Treatment of refractory diffuse diabetic macular edema with lntravitreal bevacizumab

To analyze the short term visual acuity and anatomic response after a single dose of off-label intravitreal injection of bevacizumab in diffuse diabetic macular edema [DME] not responding to conventional laser photocoagulation. Prospective analysis of consecutive case series of 45 eyes of 38 patients with refractory diffuse DME who had one intravitreal injection of 1 .25 mg of bevacizumab [Avastin] and followed up for 3 months. All patients passed at least six months since their last laser treatment before inclusion in the study. Patients underwent best corrected visual acuity determination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula and measurement of the retinal thickness by optical coherence tomography [OCT] at base line and follow up visits. At 1 month post-injection, visual acuity improved by 1 line in 7 eyes, unchanged from the pre-injection levels in 24 eyes and deteriorated in 14 eyes. At 3 months post injection, visual acuity improved in 1 8 eyes, it remained unchanged in 13 eyes and deteriorated in 14 eyes. The mean logMAR visual acuities were 0.60 [SD +/- 0.34], 0.64 [SD +/- 0.31] and 0.61 [SD +/- 0.32] at pre-injection, at 1 month post-injection and at 3 months post-injection respectively; but this mean decrease in vision was statistically not significant [P value=0.099]. The foveal thickness on optical coherence tomography had decreased in 27 eyes and it increased in 1 8 eyes at 1 month post-injection. At 3 months following injection, foveal thickness was reduced in 34 eyes, but was increased in 11 eyes. The mean foveal thicknesses were 444.95 micro [SD +/- 1 27.36], 394.95 micro [SD +/- 138.03] and 378.32 micro [SD +/- 112.01] at pre-injection, 1 month post-injection and 3 months post-injection respectively. This decrease in the foveal thickness was statistically significant [P value<0.001]. Intravitreal bevacizumab is effective in patients with diffuse DME which is refractory to treatment with conventional macular laser photocoagulation

Effect of aluminum on the histological structure of rats' cerebellar cortex and possible protection by melatonin

Aluminum [AL] is toxic to the central nervous system, and melatonin [MEL] reduces lipid peroxidation by its antioxidant activity. This study was carried out to investigate the histological changes in the cerebellar cortex of rats after AL treatment and to detect any possible protective role of MEL when given concomitantly with AL. This study used 50 adult male albino rats, randomly divided into five equal groups. Group I: control group; group II: received daily intraperitoneal [i.p.] injection of 1/2 ml 0.9% saline containing 2% ethanol; group III: received daily i.p. injection of MEL at 10 mg/kg bw dissolved in 1/2 ml 0.9% saline plus 2% ethanol; group IV: received daily i.p. injection of aluminum chloride at 10 mg/kg bw dissolved in 1/2 ml saline; group V: received both AL and MEL. After 2 months of treatment, the cerebellum was dissected out from each animal and was processed for light and electron microscopic studies. Morphometric and statistical analysis were conducted. After AL administration, the cerebellum exhibited significant reduction in the number of Purkinje cells and prominent peri neuronal spaces in the molecular layer around basket and stellate cells. Ultrastructurally, some of the few encountered Purkinje cells were shrunken with dense cytoplasm, ill-distinct nuclei, and swollen mitochondria with ruptured membranes and cristae. Granule cells revealed increased condensation of their nuclear chromatin. Concomitant administration of MEL with AL displayed an observable protection against these changes. MEL may have a protective role against AL-induced cerebellar toxicity

Assessment of liver function among nickel-plating workers in Egypt

Currently no reports are available from Egypt regarding occupational exposure to nickel and its effects on the liver. The aim of this study was to assess the liver function of workers occupationally exposed to nickel. Standard liver function tests were applied to blood samples from 25 nickel-plating workers in Damietta, Egypt and 30 administrative workers as a reference group. Levels of urine nickel, measured by inductively coupling plasma-emission spectroscopy, were significantly higher in nickel-exposed workers compared with the reference group. The levels of alanine aminotransferase and aspartate aminotransferase were significantly higher in nickel-exposed workers. The level of serum albumin was significantly negatively correlated and the levels of serum aminotransferases, and serum gamma-glutamyl-transpeptidase were significantly positively correlated with urine nickel levels. Liver function is compromised in nickel-plating workers compared with non-exposed administrative workers

