Clinical significance of LncRNA-MIAT as a non-invasive diagnostic marker of nonHodgkin's lymphoma associated with occult hepatitis C virus infection

Aims: the current research aimed to investigate LncRNA-MIAT in patients with nonHodgkin lymphoma (NHL) and to assess its correlation with clinicopathological features and treatment protocols of NHLs among Egyptian patients with Occult hepatitis C virus (HCV) infection (OCI). Patients & Methods: This study was conducted on 20 patients with NHL and 30 healthy subjects as the control group. All subjects were screened for HCV-RNA in both plasma and PBMCs. RT-PCR determined lncRNA-MIAT. Results: lncRNA-MIAT relative expression level was upregulated in NHL groups (2.73±0.86) compared to controls (1.06±0.07), P ˂0.001*. Among NHL, patients with OCI (3.2±0.63) had significantly higher levels of lncRNA-MIAT compared to HCV (2.6±1.08) and non-HCV (2.4±0.4), P ˂0.001*. Additionally, the relative expression levels of lncRNA-MIAT were significantly positively correlated with laboratory and clinicopathological features of NHL. Interestingly, concerning the treatment of DLBCLNHL, there were significantly higher levels of lncRNA-MIAT in no treatment subgroup (n=10, 3.31±0.95) compared to successfully treated subgroups [CHOP (n=7, 1.58±0.34) and R-CHOP (n=3, 11.16±0.21), P ˂0.001* Conclusions: lncRNA-MIAT level was upregulated in NHL patients, particularly patients with OCI. Thus, circulatory lncRNA-MIAT may serve as a promising non-invasive diagnostic marker for NHL associated with OCI

The gamma-glutamyl transpeptidase to platelet ratio (GPR) and the gammaglutamyl transpeptidase to albumin (GAR) versus fibroscan as indicators of hepatic fibrosis in Non-Alcoholic Fatty Liver Disease Patients

Background: Identifying patients at risk with Non-alcoholic fatty liver disease (NAFLD) related fibrosis is crucial. Many noninvasive fibrosis markers were developed recently in chronic hepatitis C and B patients, but a few were evaluated in NAFLD. Aim: to assess the accuracy of the gamma-glutamyl transpeptidase and the other noninvasive markers gamma-glutamyl transpeptidase-to-platelet ratio and gammaglutamyl transpeptidase-to-albumin ratio (GPR and GAR) versus fibroscan as indicators of hepatic fibrosis in NAFLD patients. Patients and Methods: A total of 100 NAFLD patients were examined by abdominal ultrasound and then fibroscan to assess liver steatosis and fibrosis. They were grouped into the early fibrosis group and the advanced fibrosis group. Demographic data and laboratory investigation were collected. GPR and GAR were calculated. The correlation between them and liver stiffness measurement (LSM) was reported. The accuracy of predicting liver fibrosis was assessed. Results: There was a significant positive correlation between GPR and GAR and the degree of fibrosis. GPR (P <0.001*) and GAR (P <0.001*) were independent predictors for advanced hepatic fibrosis by multiple linear regression analysis. Fibrosis score was used as the dependent variable, with the other studied biomarkers as independent variables. The AUCs of GPR and GAR were 0.790 and 0.949 in assessing liver fibrosis, respectively. Conclusion: GPR and GAR were positively correlated with hepatic fibrosis and may be used as a novel, simple, accurate, and low-cost parameter for diagnosing hepatic fibrosis in NAFLD patients.

Is alveolar cleft reconstruction still controversial? [Review of literature]

Cleft lip and palate [CL/P] is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral and complete or incomplete. Alveolar cleft reconstruction remains controversial with regard to timing, graft materials, surgical techniques, and methods of evaluation. Many studies have been conducted addressing these points to develop an acceptable universal protocol for managing CL/P. The primary goal of alveolar cleft reconstruction in CL/P patients is to provide a bony bridge at the cleft site that allows maxillary arch continuity, oronasal fistula repair, eruption of the permanent dentition into the newly formed bone, enhances nasal symmetry through providing alar base support, orthodontic movement and placement of osseointegrated implants when indicated. Other goals include improving speech, improvement of periodontal conditions, establishing better oral hygiene, and limiting growth disturbances. In order to rehabilitate oral function in CL/P patients alveolar bone grafting is necessary. Secondary bone grafting is the most widely accepted method for treating alveolar clefts. Autogenous bone graft is the primary source for reconstructing alveolar cleft defects and is currently the preferred grafting material

Risk factors of progression of chronic kidney disease patients under conservative treatment.

