evaluation of routine central nodal dissection in radiologically node negative differentiated thyroid carcinoma

Background: thyroid cancer is the most common malignant disease in endocrine system and is rapidly increasing in incidence. The use of routine prophylactic central neck dissection for the treatment of differentiated thyroid cancer has been an area of debate over the past few decades

Aim of the Work: the primary aim of surgery was to resect disease, minimize the chance of recurrence and achieve this with minimal morbidity. Selecting the appropriate procedure is critical as not only does surgery provide initial therapy, but also optimizes the patient for adjuvant radioactive iodine [RAI] therapy when required

Patients and Methods: this study was conducted to evaluate the efficacy of prophylactic central lymph nodal dissection in patients diagnosed with differentiated thyroid carcinoma from several points of view including operative time, hospital stay, postoperative complications and most importantly the recurrence. Our patients were operated upon between August 2016 and August 2017 with minimal follow up of 6 months and follow up extended to 2 years after surgery

Results: Operative time was significantly higher in group B with a mean time of 141.68 +/- 12.72 as compared to group A. The most outstanding difference in terms of complications was detected in transient hypoparathyroidism that occurred in 16% of group B patients. A single case of recurrence was detected at 12 month in group A that was confirmed by fine needle aspiration cytology which required reoperation

Conclusion: there was no convincing evidence that pCND leads to an improvement in recurrence rate, overall survival, or any clinically significant variable when applied indiscriminately to DTC patients

Microrna 192 gene expression in type II diabetic nephropathy

Background: diabetic nephropathy [DN] is the common cause of kidney failure in patients with diabetes mellitus. MicroRNAs [miRNAs] are short non-coding RNAs of about 22 nucleotides which recently have been shown to play vital roles in mammalian gene expression

Aim of the study: was to investigate the role of miRNA-192 in the pathogenesis of diabetic nephropathy and disease progression. Patients and Method: Sixty five patients with uncontrolled diabetes mellitus, they were subdivided into; thirty nine patients with normoalbuminuria [<20mg/L]; their ages ranged between 48-67 years and the onset of disease between 1-5 years; twenty six patients with microalbuminuria [20-200 mg/L], their ages ranged between 47-66 years and the onset of disease between 5-15 years, in addition to twelve apparently healthy individuals as control; their ages ranged between 51-67 years. Serum Transforming growth factor beta [TGF-beta], Interleukin 18 [IL-18] were determined using ELISA technique, the expression level of miRNA-192 in whole blood using [RT-PCR] was determined, other biochemical parameters as fasting plasma glucose [FPG], glycated haemoglobin [HbA1c], lipid profile and creatinine were estimated using commercial available kits. Patients were given written contest

Results: the level of miRNA-192 expressions was significantly lower in microalbuminuria group when compared to normoalbuminuria group. Serum level of IL-18 and TGF-beta were significantly higher in both patient groups when compared to control group and their levels were significantly higher in microalbuminuria group than normoalbuminuria group

Conclusion: together with TGF-beta1 and IL-18, miRNA- 192 may not only be used as molecular biomarker in diabetic microvascular complications but also as early marker of alterations in specific biological processes in the kidney

Study of metabolic and some hormonal aspects among pubertal type-1 diabetic girls

The onset of type-1 diabetes before menarche was a risk factor for the subsequent development of hyperandrogenic disorders. It has been also suggested that the use of exogenous insulin to treat type-1 diabetes mellitus in those patients may contribute to the development of PCOS. Abnormal lipid levels were also reported in children with type-1 diabetes mellitus during pubertal years. This study was designed to investigate metabolic and some hormonal changes in relation to puberty among type-1 diabetic girls. The study was carried out on 60 girls, 40 of them were type-1 diabetic patients [the diabetic group], subdivided into two groups [according to age and Tanner breast staging] and 20 of them were normal healthy girls [the control group], also subdivided into two groups [according to age and Tanner breast staging]. All girls were subjected to full history taking thorough clinical examination, estimation of fasting blood glucose and HbAIc [as an estimation for glycemic control], lipid profile, hormonal profile [FSH, LH and free testosterone] in addition to pelvic ultrasound. There is an increased frequency of dyslipidemia in the form of hypercholesterolemia and increased levels of LDL among type-I diabetic girls and pubertal type-I diabetic girls show higher BMI and cholesterol levels compared to controls and also show higher levels of LDL compared to prepubertal type -I diabetic children. Age at menarche is delayed in pubertal type-I diabetic girls having PCOS, while not delayed in those without PCOS but positively correlated to the longer duration of diabetes and with the level HbA Ic. Both the frequency of PCOS and the level of free testosterone are higher in pubertal type-I diabetic girls compared to their normal controls

