Evaluation of choroidal thickness in diabetic macular edema using spectral-domain optical coherence tomography enhanced depth imaging mode

Purpose: to evaluate the choroidal thickness [CH-T] and the central macular thickness [CMT] in eyes with diabetic macular edema [DME] and to detect if CH-T varies according to the type of DME

Patients and methods: One hundred forty two eyes of 96 patients were enrolled in the study. Eyes of diabetic patients with non-proliferative diabetic retinopathy [NPDR] with/without DME were evaluated. Eyes of normal subjects with no ocular or systemic diseases were included as a control group. The CMT and the underlying choroidal thickness were estimated using enhanced depth imaging mode of spectraldomain optical coherence tomography [EDI SD-OCT]. CH-T thickness was measured at the subfoveal area and at an interval of 500 microm up to 1500 microm from the center of the fovea [nasal, temporal, superior and inferior]. In eyes with DME, the type of DME was detected

Results: DME included cystoid DME [19 eyes], diffuse DME [27 eyes], and DME with serous retinal detachment [SRD] [23 eyes]. 33 eyes with NPDR without DME and 40 non diabetic normal eyes were examined. Estimation of the choroidal thickness was performed and the subfoveal CH-T was thickest in the control group and significantly decreased in the diabetic groups especially with DME. The sub-foveal CH-T was 326 +/- 25.75 microm in the control group, 256.27 +/- 30.5 microm in NPDR without DME group, 210 +/- 23.96 microm in Cystoid DME group, 215.5 +/- 27.0 microm Diffuse DME group and 195.2 +/- 23.9 microm in DME with SRD group. The CMT was 238.75 +/- 14.7 microm, 260.85 +/- 24 microm, 530 +/- 120.5 microm, 420.8 +/- 101.6 microm and 506.60 +/- 131.87 microm in the control group, NPDR without DME group, Cystoid DME, Diffuse DME and DME with SRD groups respectively. There was a statistically insignificant negative correlation between the subfoveal choroidal thickness and the CMT

Conclusion; there is an overall decrease in the CH-T in patients with NPDR and this thinning become more pronounced with the presence of diabetic macular edema

Impact of implementing standardized nursing care on hepatic encephalopathy patients outcomes in intensive care unit at Assuit university hospital

Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma us a result of liver failure. In the advanced stages it is called hepatic coma. It may ultimately lead to death. It is caused by accumulation in the blood stream of toxic substances that are normally removed by-the liver. Standards of nursing care provide the required knowledge and skills that can be used to orient new staff and guide nurses in clinical practice; moreover, standards form a basis for monitoring, evaluating and improving quality of care. Therefore, the aim was to identify the impact of implementing standardized nursing care on hepatic encephalopathy patient's outcome. Quasi-, experimental research design was used to conduct this research. This study was carried out in intensive care unit of gastroenterology and hepatology in internal medicine department at main Assuit University Hospital. The sample of this study consisted of 60 patients, divided into study and control group equally. Tools used in this study comprised three main. Tool 7> patients groups assessment sheet. Tool II:- Neurological examination including mental state assessment. Tool 111:-Evaluation sheet of hepatic encephalopathy patients. The results: it revealed that majority of the study sample was older than 55 years with a mean age [55.9 +/- 7.8 and 60.2 +/- 5.1 respectively] for the study and control group with significant difference. Regarding length of hospital stay there was a significant difference between both study and control group with p-value [< 0.001]. There results revealed significant difference between both groups regard the level and grade of lower limb edema [p < 0.01]. On the other hand, the result showed skin ulceration with statistically significant difference ktween both groups [p< 0.01]. In addition the current study revealed significant increase in both groups as regard neurological assessment using GCS, while it showed significant decrease as regards west haven criteria [p < 0.05].Conclusion:-Based on the findings of the present study, it can k concluded that the standardized nursing care were better than the routine care of the hospital for hepatic encephalopathy

Effect of indomethacin and meloxicam on monoamine levels in selected tissues of rats