Background: Chronic kidney disease (CKD) is recognized as a major health problem affecting approximately 13% of the US population. Early identification and treatment of risk factors of progression of chronic kidney disease can provide marked benefits later in the term of delaying progression to renal replacement therapy. Methods: The medical chart for 92 CKD patients on regular follow up in low clearance clinic with GFR below 20 ml/min were retrospectively reviewed annually for 4 years regular follow up period. The following variables were recorded for each patient: non-modifiable variables (Age, sex, nationality, BMI, systolic and diastolic blood pressure, smoking status, causes of kidney disease, diabetes status, hepatitis status, medication used (like ACEi/ARBs and Sodium bicarbonate) and modifiable variables which includes: Serum albumin, potassium level, serum bicarbonate level, level of proteinuria, rate of GFR decline (Delta GFR) /year, total cholesterol level and hemoglobin level. Then they were divided into 2 groups according to the endpoint during the follow up period. Group 1 include patients did not start dialysis yet and group 2 which include patients who started dialysis during their regular follow up period. Results: There is no statistically significant differences between the two groups regarding Age , sex, systolic and diastolic blood pressure and Body Mass Index( BMI), serum albumin and haemoglobin levels (p 0.295, 0.317, 0.220, 0.181,0.805, 0.884 and 0.451 respectively). There is no statistically a difference between the two groups regarding serum potassium level and serum total cholesterol level (p 0.515 and 0.517 respectively). Diabetic patients started dialysis earlier than non-diabetics with statistically significant difference between the two groups (p 0.029). The patients who weren’t taking ACEi or ARBs started dialysis earlier than those who were taking (p 0.005), while there was no significant differences between the two groups regarding sodium bicarbonate intake (p 0.256). Low sodium bicarbonate level and severity of proteinuria are of significantly important risk factors for progression of CKD disease (p 0.006 and 0.029 respectively). Conclusions: The most important risk factors for rapid progression are presence of diabetes, severity of proteinuria and low serum bicarbonate level in advanced stages of chronic kidney disease. Early recognition of these risk factors and their correction may retard the progression of CKD, which will delay the need for renal replacement therapy. In addition, ACEI or ARBs intake are almost renoprotective and may delay the rapid progression of chronic kidney disease especially in proteinuric patients.

Evaluation of hepatitis B vaccine responsiveness in hemodialysis and peritoneal dialysis patients.

Background: Hepatitis B Virus (HBV) infection is considered as a major cause of liver cirrhosis and hepatocellular carcinoma. Patients with End Stage Renal Disease (ESRD) are a risk group for HBV infection. The vaccine of hepatitis B has been recommended for prevention of HBV infection in ESRD patient especially on renal replacement therapy. Methods: Eighty seven patients with ESRD on peritoneal dialysis and hemodialysis requiring primary hepatitis B vaccination were enrolled in the study. Each of them received 40 μg of recombinant hepatitis B vaccine in a four-dose schedule. Antibody response was determined by the levels of antibodies to the hepatitis B surface antigen (anti-HBs) after last doses of the vaccination schedule. Results: We observed three response patterns to the immunizations in all patients after vaccination, the nonresponders (24.7%) never reached the minimum protective titer of 10 mIU/mL, the poor responders (18.5%) had titers between 10 and 100 mIU/mL, and the good responders (56.8%) had antibody titers above 100 mIU/mL. Despite a reduction in anti-HBs over time, the good responders did not become unprotected during the observation period, especially those participants who had titers above 1000 mIU/mL after the initial immunization. Conclusions: We concluded that the immune response of the HBV vaccine was reduced in the HD and PD patients, which need yearly re-evaluation of seroconversion with booster doses of HBV vaccination if needed.

Soft versus hard occlusal splint therapy in the management of temporomandibular disorders [TMDs]

Aim: To compare between soft and hard occlusal splint therapy for the management of myofacial pain dysfunction [MPD] or internal derangement [ID] of the temporomandibular joint [TMJ] with reciprocal clicking

Patients and methods: This study included 50 patients [age range: 24-47 years] who had been diagnosed with MPD or ID of the TMJ in the form of reciprocal clicking. Patients were divided into two groups. They were treated for 4 months with either a vacuum-formed soft occlusal splint constructed from 2-mm-thick elastic rubber sheets [soft splint group] or a hard flat occlusal splint fabricated from transparent acrylic resin [hard splint group]. Monthly follow-up visits were performed during the treatment period. Before treatment and 1, 2, 3 and 4 months after treatment, the dentist measured all parameters of TMJ function [pain visual analog scores, tenderness of masticatory muscles, clicking and tenderness of the TMJ, and range of mouth opening]

Results: All parameters of TMJ function showed significant improvement in both groups during the follow-up period, with a statistically significant difference between the two groups at the 4-month follow-up visit

Conclusions: Both forms of occlusal splints [soft and hard] improved TMJ symptoms in patients with MPD or ID of the TMJ. However, the soft occlusal splints exhibited superior results after 4 months of use

The Milk Borne Pathogens of Raw Milk from Some Egyptian Farms in Different Seasons.

