse cerebral hypoperfusion was found with SPECT in more than half of the neurologically asymptomatic SSc patients. SPECT was more sensitive in reflecting changes of cerebral blood flow than MRI. The hypoperfusion was not linked to ageing and possibly reflects the cerebral location of the microangiopathic process characterizing the disease

Testosterone, dihydrotestosterone, interleukin-6 and serotonin in varicocele fertile and infertile patients: a controlled study

The objective of this study was to determine the changes in the concentration of testosterone [T], dihydrotestosterone [DHT], serotonin and interleukin-6 [IL-6] in peripheral venous and internal spermatic vein [ISV] blood and also in seminal plasma in infertile and fertile patients with varicocele as well as in the control fertile subjects without varicocele and to correlate these changes with the autosperm parameters. Thirty-six infertile and five fertile varicocele patients as well as five control fertile non-varicocele subjects were included in the study. Autosperm was used for an objective semi-computerized semen analysis. ELISA kits were used to determine testosterone, dihydrotestosterone, serotonin and interleukin-6 aspiration of internal spermatic vein [ISV] blood was done intra-operatively during varicocelectomy in varicocele patients and during herniorrhaphy in the control subjects. The study concluded that since there was a significant deviation in T, DHT, serotonin and IL-6 in infertile patients with varicocele in comparison with both fertile varicocele and control subjects as well as since these deviations were accompanied by nearly similar changes in the autosperm parameters, it was concluded that no single deviation is solely responsible for such semen alteration but additive effect is most appropriate

pathophysiology of esophageal affection in rheumatic diseases

This study comprised 42 Egyptian female patients, 15 RA, 15 SLE and 12 SSc patients, compared to 12 healthy subjects matched with age and sex. Esophageal manometry and upper gastrointestinal endoscopic biopsy were performed for all subjects. The results of this study revealed manometric abnormalities in the three diseases. Hypoperistalsis and diminished resting lower esophageal sphincter pressure were evident in RA and SSc patients but more severe in SSc. Hypotonic lower esophageal sphincter was the prominent feature in SLE patients. Retrograde and non-transmitted contractions were detected in a variable percentage in the three diseases. No correlation was found between manometric abnormalities and disease activity, while; there was a significant correlation between these abnormalities and disease severity in SSc patients. Reflux esophagitis was detected in 26.7% of RA and 75% of SSc patients. Histopathological study revealed esophageal mucosal damage due to chronic inflammatory process and vasculitic changes in RA and SSc. The esophagus was histopathologically normal in SLE patients