Current concepts in intravitreal drug therapy for diabetic retinopathy

Diabetic retinopathy [DR] is a major cause of preventable blindness in the developed countries. Despite the advances in understanding and management of DR, it remains a challenging condition to manage. The standard of care for patients with DR include strict metabolic control of hyperglycemia, blood pressure control, normalization of serum lipids, prompt retinal laser photocoagulation and vitrectomy. For patients who respond poorly and who progressively lose vision in spite of the standard of care, intravitreal administration of steroids or/and anti-vascular endothelial growth factor [anti-VEGF] drugs appear to be a promising second-line of therapy. This review discusses the current concepts and the role of these novel therapeutic approaches in the management of DR

Intravitreal injection of triamcinolone acetonide for the treatment of refractory diabetic macular edema

A prospective descriptive / non-comparative pilot study was used to evaluate the efficacy of intravitreal injection of triamcinolone acetonide [TA] for the treatment of patients with refractory diabetic macular edema that had not responded to laser treatment. Forty eyes of 35 patients with visual acuity [VA]

parasitological study on the use of biotherapeutic yeast in the treatment of Schistosoma mansoni infected mice

Infection with Schistosoma mansoni induces humoral and T cell mediated responses and leads to a delayed hypersensitivity that result in granulomatous inflammatory disease around the parasite eggs. The nonpathogenic Saccharomyces species have potential as an exogenously administered agent for maintaining colonization resistance during antibiotic therapy, preventing diarrhea and other gastrointestinal diseases as well as its antagonistic activity [in vitro and in vivo] against various bacterial pathogens. Saccharomyces boulardii exerts its immunoprotective effect through the secretion of immunoglobulins. In this work the antibilharzial effect of S. boulardii and Saccharomyces cerevisiae was studied. Both yeast products were given orally to mice for 21 days before infection. Their effects on worm burden, egg count, fecundity and granuloma diameter were elucidated. Both were effective in reducing worm burden and egg count resulting in a significant decrease in granuloma diameter. The obtained data show that S. cerevisiae gave more potent effects on S. mansoni parasitism than S. boulardii

Risk factors contributing to fascioliasis endemicity in a focus in Dakahlia governorate 1- human host

Zoonotic fascioliasis is a problem not only in Dakahlia Governorate, but also in other Egyptian Governorates. Two hundreds and twenty patients randomly selected with suggesting manifestations were examined for fascioliasis. A total of 23 [10.4%] were positive by Kato thick smears, of which 21 were from Kafr El-Hessah and two from Oweish El-Hager. The proven human fascioliasis was examined for anti -Fasciola antibodies by IHAT and ELISA [Fhes], haemoglobin level, eosinophils percent, serum bilirubin and liver function tests. IHAT gave 82.61% positive results [19/23], and ELISA gave 100% positive results [23/23]. The clinical signs ranged between splenomegaly and ascitis in 4.34% for each up to hepatomegaly in 73.91% and mild fever in 78.26% but 2 cases were asymptomatic. Mild eosinophilia and moderate anaemia were recorded with means of 11 +/- 5.8 and 10 +/- 1.3 respectively. Mean serum bilirubin was not elevated [0.91 +/- 0.51 gm/dl]. Liver function tests [AST within normal range in all cases; <40 unit /ml but one patient had ALT above normal; >45 unit/ml]

Serum level of beta- endorphin and some lipid parameters in patients with peptic ulcer

Endogenous opioid system like beta-endorphin have a functional role in modulating pain perception. This work was conducted to study the serum level of beta-endorphin and some lipid parameters in patients with peptic ulcer in relation to the site of ulcer, severity and duration of symptoms. The study included 48 patients with peptic ulcer and 15 healthy control. The serum level of beta-endorphin were significantly higher in patients with peptic ulcer than the control [0.475 +/- 0.058 Vs 6.18+1.004 ng/ml] [P<0.001] and the level were elevated in asymptomatic more than symptomatic patients[12.014+1.517 Vs 1.652 +/- 0.23 ng/ml] [P<0.001], acute more than chronic [7.459+1.4 Vs 3.621+0.81] with no difference between gastric and duodenal ulcer [5.284 +/- 1.11 Vs 7.076 +/- 1.67]. The lowest elevation were present in chronic symptomatic patients. Serum total, LDL cholesterol and triglyceride levels were elevated in patients with chronic peptic ulcer more than acute [P<0.001] with no differences between gastric and duodenal ulcer or between symptomatic and asymptomatic patients. Serum HDL-cholesterol levels were elevated in peptic ulcer patients who are acute more than chronic with no differences between gastric and duodenal ulcer or between symptomatic and asymptomatic patients