Insulin secretion and insulin resistance in patients with chronic hepatitis C

The prevalence of type 2 diabetes mellitus is significantly higher in patients with chronic hepatitis C than in those with chronic hepatitis B or even healthy subjects. Although insulin resistance appears to play an important part in the pathogensis of diabetes in these patients, the exact mechanism of this finding is not completely known. High levels of pro-inflammatory cytokines was suggested as a possible mechanism. This work was conducted to detect the primary mechanism of development of diabetes in individuals with HCV infection. A total of 30 non-diabetic non-cirrhotic patients with chronic hepatitis C were included in the study and 15 non-diabetic non-cirrhotic patients with chronic hepatitis B served as the control group. Both groups were closely matched by age, gender, BMI and transaminases. Insulin resistance, beta-cell function, and proinflammatory cytokines [TNF-alpha and 1L6] were evaluated in both .groups. There was no difference between the patients with chronic hepatitis C and those with chronic hepatitis B as regards Beta cell function as determined by HOMA-beta [3 16 +/- 184 vs 248 +/- 225, P>05] but insulin resistance as determined by HOMA-IR [6.5 +/- 4.4 vs 2.8 +/- 1.6, P<.05] and serum levels of TNF-alpha [7.3 +/- 2.8 vs 5.l +/- o.9, p<.01] and IL-6 [419.2 +/- 137.6 vs 302.2 +/- 80.6, P<.05] were significantly higher among the patients with chronic hepatitis C than those with chronic hepatitis B. There was no correlation between HOMA-IR and each of age of patients, FPG, ALT, viral load as measured by HCV PCR and levels of TNF-alpha and IL-6 [P>05]. Insulin resistance may be the primary mechanism of development of diabetes in patients with chronic hepatitis C. Although pro-inflammatory cytokines are increased in these patients, other causes and mechanisms may also be implicated in development of the insulin resistance in these patients

Vascular endothelial growth factor and diabetic nephropathy in type-2 diabetic patients

Diabetes usually accompanied with multiple complications affecting both the microvasculature and macrovasculature. Vascular endothelial growth factor [VEGF] has been implicated in the pathogenesis of diabetic nephropathy. This study was designed to investigate serum and urinary VEGF in type-2 diabetic patients and assess whether serum and urinary VEGF levels are related to the severity of diabetic nephropathy. The study included 80 type-2 Egyptian diabetic patients [46 female, 34 male] attending the outpatient clinics of NIDE and 30 normal controls. Blood pressure, BMI, FBS, HBA1c, lipid profile, urea, creatinine, uric acid, microalbuminurea and VEGF [serum and urine] were measured. Fundus examination, chest X-ray and ECG were performed for all subjects and echocardiography was done when indicated. There was a significant increase in plasma VEGF concentrations in diabetic patients than in normal controls. Patients with higher levels of serum VEGF concentrations had a significant increase in systolic BP, diastolic BP, FBS, HbA1c, serum creatinine, albumin/creatinine ratio and retinopathy than those with lower levels of serum VEGF concentrations. There was also a significant increase in urinary VEGF concentrations in diabetic patients than in normal controls. Urinary VEGF levels appeared to be positively correlated with both urinary ACR and serum creatinine. These data demonstrate the ability to reveal new markers for diabetic nephropathy, an important step forward in advancing accurate diagnosis and understanding of disease mechanisms

Evidence for effectiveness of intervention to combat obesity among workers at El Minia University

