Plagiarism in medical scientific research

Plagiarism is defined as "the practice of taking someone else's words, work or ideas and passing them off as one's own". It is probably the most common form of scientific dishonesty found in research articles. The aim of this review is to present a comprehensive account about plagiarism to raise awareness of all aspects of plagiarism. The key words "plagiarism", "types", "detection" and "consequences" were used to retrieve articles from the MEDLINE database. About five hundred articles were retrieved. Articles were divided into subgroups, with each group covering an aspect of plagiarism. Main findings and updates were summarized for each topic. The main reason behind plagiarism was found to be a lack of knowledge about the subject. When coupled with insufficient time, immature writing skills and the pressure on researchers to get their work published in good journals, authors take unacknowledged pieces of others' work and commit plagiarism. In the past, it was difficult to detect plagiarism; however, in recent years, many plagiarism-detection services and software programs have become available. The present article details how journals use these services and software as a helpful tool to check for plagiarism in submitted manuscripts. Within academia, plagiarism is an offense that can be devastating. Plagiarism is the most common problem in research writing. The cornerstone in preventing this problem from getting worse is to raise awareness about how to cope with this growing problem of research misconduct

The accuracy of transvaginal ultrasound and uterineartery Doppler in the diagnosis of adenomyosis

To measure the accuracy of combined two dimensional [2D] trans-vaginal ultrasound [TVS] and color Doppler in diagnosis of adenomyosis uteri and to assess the role of Doppler indices of the uterine arteries in diagnosis of adenomyosis. A cross-sectional observational study. One hundred women complaining of pelvic pain and or uterine bleeding and were clinically and sonographically diagnosed to have adenomyosis and scheduled for hysterectomy were approached for participation. Eighty patients were recruited and subjected to color and uterine artery Doppler studies [systolic/ diastolic [S/D] ratio, resistance and pulsatility index [RI and PI] in a trial to diagnose adenomyosis. The finding of 2D-TVS and color Doppler were compared to a gold standard of histopathology of the retrieved uterine specimens. Sensitivity, specificity, positive and negative predictive values were measured. Fifty specimens out of 80 uteri histologically confirmed to have adenomyosis by histopathology. Sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of the 2D-TVS in the diagnosis of adenomyosis were 76.0%, 83.3%, 88.4%, 67.6% and 78.8%, respectively. However, for combined 2D-TVS and the color-Doppler ultrasound the figures were 86.0%, 86.67%, 91.5%, 78.8% and 86.3%, respectively. Myometrial cysts were the most commonly diagnosed [53.8%] ultrasonographic criteria. However, uterine artery S/D, RI and PI showed no significant association with adenomyosis. Combined 2D-TVS and color Doppler ultrasound is superior to 2D-TVS alone in diagnosis of adenomyosis. Uterine artery Doppler study was of no diagnostic value in adenomyosis

Decision making performance process among head nurses

Decisions play important roles as they determine both organizational and managerial activities. It is the key part of head nurses' activities. Decisions are made at every level of nursing management to ensure that the nursing department goals are achieved.The study aimed to assess the decision making performance process among head nurses. The study was conducted at El-Menshawi and El-Mahala General Hospitals which are affiliated to the Ministry of Health and Population. Study subject included all [95] head nurses working at the assigned hospitals. Decision Making Analysis of Areas and Activities Questionnaire and Decision Making Rating Scale for head nurses were used as tools for data collection.More than one third of head nurses propose the budget of nursing department imposed on them and make decision in concerning the needed qualifications of nursing personnel on each unit in conjunction with the chief. Seventy percentages of head nurses at El-Mahala General Hospital had high levels in the decision making process. More than half at El-Mahala hospital had moderate levels in the strategy of decision making performance process.Head nurses fulfilled the areas and activities of decision making process but a lot of decisions making is done with the chief either with or without subordinating opinions. Establishing training programs is recommended to help head nurses and subordinate staff in making effective decision, developing the budget of nursing unit and improving standard of care activities

Laboratory differentiation between streptococcus species isolated from different sources

