Carotid intima-media thickness assessment in obese patients with chronic renal failure

Background/Aim: measurement of carotid artery intima-media thickness [CIMT] is reliable for early detection of atherosclerosis, one of obesity's complications, which is a leading cause of mortality among patients with end-stage renal disease. The study aimed to evaluate CIMT in relation to obesity, chronic renal failure [CRF] and both, for the early prevention of cardiovascular problems

Patients and methods: this cross-sectional study included 118 adult individuals of both sexes, aged 30-60 years. Patients with CRF were gathered from the renal dialysis unit of King Fahd Hospital-Kasr El Einy Hospital, and the obese without CRF from the 'Management of Visceral obesity Unit', in' Medical Excellence Research Center [MERC]', National Research Centre, during the period spanning from June 2015 to April 2016.They were grouped into three groups: a case group, which included 45 obese individuals with CRF, and two control groups: one comprised 39 nonobese patients with CRF and the other group comprised 34 obese patients without CRF. Anthropometric assessment, lipid profile, and ultrasound measurement of CIMT were performed for each patient

Results: CIMT was greater in all groups than the normal range [0.06-0.08 cm], particularly in the obese group without renal failure. CIMT had a highly significant correlation with waist circumference and insignificant correlation with BMI and lipid profile in different groups

Conclusion: the increase in CIMT was related to obesity and renal failure, but it was more prominent with obesity. CIMT had highly significant correlation with central obesity in cases wherein obesity and renal failure were coexisting together and insignificant correlation with lipid profile

Axillary lymph node in rheumatoid arthritis: Does it associate disease activity?

Lymph node [LN] in rheumatoid arthritis [RA] has been the focus of recent research work; as it is implicated in disease pathogenesis. Power Doppler ultrasonography [PD-US] is increasingly used for imaging of lymph nodes in conditions other than arthritis. To assess the axillary LN in RA using PD-US, and to correlate the findings to disease activity. Fourteen Consecutive RA patients were subjected to clinical examination and PD-US of axillary LNs, metacarpophalangeal joints [MCPJs] and wrist joints of the ipsilateral sides. LNs were assessed for cortex/hilum [CH] area ratio, longitudinal/transverse [LT] axis ratio and PD signal type. Joints were assessed for grey scale [GS] score and PD score. GS and PD signals were assigned to each joint in accordance with semi-quantitative 0-3 scales for each. DAS28 score was used for disease activity assessment. PD-US detected subclinical LN changes in 24/28 of the examined axillae in RA patients. Changes included hypertrophy mainly of the cortical area and amplification of vascularity of the central type. LN changes did not correlate to DAS28 score; rather correlated to GS and PD scores of ipsilateral wrist and MCPJs as assessed by PD-US. PD-US detects subclinical axillary LN changes in RA patients. These changes do not correlate to DAS28. Axillary LN changes associate signs of synovitis in ipsilateral wrist and MCPJs as assessed by PD-US. Owing to the small number of patients enrolled, results presented in this work should be considered preliminary

Histological Study on Effect of Mesenchymal Stem Cell Therapy on Experimental Renal Injury Induced by Ischemia/Reperfusion in Male Albino Rat

BACKGROUND AND OBJECTIVES: Acute kidney injury (AKI) represents a major clinical problem with high mortality and limited treatment protocols. This study was planned to evaluate the therapeutic effectiveness of bone marrow-derived mesenchymal stem cells (BM-MSCs) in a rat model of ischemia/reperfusion (I/R) AKI. METHODS AND RESULTS: This study was carried out on thirty adult male albino rats. Animals were divided equally into three groups. Group I (control sham-operated group) (n=10), were subdivided equally into two subgroups; Ia and Ib. The experimental group (n=20) were all subjected to I/R injury by clamping both renal pedicles for 40 minutes. Half of the I/R animals did not receive MSC therapy (group II) [non-MSC treated group]. The other half of the I/R animals received single intravenous injection of PKH26 labelled BM-MSCs immediately after removal of the clamps and visual confirmation of reflow (group III) [MSC treated group]. Animals were sacrificed 24 hrs (subgroups IIa & IIIa) and 72 hrs (subgroups IIb & IIIb) after intervention. Serological measurements included serum urea and creatinine. Kidney specimens were processed for H&E, PAS and PCNA. Mean % of renal corpuscles with affected glomeruli, mean % of affected tubules, mean area % of PAS-positive reaction and mean area % of PCNA immunoreactivity were measured by histomorphometric studies and statistically compared. MSCs-treated group exhibited protection against renal injury serologically and histologically. CONCLUSIONS: Results of the present study suggest a potential reno-protective capacity of MSCs which could be of considerable therapeutic promise for cell-based management of clinical AKI.