Taxonomy, identification and biological activities of a novel isolate of Streptomyces tendae

Various isolates of streptomycetes spp. obtained from different localities of Baghdad soils were tested for their antimicrobial activities. Five isolates showed the highest antimicrobial potentialities in the culture broth. The isolate AR1 was the most active one and thus was selected for identification. Morphological, cultural, physiological, biochemical characteristics and biological properties as well as enzymatic activities and cell wall composition suggested that the isolate is belonging to the genus Streptomyces. The 16S ribosomal DNA amplification for phylogenetic study revealed that the isolate was highly related to Streptomyces tendae [99%], so it is designated as Streptomyces tendae AR1. This new strain is capable of producing antimicrobial agent[s], which is active in vitro against Gram+ve and Gram-ve bacteria [Bacillus cereus, Bacillus subtilis, Staphylococcus aureus, Micrococcus luteus. Escherichia coli and Pseudomonas aeruginosa], yeasts [Candida albicans, Candida pseudotropicalis and Rhodotorula minuta] and fungi [Aspergillus flavus, Aspergillus niger, Aspergillus terreus, Botrytis allii, Diplodia oryzae, Fusarium oxysporum, Helmenthosporum turcicum, Machrophomina phaseoli and Trichoderma viride]

Outcome of the treatment of retinopathy of prematurity in Qatar

To evaluate the results of the treatment of Retinopathy of Prematurity [ROP] patients in Qatar a retrospective analysis was made of 43 infants treated between January 1999 and December 2002 initially with indirect laser transpupillary photocoagulation. Cryotherapy was used only on those needing re-treatment. A favorable outcome overall was obtained in 40 cases [90%] after ten received re-treatment. The statistical interpretation, complicating factors and outcomes are discussed. It is concluded that the results of threshold ROP treatment in Qatar are encouraging

Immunization of mice with crud extract of saccharomyces boulardii yeast induces cross-reactive immune responses with antigenic preparations from different develop-mental stages of the schistosoma mansoni and reduces the parasite worm burden

Immunization of mice with Saccharomyces boulardii crude extract caused a significant reduction in Schistosoma mansoni worm burden [23.7%; P = 0.02] in comparison to control mice. Mice sera collected after the 1st immunization showed a significant increase [P < 0.05] in both IgM and IgG against parasite soluble cercarial antigenic preparation [CAP] than unimmunized mice sera [UMS]. Upon 2nd immunization, sera from yeast extract immunized mice [YIM] showed increase of IgM and IgG [1.6 and 1 fold] against CAP than UMS. Sera collected 2, 4 and 6 weeks [W] after infection of YIM with S. mansoni cercariae showed higher 1gM [1.4, 1.5 and 1 folds] and IgG [0.9, 1.2 and 1.1 folds] levels against CAP than sera of infected UM [IUM]. When compared to sera from UM, a week post lst and 2nd immunization sera showed a significant elevation [P < 0.05] of both IgM and IgG to parasite soluble adult worm antigenic preparation [SWAP]. Sera collected at 2, 4 and 6W after infection of YIM with parasite cercariae showed higher 1gM [11, 1.3 and 1.2 folds] and IgG [1.2, 1.1 and1.3 folds] reactivities against SWAP than sera of IUM. One week post 1t and 2 immunization with the yeast extract, sera showed a significant increase [P < 0.05] of both 1gM and IgG levels against parasite soluble egg antigen when compared with sera from UM. At 2 and 4W post infection, sera from immunized infected mice showed a significant decrease in IgM [P < 0.05] but the decrease of IgG [0.7 fold] was not significant when compared to IUM. Six weeks post infection the decrease in both antibodies remained but it was significant for IgG [P < 0.05] but not for IgM [2.1 folds] when compared with IUM. Immunization with S. boulardii extract caused a non-significant increase [1.2 folds] in mesenteric lymph node [MLN]-CD4+T cells, significant elevation of MLN-CD8+T cells [P < 0.05] and a non-significant increase [0.9 folds] of B-cells when compared to that of UM. Also, Immunization with S. boulardii extract caused 1 fold elevation in both CD4+ and CD8 +/- T lymphocytes in thymus of YIM when compared with their counts in thymus of UM

Role of mast cells and T-lymphocytes in pemphigus vulgaris: significance of CD44 and the c-kit gene product [CD117]