This study was planned to throw light on the most important Streptococcus bacteria that isolated from the milk and pus and the most important laboratory tests that used in differentiation between the streptococcal bacterial species. This study was carried-out on a total number of 100 random samples of milk which were collected from different areas at Behera Governorate. Also. 100 pus samples from closed abscesses from different parts of cattle body where collected and examined bacteriologically for streptococcus introduction. Our results concluded that, the streptococcus agalactiae and streptococcus pyogenes are the most important bacterial isolates that causes severe losses to milk industry, also the streptococcus pyogenes of zoonotic importance as it transmitted to human. The catalase test, oxidatse test and heinolytic test are the main tests used for diagnosis and differentiation between streptococcus agaiactiae and streptococcus pyogenes. The bacitracin sensitivity test is main test for differentiation between streptococcus agalactiae and streptococcus pyogenes The results also indicated that the level of streptococcus agalactiae in milk higher than that of streptococcus pyogenes and reached to 7% and 3% for streptococcus agalctiae and pyogenes, while, in pus its levels reached to 0 and 40% for streptococcus agalactiae and pyogenes in pus. Also the results cleared that the PCR method for detection of mastitis considered as the best method

Immunohistochemical expression of MMP-2, and mmp.-9 in serous versus mucinous ovarian tumors: correlation with angiogenesis and clinico-pathological characteristics

Purpose: to analyze the expression of MMP-2. MMP-9, and VEGF and mean vascular count [MVC] in both serous and mucinous ovarian tumors. The correlation of these markers with clinico-patological characteristics was also evaluated

Methods: Ninety five paraffin-embedded sections of ovarian tumors were stained for MMP-2, MMP-9. VEGF and CD34 using standard immunohistochemistry. The intensity and percentage of positive cells were evaluated using HSCORE for MMPs and VEGF. The MVC as stained by CD34[X 400] was also evaluated. Correlations between HSCOREs of MMP-2, MMP-9 with VEGF expressions were evaluated. The relationships between the above markers with clinico-pathological characteristics and the correlations between VEGF with MVC were also studied

Results: There is a significant increase in HSCOREs of tumor and stromal cells with the transitions through tumorigenesis phases [P<0.0001 for all markers]. Serous tumors showed significantly higher expression of VEGF, MMP-2 and MMP-9 and MVC as compared with mucinous tumors. The expression of all markers was significantly correlated with clinic-pathological characteristics of the tumors

Conclusion: MMP-2, MMP-9 and VEGF are expressed by both tumor and stromal cells of ovarian tumors and their expressions are associated with the transitions from benign, through borderline, to malignant nature. The above markers are correlated with clinico-pathological characteristics

Haemostatic activation in acute coronary syndrome patients in relation to physical exercise

Thrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease [CAD], Platelets are known to play a fundamental role in acute coronary syndromes [ACS]. After atherosclerotic plaque rupture, platelets can form pathogenic, occlusive thrombi leading to acute ischemic events. The precise mechanisms of platelet activation in acute coronary syndromes are still under investigation. Physical activity could regulate the development of ACS via effects on platelet function. Several studies have shown that acute physical exercise increases platelet reactivity, typically assessed by aggregation assays, in both healthy individuals and in patients with cardiovascular disease. The aim of this study was to investigated the effect of moderate and strenuous exercise on arterial thrombus formation. Assay of some hemostatic marker as Platelet activation, thrombin generation [TF[pg/ml],TAT_ micro g/l and dimerand tPA concentration] von Willebrand factor, platelet aggregation tests, Coronary Angiography. haemostatic parameters in patients with ACS correlated with other clinical parameters under physical exercise Patients with ACS showed higher values for fibrinogen, tPA, TAT_, as indicators for a thrombin synthesis, and a marker for prothrombotic conditions, was elevated in patients with ACS,. Von Willebrand factor and D-dimer showed no statistical significant differences during rest., Exercise increased hemostatic parameters in an strenuous physical exercise in ACS Patients[< 0.05]. Exercise also increased plasma levels of fibrinogen and von Willebrand factor ,but there was an increase in the generation of T-AT complexes,. [P < 0.05]. Exercise did not affect platelet aggregation regardless of its intensity when triggered by the agonists ADP or collagen. Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary male volunteers