Prevalence and risk factors of carotid plaques detected with B-mode ultrasound in rheumatoid arthritis

To determine the prevalence of increased intima-media thickness [IMT] of the carotid arteries and its relationships with classical atherosclerosis risk factors and disease features in patients with rheumatoid arthritis [RA]. Twenty female RA patients were included in the study. All patients were subjected to full history taking, thorough clinical examination and laboratory investigations. In addition, intima-media thickness [IMT] and presence of carotid plaques were assessed using carotid B-mode ultrasound. Presence of traditional cardiovascular [CV] risk factors was also investigated. Plaques could be detected in 40% of our patients. There was a statistically highly significant correlation between the presence of plaques and patients' age, disease duration and deformed joint count [p<0.001]. There was also a statistically significant relationship between the presence of plaques and increased ESR and CRP levels, lower body mass index, presence of diabetes mellitus, hypertension, hypercholesterolemia and higher cumulative glucocorticoid doses [P<0.05]. It did not correlate significantly with tender or swollen joint count, subcutaneous nodules or rheumatoid factor positivity. Increased IMT was statistically significantly correlated with age, disease duration, ESR, diabetes mellitus, hypertension and hypercholesterolemia. RA patients with carotid plaques had significantly longer disease duration, higher deformed joint count, higher ESR, higher levels of CRP and higher cumulative glucocorticoid dose than those without plaque. Increased IMT was correlated with the disease duration and ESR. These findings suggest that there is increased risk of atherosclerosis in patients with rheumatoid arthritis especially those with more severe disease and longer disease duration

Relation between homocysteine, folate, vitamin B12 and MTHFR C677T polymorphism and bone turnover markers in postmenopausal women

To investigate the association between total Homocysteine [tHcy] levels with bone turnover markers and lumbar spine BMD, and to study the influences of MTHFR genotypes and B-vitamins on tHcy and BMD in a group of Egyptian postmenopausal women. 66 Egyptian postmenopausal women were subjected to clinical assessment and lumbar spine BMD measurement. Venous blood samples were collected to measure the levels of plasma tHcy, plasma folate, vitamin B12, osteocalcin, serum cross-linking telopeptide of type I collagen [S-CTX] and the MTHFR C677T genotyping. According to the T-score, the participants were divided into three groups: normal [N], osteopenic [OPN] and osteoporotic [OPR]. tHcy levels were statistically significantly higher, and serum folate levels statistically significantly lower in the OPR group compared to the other two groups. Nonsignificant differences between the three groups regarding vitamin B12 levels and percentage of the 3 MTHFR genotypes were found. Osteocalcin and the S-CTX levels were statistically significantly higher in the OPR group than the other two groups. BMD was statistically significantly positively correlated with folate and negatively correlated with tHcy, Osteocalcin and S-CTX, while was nonsignificantly correlated with vitamin B12 levels. tHcy was statistically significantly negatively correlated with folate and positively correlated with Osteocalcin and S-CTX, while was nonsignificantly correlated with vitamin B12. The MTHFR genotype groups were not associated with the BMD, tHcy, folate or vitamin B12 levels. In postmenopausal women, tHcy and folate could be related to lumbar spine BMD while vitamin B12 and the MTHFR genotypes seem not to have relation to BMD

Comparative quality assessment of wild and cultured Nile tilapia [Tilapia niloticus] stored at 4°C