The prevalence of obesity and its associated health .problems have increased sharply in the past 2 decades particularly in developing countries. Lifestyle interventions include exercise, dietary change, behavior therapy, or some combination of these components. To describe the problem of obesity and its contributing factors among workers at El-Minia University and to explore whether the three modalities of life style intervention used with obese workers differ in their efficacy to improve outcome measures. An interventional study in which 480 workers from El-Minia University were participated. Data were collected by a special designed detailed questionnaire. Weight, height, waist and hip circumferences were measured; vital signs and blood examination for sugar and lipid profile were undertaken. Three types of life styles interventions were done to the obese: dietary modification, exercise promotion, and combination of dietary and exercise intervention. Post-intervention questionnaire, anthropometry and other outcome indicators were measured. More than two thirds [68.2%] of the participants were obese or at risk of obesity [overweight]. Obesity was nearly twice more common in females than males [61.2 vs. 38.8%] and increased with increasing age. Central obesity determined according to waist circumference was found to be 32.8% and 38.4% among males and females respectively. About 41% of administrative workers and nearly 28% of teaching staff and 23% of manual workers were obese. Eating more than three regular meals and eating snacks have significant relation to the development of obesity. The most contributing risk factor of obesity is the sedentary type of work followed by obesity during the childhood, and eating unhealthy snacks. There is a statistical significant relation between parity and the development of obesity. Obese workers had significantly higher systolic blood pressure than non-obese. The cholesterol level decreased significantly and HDL increased significantly after the intervention, There is significant decrease in BMI in the three groups after the intervention, but the combination of diet and exercise intervention is better than diet intervention alone which in turn is better than exercise intervention alone. Overweight and obesity were highly prevalent among workers at El Minia University which pose them more at risk of hypertension, diabetes mellitus, as well as joint and back pain. There is an inverse association between physical activity and weight gain. There was sufficient evidence to suggest that dietary plus exercise intervention is the best method to combat obesity and to improve outcome measures

Role of reduced glutathione, nitric oxide and some trace elements in Alzheimer's disease and vascular dementia

Dementia is an acquired impairment of intellectual and memory functioning. Oxidative stress is thought to be associated with the majority subtypes of dementia; Alzheimer's disease [AD] and vascular dementia [VaD], as well as type II diabetes mellitus. The current study was performed to investigate the hypothesis of decreased activity of antioxidant defense system protecting tissues from free radical damage in patients with AD and VaD by measuring the levels of reduced glutathione, nitric oxide, and some trace elements neurotoxicity, also to evaluate the association of diabetes mellitus as a risk for Alzheimer's disease. This study, included 20 healthy subjects as control group [group I, consisted of 14 males and 6 females; mean age 75.8 +/- 0.78 years], 20 patients were diagnosed as Alzheimer disease [group II, consisted of 8 .males and 12 females; mean age 74.45 +/- 0.44 years], 10 patients has Alzheimer disease with type II diabetes [group III, consisted of 7 males and 3 females; mean age 74.3 +/- 1.02 years] and 10 patients were diagnosed as having vascular dementia [group IV, consisted of 4 males and 6 females; mean age 75.4 +/- 1.77 years]. The following plasma parameters were measured and compared among subject groups: reduced glutathione [GSH], nitric oxide [NO], copper, zinc, iron· and blood hemoglobin. The results showed that GSH concentration was significantly decreased in the dementia groups compared to control group, whereas level of NO was significantly increased in dementia groups in comparison to controls, however, the level was markedly increased in Alzheimer disease with type II diabetes mellitus. Furthermore, the copper level was significantly increased in AD and VaD than control group at P<0.001. The results revealed non-significant elevation in plasma content of Zn in dementia groups versus controls. Plasma iron concentration was significantly lower in dementia groups when compared to the controls [P< 0.0001], and its level was positively correlated with hemoglobin level [r = 0.722, P = 0.019] in VaD. It can be concluded that, the reduced levels of GSH, hemoglobin and iron along with the elevated levels of NO and copper are significantly associated with the development of AD which supports the hypothesis that decreased activity of antioxidant defense system is associated with excessive free radical production that has the potential of augmenting neuron degradation observed in this disease. Also, anemia and diabetes mellitus increase the risk of dementia, particularly in VaD and the disturbance in trace elements are all involved in the disease pathogenesis. Therefore, we may suggest that the administration of free radical scavengers and iron could provides a therapeutic inroad in the fight against dementia