Serum 25 hydroxy vitamin D levels in adult asthmatic patients

Patients with chronic lung disease as asthma appear to be at increased risk for vitamin D deficiency for reasons that are not clear. A cross sectional study including 75 asthmatic adults aged older than 18 years and 75 adults healthy control aged older than 18 years [35 males and 40 females for both groups] assessing the relationship between serum 25 hydroxy vitamin D levels and lung function. In our study only [12.31%] of our asthmatic adults had sufficient vitamin D levels [>/=30 ng/ml], wherase [85%] of healthy control subjects expressed sufficient levels. Vitamin D deficiency [<20 ng/ml] was observed in 59 [78.66%] asthmatic patients [17.28 +/- 2.4 ng/ml]. Deficiency was not observed in controls [33.67 +/- 6.3]. In asthmatic patients Serum 25 [OH] vitamin D was positively correlated with forced expiratory volume in 1 second% [FEV1%] predicted andforced expiratory/forced vital capacity ratio [FEV1/FVC][P=<0.05 for all]. There was no significant association between serum vitamin D level and eosinophil count. Reduced vitamin D levels are highly prevalent in adult asthmatic patients and are associated with impaired pulmonary functions

Obstetric outcomes of teenage pregnancy versus adult pregnancy in Egypt

The aim of this study was to compare the obstetric outcome of the teenage pregnancy with that of adult pregnancy. 3260 women with first pregnancy attending Assiut hospital for delivery participated in the study. According to mother age the women were assigned into one of two groups; the 1[st] group included 847 women; the teenage group [primigravida with age of nineteen or less] and the 2[rd] group included 2413 women, the elderly group [primigravida with age more than nineteen]. A structural questionnaire was conducted including background information that covers details of socioeconomic status, obstetric history and complication, delivery and its complications andietal and neonatal outcomes. Complete medical and obstetric examination was performed for every woman in the study as well as their born baby. Only 847 [26.0%] teenagers were

Assessment of metabolic response after lipoabdominoplasty in normal to overweight women

Lipoabdominoplasty [LEAP] is a cosmetic body contouring procedure used to improve abdominal type of obesity which is implicated in the development of different metabolic; especially insulin resistance; metabolic syndrome, and cardiovascular risks. The aim of the present study was undertaken to investigate the different effects [LEAP] on carbohydrate, lipid metabolism and inflammatory markers as well as the relationship of these changes with insulin resistance in normal to overweight women suffering from abdominal obesity. A total of 16 non-diabetic normal to overweight women [BMI 25.77kg/m[2] +/- 1.3] with a mean age of 34.25 +/- 4.17 years were studied. Before LEAP all demographic data regarding age, smoking and medical history of diabetes or hypertension were obtained. Complete physical examination including measurement of blood pressure [BP] both systolic [SBP] and diastolic [DBP], anthropometric measurements including waist [WC] and hip circumferences, height, weight and calculation of waist to hip ratios [WHR] and body mass index [BMI] were performed. 12-14 hours lasting samples were collected to measure fasting blood glucose [FBS], insulin, total cholesterol [TC], high density lipoprotein [HDL-C], low-density lipoprotein [LDL-C], triglyceride [TG], C-Reactive protein [CRP], apolipoprotein Al [Apo A1], apolipoprotein B [Apo B], lipid risk ratios and Homostaic Model Assessment Index [HOMA-I] were calculated. All measurements and physical examinations were repeated one and six months after the operation. Data were analyzed with SPSS-11 software using student 't' test and Pearson correlation test. LEAP decreased body weight, BMI, WC and WHR significantly one month postoperatively which showed slight nonsignificant increase six months later. SBP, DBP, TC, HDL-C, LDL-C, Apo A1, and CRP did not change significantly throughout the study, TG and Apo B decreased Mgnificantly one month after LBAP but its levels returned nearly to preoperative values six months later. All the changes occurred were independent on insulin resistance throughout she study as evidenced by the nonsignificant correlations of the previous parameters with HOMA-I; as a measure of insulin resistance. LBAP transiently improved but had no lasting effects on some but not all metabolic and lipid risk factors. These changes were independent on insulin resistance. Decreasing adipose tissue mass alone by cosmetic body contouring operations will not achieve the metabolic benefits of weight loss and should be followed by conventional dietary and exercise programs therapy

BRCA1 gene expression in women breast cancer in relation to other prognostic markers