Sixty Nile [Tilapia nilotica] fish of about 200 -250 gm [30 wild and 30 aquacultured] were collected alive and transported directly to the laboratory surrounded by ice bags in an ice box. Organolyptic, bacteriological and chemical examination to estimate the freshness rating and the quality parameters were carried out directly after fish arrival to the laboratory and periodically during chilling storage at 4°C. The mean [ +/- St. Error] Demerit scores of wild and aquacultured [Tilapia niloticus] fish were 0.0 +/- 0.0 and 0.0 +/- 0.0 at zero time and increased gradually during the storage time till it reaches 16.8 +/- 1.37 and 18.2 +/- 1.41 respectively at the end of the storage period. The mean [ +/- St, Error] Aerobic bacterial counts of wild and aquacultured [Tilapia niloticus] fish were [<102 and 0.4X10[2] +/- 0.13X10[2]] and [<3 and <3] respectively at zero time and increased gradually during the storage time till it reaches [6.8X10[5] +/- 7.85X10[2] and 6.1X10[6] +/- 9.70 X 10[2]] and [0.85 X102 +/- 0.12 X10[2] and 0.94X10[2] +/- 0.14X10[2]] respectively at the end of the storage period and there was a significant difference [P> 0.05] between the means of both aerobic plate counts and coliforms counts of the wild and aqua-cultured [Tilapia niloticus] fish during all storage period. The mean values [ +/- St. Error] of Total Volatile Bases - Nitrogen [mg/100g] and Thiobarbituric acid number [mg Mal./ Kg] of the wild and aquacultured [Tilapia niloticus] fish samples were [3.16 +/- 0.05 and 3.58 +/- 0.07] and [0.036 +/- 0.003 and 0.081 +/- 0.009] respectively at zero time and increased gradually during the storage time till it reaches [32.83 +/- 1.17 and 33.72 +/- 1.21] and [2.164 +/- 0.168 and 2.535 +/- 0.195] respectively at the end of the storage period and there was no significant difference [P> 0.05] between the means of both TVB-N and TBA of the wild and aquacultured [Tilapia niloticus] fish

Anticyclic citrullinated peptide antibodies in systemic sclerosis

To measure the serum levels of anti CCP antibodies in patients with systemic sclerosis and to correlate these levels with joint involvement extent of skin sclerosis and pulmonary involvement. 22 SSc patients were grouped into [group II] included 10 patients had limited cutaneous SSc and [group III] included 12 patients had diffuse SSc in addition to 10 healthy subjects as a control group [group I]. All patients and controls were subjected to full history taking, thorough clinical examination, routine blood investigations, chest and hand-x-ray, pulmonary function tests, capillary microscope. Measurement of anti-CCP antibodies using ELISA technique. Anti-CCP antibodies serum level was significantly higher in SSc patients than the control [p<0.05]. Also anti-CCP antibodies serum level was significantly higher in patients with arthritis and pulmonary affection than those without arthritis or pulmonary affection. There was a significant association between anti-CCP antibodies positivity and capillaroscopic abnormalities. Our results suggest that anti-CCP antibodies might be linked to disease severity

Metacarpal index phalanx versus dual-energy X-Ray absorptiometry in osteoporosis

Osteoporosis is one of the most common metabolic diseases. It is responsible for considerable morbidity, mortality and costs. Our aim was to evaluate metacarpal index as a diagnostic tool for bone mass measurement as compared with DEXA. The study included 50 males above 60 years of age with a history of osteoporotic fractures as well as 20 apparently healthy males. Their ages ranged from 20-25 years. Metacarpals index had sensitivity of 46%, specificity of 95% positive predictive value 96%, negative predictive value 41% in comparison to DEXA. Metacarpals index can be used as a routine test for exclusion of osteoporosis

Differential T-helper 2 cell function predominance in pregnant rheumatoid arthritis females: a possible concept for pregnancy-induced amelioration

Despite being a physiological process, pregnancy has been noted by clinicians to have various impacts on different diseases in general and on immune-modulated diseases in particular. Concerning rheumatoid arthritis [RA], several studies reported a favorable outcome of the disease during pregnancy. Several researches looked at this pregnancy-induced improvement as a result of a change in the T helper 1/T helper 2 [Th1/Th2] function with predominance of Th2 function. To assess the status of serum levels of soluble tumor necrosis factor receptor [sTNF-R], interleukin-1 receptor antagonist [IL-1Ra] and soluble CD30 [sCD30] -during the three trimesters of pregnancy- in pregnant ladies and evaluate their relations to disease activity in RA patients. The study was performed on 21 pregnant RA patients, of whom only 17 completed the study. They were subjected to clinical assessment of their disease activity and had their sera tested for the level of the three aforementioned indirect Th2 cell function markers. This clinical examination and serum tests were performed once in each pregnancy trimester. These results were compared to those of thirty other controls: ten non-pregnant RA patients, ten pregnant healthy subjects and ten non-pregnant healthy subjects. The study showed definite and significant higher levels of sTNF-R and IL-1Ra in pregnant RA patients and pregnant healthy subjects when compared with non-pregnant controls. These rises of markers levels were negatively correlated with the disease activity. There were no corresponding differences in levels of sCD30 in the two groups. We conclude that during pregnancy there is a differential predominance of Th2 cell function involving an increase in some anti-inflammatory cytokines that could explain the clinical improvement of RA during pregnancy