Molecular mechanisms underlying the pathophysiology of pemphigus vulgaris are still not clear. We aimed to determine the significance of detecting expression of some antigens that might be pivotal to the process, namely CD44 and CD117, in patients with active pemphigus vulgaris. Seventeen patients with active pemphigus vulgaris and 19 normal healthy controls were included in the study. The immunohistochemical results showed prominent expression of CD44 in 13 of the patients and CD117 in 9 of the patients with new blister formation. CD44 percentage values in peripheral T-lymphocytes were significantly higher in patients than controls, as detected by flow cytometry. In addition, there was a significant increase in a soluble form of c-kit in sera of patients with active pemphigus vulgaris compared to controls

Evaluation of serum alpha-L-fucosidase and alpha-fetoprotein levels in patients with liver cirrhosis and hepatocellular carcinoma

Hepatocellular carcinoma [HCC] develops during the natural history of cirrhosis. HCC lesion of one cm in diameter with high or low echogenicity can be detected by ultrasonography and confirmed by needle biopsy. However, it is still very difficult to detect small isoechogenic HCC lesions, especially when AFP is normal. The serum level of alpha -L-fucosidase has been proposed as a marker of HCC. The aim of our study was to evaluate the serum alpha-L-fucosidase and alpha-fetoprotein levels in patients with liver cirrhosis and HCC. All patients were subjected to full history taking, clinical examination, laboratory investigations, abdominal ultrasonagraphy and ultrasongraphy guided percutaneous fine needle aspiration biopsy. To evaluate the role of serum alpha-L-fucosidase [AFU] in the diagnosis of hepatocellular carcinoma [HCC], we simultaneously studied both AFU activity and alpha-fetoprotein [AFP] levels in 40 patients with cirrhosis, 40 patients with HCC and 40 healthy subjects. Serum AFU activity in patients with HCC [573 +/- 210 nmol/ml/hr] and cirrhosis [285 +/- 143 nmol/ml/hr] was significantly higher than controls [216 +/- I l7nmol/ml/hr, p < 0.001]. With 450 nmol/ml/hr [mean value of controls plus 2 standard deviations] considered as the cut-off point, AFU was more sensitive [76 vs 65.4%] but less specific [90.9 vs 95.5%] than AFP at a level of> 400 ng/ml as a tumor marker of HCC. We conclude that AFU is a useful marker, in conjunction with AFP and ultrasonography, for detecting HCC

Modified acromioplasty for shoulder impingement syndrome with an intact rotator cuff

The study included 20 consecutive patients [14 males and 6 females] with an average age of 6.4 years. The dominant extremity was involved in 17 patients. The follow-up period was 20 months. Before operation, all the patients had shoulder pain for at least one year despite conservative treatment. At operation, the rotator cuff tendons were explored and were intact. The modified two-step acromioplasty followed by proper rehabilitation was successful in 90% of patients. It was believed that removal of only the inferior prominence is insufficient and may lead to continuing or recurring of symptoms and that the removal of the anterior portion is advised as it continues to irritate the subacromial bursa and the rotator cuff

Endometrial histological changes observed by light and electron microscopy among norplant Ousers

Endometrial biopsies were taken from 40 women attending the Fertility Care Unit [FCU], Mansoura University Hospitals who were using Norplant for more than 6 months, thirty cases were complaining of menstrual disturbances and ten were regularly menstruating, Endometrial biopsies were also taken from 10 women attending the FCU and asking for IUCD insertion with no previous use of any hormonal therapy in the last six months and these cases were considered as control. Endometrial biopsies were subjected to light and electron microscopical examination to identify the ultrastructural changes of the endometrium among Norplant users aiming at better understanding of the mechanism of bleeding that occur in some Norplant users. Regressive to atrophic, suppressed and hyperplastic changes were observed in the endometrium of Norplant users complaining of irregular bleeding. It was found that Norplant induces alteration in the ultrastructure of endometrial cells, as gaping areas in the basement membrane, defective ciliogenesis, and irregularity of epithelium including necrosis and denudation. Moreover, endothelial hypertrophy of small blood vessels, and loss of the epithelium of the uterine lumen exposing blood vessels in the underlying stroma were also observed, especially among Norplant users with abnormal uterine bleeding. These endometrial ultrastructural changes may explain the mechanism of bleeding and hence can be a helpful guidance to the best therapeutic modality of abnormal bleeding in some Norplant users

effect of antireflux treatment on pulmonary functions and bronchial responsiveness in patients with non - allergic asthma associated with gastro - esophageal reflux