Breast cancer causes major part of cancer deaths in women and is increasing in incidence. This study assessed the BRCA1 gene expression in breast cancer in women, and compared it with other known prognostic factors for the disease. Thirty patients with positive family history of breast cancer were selected from Beni-Suef and Cairo Universities Hospitals, Egypt for the study. A control group of 10 healthy subjects were also included. Blood samples were withdrawn for routine laboratory and tumor marker [CA15-3] being done by ADVIA Centaur. Archival formalin-fixed paraffin-embedded breast cancer tissues were obtained from the pathology files. Histological types and grading of the tumor were assayed. The immunohistochemistry [IHC] and RNA extraction were also done. Histological grading of the carcinomas was done according to the system of Scarff-Bloom-Richardson. Cells from MCF-7 cell line grown in Roswell medium [Gibco BRL] and known to express BRCA1 were processed into paraffin and used as positive controls for both IHC and real-time reverse transcription-polymerase chain reaction [RT-PCR]. BRCA1 expression was correlated with age, histological type and grade of breast cancer, estrogen and progesterone receptor status, and CA15-3. After statistical analysis of the data, demonstrable BRCA1 mRNA was found in 6 patients samples [20% of the breast cancer tissues] while the other patients showed 80% negative BRCA1 mRNA expression as well as the control group. A positive significant relationship was demonstrated between BRCA1 [mRNA] expression and high histological grade, negative estrogen and progesterone receptor status, and high levels of serum CA15-3. A significant negative correlation was found between BRCA1 mRNA expression and age [r=-0.683; p<0.01] The study demonstrated lack of BRCA 1 gene expression [mRNA] in the majority of breast cancers in Egypt and confirmed the relationship between BRCA1 expression and parameters that determine poor prognosis in breast cancer. Our results suggested that BRCA1 is seen in high-risk women known with positive family history of breast cancer. Strategies for recruitment of Egyptian women in studies of genetic testing for different breast cancer genes have varied levels of success. Our study highlights the need for further studies in this population group

Effect of cardiopulmonary bypass on the pharmacokinetics of intravenous paracetamol [Propacetmol hydrochloride]

Recently, intravenous paracetamol [propacetamol] is commonly in use as analgesic and antipyretic after surgery. To our knowledge, the pharmacokinetic of intravenous paracetamol in patients undergoing cardiac surgery with cardiopulmonary bypass were not previously described. This study was designed to investigate the effect of cardiopulmonary bypass on the pharmacokinetics of single intravenous dose of paracetamol in adult patients undergoing coronary artery bypass surgery with hypothermic cardiopulmonary bypass. Nine patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass using mild hypothermia 30°C were selected. Intravenous paracetamol [2g single dose of Propacetamol hydrochloride [Pro-Daflgan UPSA, Fr]] was infused over 10 min and arterial samples were taken starting from 20 min after infusion and afterwards over 8 hours from infusion. Plasma paracetamol concentrations were measured by high-pressure liquid chromatography. The pharmacokinetics of paracetamol was calculated assuming a linear one compartment model with instantaneous input and first order output. The pharmacokinetic data were reported as mean [SD]. ANOVA was used to compare between the pharmacokinetic parameters before and after CPB. C[max] 10.19 [0.9545] mg.litre[-1] appeared 20 min after the end of infusion [experimentally]. Mean clearance [CL] was significantly reduced by about 40% in post CPB [prebypass 0.589 [0.1069] L.h[-1].kg[-1] vs. 0.357 [0.0394] L.h[-1].kg[-1] after CPB, P < 0.05]. The elimination rate constant [Ke] was significantly reduced by about 43% after CPB compared to pre-bypass values. However, the elimination half-life [t[1/2]] was significantly increased from 1.380 h before bypass to 2.431h in post bypass period. It appears from this study that hypotuermic cardiopulmonary bypass can affect the kinetic profile of IV paracetamol in patients undergoing coronary artery bypass graft surgery, and these changes should be considered while using this drug in such situations

Predictors of cerebral blood flow velocity in children undergoing open heart surgery for congenital heart diseases

Background: The use of TCD during paediatric cardiac surgery can help in early detection of cerebral blood flow velocity. The aim of this study was to describe the changes in cerebral blood flow velocity and to explore the relationship of such changes with different haemdynamic and cardiopulmonary bypass parameters in children undergoing open heart surgery