Traditional and nontraditional cardiovascular risk factors in women with active rheumatoid arthritis: relation to disease activity

Cardiovascular event rates are markedly increased in rheumatoid arthritis [RA], and RA atherogenesis remains poorly understood. The relative contributions of traditional and nontraditional risk factors to cardiovascular disease [CVD] in RA await elucidation. To compare traditional and nontraditional cardiovascular risk factors in RA patients Vs age and sex-matched healthy control population and in seropositive Vs seronegative RA patients and to correlate these potential risk factors with the disease duration and activity. Thirty nine active RA women were divided according to the presence or absence of rheumatoid factor into two groups and twenty nine age- and sex-matched apparently healthy control women. After controlling for age and menopausal status, traditional cardiovascular risk factors including body mass index [BMI], waist circumference, hypertension, fasting lipids [Triglycerides [TG], Total cholesterol [TC], Low density lipoprotein cholesterol [LDL-C] and High density lipoprotein cholesterol [HDL-C]], and insulin sensitivity [IS], and nontraditional cardiovascular risk factors, including high-sensitivity C-reactive protein [hs-CRP], IL-1, IL-6 and tumor necrosis factor-a were compared in RA patients versus healthy control individuals and in seropositive versus seronegative RA patients. Insulin sensitivity was determined by the Quantitative Insulin Sensitivity Check Index [QUICKI]. Traditional and nontraditional risk factors for CVD were correlated with disease duration and activity. Rheumatoid factor was positive in twenty six [67%] of RA patients. Significant higher percentage of individuals with hypertension [p<0.05], significant lower levels of HDL-C and QUICKI [p<0.001, <0.05 respectively] and significant higher levels of LDL-C and hs-CRP, IL-1, IL-6 and TNF-a concentrations [p<0.05, 0.001, 0.001, 0.001 and 0.001 respectively] were observed in RA patients Vs controls. Significant lower HDL-C [p<0.05] and higher hs-CRP, and IL-6 concentrations [p<0.01, 0.05 respectively] were observed in seropositive Vs seronegative RA patients. No correlation was found between traditional and nontraditional risk factors for CVD and duration of disease. HDL-cholesterol, hs-CRP, Interleukin -1 and Interleukin -6 correlated significantly with disease activity score [p<0.05, <0.01, <0.05 and <0.02 respectively]. Excess traditional and nontraditional cardiovascular risk factors were observed in RA patients as compared with controls and in seropositive RA patients as compared with seronegative RA patients. This results in a tendency towards increased frequency of CV death in RA patients, more commonly in seropositive patients. Non-traditional risk factors play a more important role than traditional risk factors in cardiovascular disease in RA

Effect of progressive resistance training on glycemic control in elderly type II diabetic patients

To investigate the effect of progressive resistance training [PRT] on glycemic control in elderly type II diabetic patients. The study was conducted on 40 elderly individuals with type II diabetes. They were divided into 2 equal groups. The progressive resistance training [PRT] group received 16 weeks of PRT program plus the usual diabetic care, while the control group received a controlled exercise program plus the usual diabetic care. Glycemic control, lipid profile, resting blood pressure, muscle strength and anthropometry were evaluated for the 2 groups at baseline and at end of the study. For the PRT group we found a highly significant reduction in glycosylated hemoglobin level [HbA1c] [t=13.64, p<0.001], highly significant increase in muscle strength [t=10.19, p<0.001], trend for reduction in blood pressure and trend for reduction in triglyceride level. PRT when included with usual diabetic care for elderly people with type II diabetes is of benefit in glycemic control and at the same time is safe and well tolerated

correlation between the immunohistochemical expression of mutant P53 protein and HER-2/neu with clinical behaviour of infiltrating duct carcinoma of breast

A series of 40 females complaining of infiltrating duct carcinoma was included in this study. Clinicopathological background, histological grade and immunohistochemical staining for p53, HER-2/neu as well as estrogen and progesterone receptors were analyzed. The results showed that 14 cases were positive to p53, 12 were positive to HER-2/neu, 30 were positive to estrogen receptor and 22 were positive to progesterone receptors. The statistical analysis showed a positive correlation between p53 protein staining with tumor grade and an invasive relation to the hormonal status; whereas, HER-2/neu showed a significant correlation to the lymph node status. No correlation was detected between p53 protein, HER-2/neu protein expression and progression free survival. HER-2/neu protein-positive patients showed an improved response to anthracycline-containing regimen. A complete response was attained in 5% of the cases, partial response in 25%, stationary disease in 60% and 10% of the cases had progressive course