This study was conducted on 100 non allergic asthmatic patients. Upper gastrointestinal endoscopy was performed for all patients and revealed the presence of gastroesophageal reflux [GER] in 38 patients [38%]. According to the results of endoscopy, patients were classified into four groups. Group I: included 13 asthmatic patients associated with GER. They received the classic dose of antireflux medication for 12 weeks. Group II : included 13 asthmatic patients associated with GER they received double the classic dose of antireflux medication for 12 weeks. Group III : included 12 asthmatic patients associated with GER. They did not receive antireflux therapy. Group IV: included 13 asthmatic patients not associated with reflux. They received the classic dose of antireflux therapy for 12 weeks. For all the patients ventilatory function tests, bronchial responsiveness to methacholine and endoscopy were done and repeated after 3 months to evaluate the effect of antireflux therapy on them. In groups I and II, there was marked improvement in the endoscopic findings of GER after treatment. In group II all the parameters of ventilatory function tests were found to be statistically significantly higher after treatment when compared to that before treatment. In groups I and II, PD20 was significantly higher after treatment when compared to that before treatment. It could be concluded that GER is common among asthmatics. Asthma associated with GER can be improved by adequate antireflux therapy taken for at least 12 weeks

Effect of increasing dietary calcium on lipid metabolism in rats

The influence of increasing dietary calcium level from 0.5% to 2.5% on serum and tissue lipids in a low fat, cholesterol free diet containing sucrose or starch with corn oil or ghee was studied in male albino rats for six weeks. The concentration of serum total cholesterol tended to be lower [not significant] with higher calcium level. Liver cholesterol was lower for rats fed starch diets, also, for rats fed sucrose-oil diets. Cholesterol in heart was lower for rats fed oil- starch diet. Triacylglycerol concentration was lower in serum and liver of rats fed ghee-sucrose and higher in liver of rats fed oil- starch diets. The concentration of phospholipids was lower in serum and heart in rats fed oil-starch and ghee-sucrose diets, also, in liver in rats fed starch diets. Total lipids were decreased in serum of rats fed ghee diets, while total lipids in heart increased by increasing dietary Ca level except in ghee-starch group. Percentage of serum HDL-cholesterol/total cholesterol was higher [not significant] in rats fed 2.5% calcium, as well LDL-C/total cholesterol was higher for rats fed sucrose diets. Feeding starch diets resulted in lower serum total cholesterol, triacylglycerol, phospholipids and total lipids compared with sucrose diets

Hypocholesterolemic effect of dietary chicken protein Vs casein rats fed low fat diets

Four groups of rats were fed for 7 weeks on one of four diets containing casein or chicken meat at two level of protein 10% or 20%. Results showed that increasing chicken protein level caused a decrease in serum total cholesterol and triacylglycerol, also the ratio of HDL-cholesterol to total cholesterol was increased. Significant negative correlations were found between protein intake and serum total cholesterol or triacylglycerol concentrations. As compared to casein, 20% chicken protein diet induced significantly lower concentration of serum total cholesterol. Also chicken diets at both levels of protein induced significantly lower concentrations of LDL-cholesterol and triacylglycerol Ratios of HDL-cholesterol to LDL-cholesterol were 57% [sig.] and 37% higher for rats fed chicken diets than those fed casein diets. Like serum cholesterol, liver and heart cholesterol was decreased by increasing dietary chicken protein. Also liver and heart total cholesterol were significantly lower for rats fed 20% chicken protein than casein group

Serum lipid response of adult male rats to levels of either casein or stewed bean protein

The effects of feeding casein and stewed bean protein for seven weeks on serum lipids, lipoproteins and on liver and heart lipids concentrations in adult male albino rats were investigated. Diets were planned to provide 10% or 20% protein from either casein or stewed bean, 6% fat with no cholesterol was added. Levels of protein used had no significant effects on serum lipids and lipoproteins for rats fed casein diets. Whereas 20% bean protein group had significantly higher concentrations of serum HDL-cholesterol [HDL-c], LDL-cholesterol [LDL-c], triacylgycerol and the ratio of HDL-cholesterol to total cholesterol. As compared to casein, 10% bean protein had significantly lower. LDL-c, LDL-c, HDL-c to total cholesterol ratio, triacylglycerol and total lipid, while total cholesterol was significantly increased. Whereas at 20% protein level bean diet reduced serum triacylglycerol and increased total lipids concentrations Rats fed bean diets had significantly lower liver cholesterol while liver triacylglycerol increased. Also heart cholesterol, tricylglycerol and phospholipids concentrations were significantly increased for rats fed 10% bean protein, whereas for group fed 20% bean protein only heart triacylglycerol was affected