Methods: Sixteen patients from 1-12 years undergoing correction for congenital heart defects were included in this study. Two-channel transcranial Doppler system [Multi-Dop T[2] / DWL, Elektronische System GmbHGermany] were used for measuring mean cerebral blood flow velocity in middle cerebral artery after induction [basal], after sternotomy, during aortic cannulation, during stable CPB [10 min. after start of bypass], during rewarming, after weaning from CPB and after skin closure. Concomitant measurements of mean arterial blood pressure, arterial CO[2], haematorcrite, temperature and arterial oxygen tension were recorded with cerebral blood flow velocity. One way analysis of variance was used to study the changes in cerebral blood flow velocity and multiple regression analysis to predict different factors that can affect cerebral blood flow velocity

Results: A significant reduction in mean cerebral blood flow velocity was detected during stable CPB, during rewarming and after CPB compared with base line value. Before CPB, cerebral blood flow was directly dependent on the age and PaCO[2], while during rewarming it was only directly dependent on mean arterial blood pressure [P = 0.036]. However, an inverse association was found between PaO[2] and CBFV after CPB

Conclusion: These results suggest that cerebral blood flow velocity was reduced during hypothermic CPB, and it was only affected by mean arterial blood pressure during rewarming

Bioactive benzopyrone derivatives from new recombinant fusant of marine streptomyces

In our search for bioactive secondary metabolites from marine Streptomycetes, three microbial benzopyrone derivatives [1-3], 7-methylcoumarin [1] and the flavonoides, Rhamnazin [2] and Cirsimaritin [3], were obtained during the working up of the ethyl acetate fraction of a marine Streptomyces fusant obtained from protoplast fusion between Streptomyces sp. Merv 1996 and Streptomyces sp. Merv 7409. The structures of the three compounds [1-3] were established by NMR, mass, UV spectra, and by comparison with literature data. Marine Streptomyces strains were identified based on their taxonomical studies, type of cell wall and G+C content as two different bioactive strains of the genus Streptomyces. We described additionally, the fermentation, isolation, as well as the biological activity. The isolates [1-3] are reported here as microbial products for the first time

Histological study of the effect of leptin hormone on the maturation of ovarian follicles of albino rats

Leptin is an adipocyte secreted hormone with a well documented metabolic role causing body weight loss. Leptin hormone has been further implicated in fertility regulation and it appeared to be a permissive factor for puberty. The present study focused on the assessment of the histological changes that might occur in the ovaries of immature female albino rats in response to the repeated injections of leptin hormone. Fifty seven just-weaned, immature female albino rats [22days old] were divided among control groups that had received daily subcutaneous injections of HC1/NaOH solvent; and experimented groups that had received daily 5pg of subcutaneous leptin hormone till the age of 44days [total experimental duration was 22 days]. The body weights of rats were daily recorded. The females were subjected to daily vaginal smears stained by Giemsa stain for assessment of the onset of the oestrus cycle. Three animals from both groups were sacrificed by decapitation every two days after the injections until reaching the expected age of maturation in female albino rats [42-44 days old]. The weights of the dissected ovaries were recorded. Sections from the ovaries and uterus were examined histologically by routine hematoxylin and eosin [H and E], trichrome and periodic acid Schiff's stains PAS]. Counting of the large growing antral follicles in all ovarian H and E sections was done, statistically analysed and represented. The endometrium in selected groups was labelled for the immunohistochemical detection of the expression of the nuclear alpha oestrogen receptor. The ovaries were also examined by the transmission electron microscope for the assessment of the maturation changes at the cellular level within the different structural components of the ovaries. Revealed that, in addition to the reduction in the total body weight, leptin hormone accelerated the maturation of the ovarian follicles and stromal tissue in immature female rats as early as the age of 26 days with enhancement of the early onset of the oestrus cycle and the associated changes in these females. These results were highly significant compared to the equivalent control female rats, which started to show ovarian maturation changes only on approaching the age of 42-44 days. It was suggested that leptin hormonal therapy could be beneficial for the management of delayed puberty in young females and maybe in related reproduction disorders particularly f associated with overweight problems