The effects of i.p. injection of indomethacine [25 mg/kg body wt] or meloxicam [4 mg/kg body wt] on the levels of dopamine [DA], norepinephrine [NE], serotonin [5-HT] and 5-hydroxyindolacetic acid [5-HIAA] were examined in plasma, different brain regions, liver and adrenal gland of male albino rats after 2, 4, 8 and 24 hrs of injection. Administration of either indomethacin or meloxicam was found to have a variety of actions in monoamine levels, producing either potentiation, no effect, or inhibition. The most pronounced increasing effects were observed with indomethacin on DA levels after 2, 4 and 8 hrs, on NE levels after 4 and 8 hrs and on 5-HT levels after 2 and 4 hr in most of the tissues examined. The increase was also observed in DA levels after 4 and 24 hrs following meloxicam treatment. However, the most prominent inhibitory effect was noticed following treatment with meloxicam in NE levels after 2 and 8 hrs and in 5-HIAA levels after the different time intervals in all the selected tissues. It is possible to conclude that the potentiating effect of indomethacin and meloxicam may be due to inhibition of cyclooxygenase pathway for the oxidative metabolism of arachidonic acid, with consequent conversion of the acid into lipooxygenase system and the generation of products which enhance amine release. Meanwhile the inhibitory effect of two drugs may be related to inhibition of protein kinase C blockade of oxidative phosphorylation and a reduction in the ATP content of the tell required for amine release

Cellular phenotypes and immunity in acquired aural cholesteatoma

Middle ear cholesteatoma is characterized by the presence or a keratinizing squamous epithelium with proliferative features and associated with marked bone destruction. Aims of this study to detect the cellular phenotypes and their immunological functional state in aquired aural cholesteatoma. So, cellular membranous expression of CD4, CD8 and HLA-DR antigens on the infilterated mononuclear cells in cholesteatoma were studied through immunohistochemical method. Nine formalin-fixed cholesteatoma specimens were obtained from patients of chronic otitis media during their ear surgery. The patients' ages ranged between 11 to 43 years [mean age=22 yrs. and SD +/- 6.5] and they involved 15 males and 12 females. All patients had dry ears with no signs of bacterial infections for at least 2 weeks preoperatively. Also, three normal skin specimens from external auditory canals of these patients were taken as a control. All tissue specimens were subjected to Hematoxylin and Eosin staining and immunohistochemical [strept-avidin-peroxidase] method staining. The results showed CD4 positive [=T- helper or inducer] lymphocytes in 24 out of 27 specimens [88.8%] with subepithelial distribution and at the periphery of lymphoid follicles in 15 cases [55.5%].While, CD 8 positive [=T-suppressor or cytotxic] lymphocytes were seen only in 6 out of 27 specimens [22.2%] with diffuse distribution pattern. On the other hand, HLA-DR expression was observed in both cholesteatoma matrix and perimatrix cellular components indicating their immunocompetent activity. Keratinocytes of cholesteatoma matrix were HLA-DR positive in 18 specimens [66.6%] while, "epidermal Langerhans" cells were positive in 12 specimens [44.4%]. In the perimatrix of all specimens, infilterated lymphocytes and macrophages were positive for HLA-DR expression. Also, [either intact or degranulated mast cells] were demonstrated in all specimens scattered in the cholesteatoma perimatrix. Active T-helper cells are directly correlated to the expression HLA-DR has a certain playing. Role in epithelial proliferation and participating in bone resorption rather than cytotoxic T-lymphocytes. Also, activated keratinocytes and Langerhans' cells and sensitized mast cells contribute to the biologic features of cholesteatoma

Studies on swollen head synomen in Egypt: 1 Serological survey and comparison between two ELISA kits for detection of antibody

Swollen Head Syndrome [SHS] affects both broiler and broiler breaders and has become a problem in many countries. Clinical signs similar to those described in SHS conditions have been recorded in Egypt. The disease was recorded in difference ages and different breeds including native breed that showing respiratory manifestations, mortality and low, egg production. 375 serum samples from 15 farms that showing respiratory manifestations, mortality and low egg production were examined for the presence of antibodies against SHS virus using Enzyme linked Immunosorbent Assay [ELISA] based on two different types of antigen strain British and French antigens. Antibodies were detected in 14 farms but not in one farm. The results obtained from testing with two different types of ELISA kits showed no statistical significant difference