Estrogen receptor beta gene polymorphism and endometrial inadequacy

To correlate four estrogen receptor beta polymorphisms to endometrial thickness. 24 patients with consistently thin endometrium, in natural and stimulated cycles undergoing controlled ovarian hyper stimulation for ICSI for various indications and 50 control subjects with normal endometrium undergoing COH for ICSI for male factor infertility. Sonographic evaluation of endometrium, PCR on peripheral blood leucocytes using specific primers to detect the determined four polymorphisms, as well as hormone values in COH cycles and ICSI outcome, are recorded. The deletion polymorphism was not found in either groups. The second polymorphism [P846] was significantly more commonly detected in cases of normal endometrium [50% versus 8% in cases with thin endometrium]. The third polymorphism [P1082] was not found in control group and only one case [4%] with thin endometrium and this was not significant. The last silent polymorphism [P1421] was found in 8% of cases and surprisingly all subjects of control group and this was statistically highly significant. The presence of certain ER beta polymorphisms correlate with good endometrial thickness

Prenatal Diagnosis of congenital diaphragmatic hernia improves the postoperative outcome: a local experience

To date, uniform standards for congenital diaphragmatic [CDH] management have not existed. This study was to compare infants with congenital diaphragmatic hernia [CHD] who had undergone a prenatal diagnosis to those who had not undergone such diagnosis. Sixteen infants with CDH who were admitted to the neonatal intensive care unit [NICU] of Suez canal university hospital from December 2000 to August 2004 were prospectively studied. They were classified into two groups; group I including 7 infants who were prenatally diagnosed as CDH by serial ultrasound scans. In group II: 9 infants were diagnosed as having CDH after birth with no prenatal diagnosis. Special care for respiration and resuscitation was performed for all patients in the two group according to a special resuscitation protocol. After stabilization and resuscitation, surgical intervention was done under special anesthetic care. The outcome of the morbidity and mortality in both groups were studied and statistically evaluated. The mean gestational age was 37. +/- 1.05 weeds in group I in contrast to 35.18 +/- 2.7 weeks in group II. [P=0.04] and the mean birth weight was 2.5 +/- 0.8 kg in group I in contrast to 2.1 +/- 1.3 in group II. All infants required mechanical ventilation. In group I, the mean gestational age at prenatal diagnosis was 26.5 weeks. The lung area head circumference ratio [LHR] ranged from 0.36 to 0.23. associated abnormalities in group I included ventricular septal defect, atrial septal defect, polyhydramnios, premature rupture of membrane and preterm labor. In group I, the overall survival rate was 4 patients out of 7 [57.1%] in group II, 2 infants out of 9 survived with a survival rate of 22.2% with a statistically significant difference. Prenatally diagnosed infants with CDH have a better survival rate and a less morbidity compared with those who have not undergone this diagnosis

Epidemiological study of nocturnal enuresis in El Minia school children

To estimate the prevalence of primary nocturnal enuresis [PNE] in El Minia primary school children, and to examine factors associated with PNE and the severity of the problem. Subjects and In all, 1712 questionnaires were sent to parents of schoolchildren aged 6-11 years randomly selected from five primary schools in El Minia City, Egypt. The questionnaire was designed to collect information about the prevalence of and factors associated with PNE. Of the questionnaire distributed, 1192 [70%] were completed. PNE was reported in 102 [8.5%] of the children. Only 12 cases [12%] of these children [102] were wet > 3 nights per week. Factors associated with PNE included male gender, deep sleep, divorced parents or separated family and a positive family history of enuresis. Of these factors, only those children with deep sleep were more likely to have > 3 wet nights per week. The prevalence of and factors associated with PNE in El Minia district are similar to those reported in western countries, but the percentage of children with severe enuresis is lower than in Sweden, France and Turkey. Deep keepers are more likely to have severe enuresis

Proinflammatory cytokines and endothelial dysfunction in obese subjects: effect of weight reduction

Obesity is associated with an increased risk of developing atherosclerosis, which may be mediated, at least in part, by increased secretion of proinflammatory cytokines by adipose tissue. The aim of present study was to determine whether circulating levels of inflammatory cytokines and intercellular adhesion molecule-1 [sICAM-1] are elevated in obese subjects and whether they could be reduced by a substantical decrease in body weight. Forty-two healthy obese subjects [22 females and 20 males, age range 25 to 40 years, body mass index 35.2 +/- 3.64 Kg/m2, waist to hip ratio 0.883+0.085, and 20 age and sex matched normal weight controls were studied. Compared with nonobese subjects, obese subjects had increased basal concentrations of tumor necrosis factor-alpha [TNF-alpha]. [P<0.001], interleukin-6 [IL-6], [P<0.001] and sICAM-1 [P<0.001]. Flow mediated dilatation [FMD] was impaired in obese subjects when compared to lean controls [7.52% +/- 3.05 Vs 10.28% +/- 1.64, P<0.001]. Concentrations of TNF-alpha and lL-6 were related [P<0.001] to visceral obesity, as well as to slCAM-1 levels and FMD. After one year of a multidisciplinary program of weight reduction [diet, exercise, behavioral counseling], all obese women lost at least 10% of their original weight. Compared with baseline, sustained weight loss was associated with reduction of cytokines [TNF-alpha, IL-6] [P<0.001] and sICAM-1 [P = 0.001] concentrations in addition to improvement of FMD [P<0.001]. In obese subjects, endothelial activation and dysfunction correlates with visceral body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating endothelial dysfunction in obese subjects

Relationship between plasma homocysteine level and some cardiovascular risk factors in patients with type 2 diabetes

High plasma homocysteine [Hcy] concentration is risk factor for cardiovascular disease. Insulin resistance has been hypothesized to play an important role in the development of atherosclerotic disease. The information on the association between insulin resistance, other cardiovascular risk factors and plasma Hcy in type 2 diabetes is limited. The aim of our study was to assess the impact of insulin resistance and other cardiovascular risk factors on plasma total Hcy levels in patients with type 2 diabetes. The study included 40 patients with type 2 diabetes [aged 42.0 +/- 4.1 years] and 15 healthy controls, matched in age and sex with the patients. The following parameters were assessed: fasting plasma glucose [FPG], fasting plasma insulin [FPI], homeostasis model assessment of insulin resistance [HOMA-IR], serum total cholesterol, triglycerides, HDL-C, LDL-C and plasma total Hcy. Our study revealed significant increase in SBP, FPG, FPI, HOMA-IR, and total Hcy in type 2 diabetic patients compared to control group [137 +/- 4 vs 123 +/- 5 mmHg, 103 +/- 10.1 vs 83.2 +/- 6.9 mg/dl; 20.1 +/- 4.1 vs 8.8 +/- 3.1 mu/L, 5.8 +/- 0.8 vs 1.93 +/- 0.26, 13.6 +/- 1.2 vs 7.6 +/- 0.8 umol/L, respectively, all P<0.001]. As regard serum lipids our results revealed significant increase in total cholesterol, triglycerides and LDL-C but significant decrease in HDL-C in type 2 diabetic patients compared to control group [210 +/- 39 vs 160 +/- 21 mg/dl, 220 +/- 29 vs 106 +/- 10 mg/dl, 129 +/- 28 vs 88 +/- 21 mg/dl, 40 +/- 11 vs 52 +/- 16 mg/dl, respectively, all P<0.05]. In patients with type 2 diabetes there was significant positive correlation between total Hcy and SBP, FPG, FPI, HOMA-IR, total cholesterol and LDL-C [r = 327, P = 0.005, r = 240, P = 0.049, r = 0.513, P<0.001; r = 0.601, P<0.001, r = 0.241, P = 0.048; r = 0.250, P = 0.040 respectively], but there was significant negative correlation between total Hcy and HDL-C [r = -0.301, P = 0.009]. Increases in total homocysteine levels in type 2 diabetes are associated with insulin resistance and other cardiovascular riskfactors. Thus insulin resistance may be an important determinant of Hcy levels in those patients

Holmium: YAG laser intracoproeal lithotripsy in the treatment of middle and upper urinary tract calculi: preliminary report

To evaluate the efficacy of Holmium:YAG laser lithotripsy in treatment of upper urethral and renal calculi, 20 patients with a mean age of 47 years with upper urinary tract calculi [3 renal and 17 ureteric] were treated by Holmium:YAG laser lithotripsy via 7F flexible ureteroscope. The size of stones ranged from 7 to 20 mm [means is 10 + 2 mm]. All patients were followed for three months after treatment. Seventeen [85%] out of 20 patients were stone free at three months follow up. All stones were accessible using 7F flexible ureteroscope. All stones were fragmented regardless of its composition, size or location. No complications were encountered in relation to the procedure or laser fiber