Milk has good quality protein and is a unique substance in that it is consumed as fluid milk with minimal processing and also it is the raw material used to manufacture a wide variety of products. Milk is susceptible to contamination by many pathogenic microorganisms, which result in infection and threat to consumer’s health. The aim of this study was to determinate occurrence of pathogenic microorganisms in raw milk in four seasons from different locations in Egypt, the obtained counts results showed that the samples gave the lowest Total Plate Count (TPC) of 3x105cfu/ml in winter’s samples. While, the summer's sample showed the highest TPC of 5.8x107cfu/ml. E. coli count ranged from 2x102cfu/ml to 5.8x 105cfu/ml which the lowest count was noticed in winter’s samples. Staphylococcal count ranged from 2.7 x 103cfu/ml (winter sample) to1.28 x 106cfu/ml (another sample in the same season). These results indicated poor hygienic standard of raw milk from uncontrolled environments and the increased public health risk of those consuming raw milk from such uncontrolled sources and all these tests consume time but with Cultureindependent methods that are based on protocols where total DNA (or RNA) is directly extracted from the substrate it can save time. Coupled with a global analysis, these methods make it possible to study the total diversity from the bulk extract in a single step.

Salivary PCR detection of Helicobacter pylori DNA in Egyptian patients with dyspepsia

Several methods are available for detecting Helicobacter pylori infection: [1] invasive methods based on gastric biopsies, [2] non invasive methods like Urea Breath Test [UBT], serology and stool antigen tests. Importance of salivary PCR in detection of H. pylori is still questionable. To evaluate the role of salivary PCR technique in detecting H. pylori gastric affection in Egyptian patients with dyspepsia and in differentiating between functional dyspepsia and acid-ulcer syndrome. This study included 60 patients with dyspepsia classified into three groups: [Group 1] patients with gastric H. pylori and ulcers or erosions [n = 20], [Group 2] patients with gastric H. pylori and no ulcers or erosions and had functional dyspepsia [n = 20], [Group 3] patients without H. pylori and had functional dyspepsia [n = 20]. All underwent upper gastrointestinal endoscopy with biopsies, rapid urease test and salivary samples for H. pylori PCR. Significant difference between the three groups regarding salivary PCR values. No significant difference between Group 1 and Group 2 but both had significant difference with Group 3, significant difference between gastric H. pylori positive patients [n = 40] and negative ones [n = 20]. Salivary PCR test had sensitivity of 85%, specificity of 70% in diagnosing H. pylori. PCR value of 534000 Iu/ml had best sensitivity [75%] and specificity [100%] for diagnosing H. pylori, highly significant positive correlation between H. pylori gastric affection and salivary PCR values. No significant difference between patients with acid ulcer syndrome [n = 20] and those with functional dyspepsia [n = 40] as regard salivary PCR mean values. Salivary PCR test showed sensitivity of 100%, specificity of 50% in differentiating between patients with acid ulcer syndrome and those with functional dyspepsia. PCR value of 440000 Iu/ml had best sensitivity [100%] and specificity [55%] in differentiating acid ulcer syndrome from functional dyspepsia with non significant. H. pylori salivary PCR may be of value in diagnosing H. pylori gastric affection and is strongly correlated with it but it is of limited value in differentiating between acid ulcer syndrome and functional dyspepsia

challenges of managing glioblastoma multiforme in developing countries: a between cost and quality of care

The management of glioblastoma multiforme [GBM] in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide. Retrospective case series. Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed. We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age [median age, 51 years], with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months [median, 9.4 months]. The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities. The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients

Nutritional assessment of patients in a large Saudi dialysis center

To examine interventions used to manage malnutrition, and obesity, and to share experiences, concerns, and solutions to these problems for management of nutritional disorders in Saudi patients on maintenance hemodialysis. The subjects included in this cross-sectional study were chronic hemodialysis patients in the Prince Salman Center for Kidney Diseases [PSCKD], Riyadh, Kingdom of Saudi Arabia during the period from September 2007 to September 2008. Medical history, examination, baseline laboratory tests, and the nutritional status was assessed using the subjective global assessment score [SGA]. Subjects in the study had a mean age of 50 +/- 16 years, 108 [54%] were males and 92 [46%] were females with a mean single pooled Kt/v of 1.4 +/- 0.15, and a mean normalized protein catabolic ratio of 1.13 +/- 0.2. Regarding body mass index, 4% of patients were underweight, 49% had average weight, 27.5% were overweight, 14% were obese, and 5.5% had morbid obesity. The SGA classified patients into 68% normal, 24% mild to moderately malnourished, and 8% with severe malnutrition. Using different parameters for individualization of metabolic needs to each patient's own metabolic status, and for detection of the coexisting nutritional conditions is essential for optimal care for hemodialysis patients

Lateral trans-psoas approach to fix the lumbar spine

The present study describes a new surgical approach to fix the lumbar spine with evaluation of the prospective early outcome. In the period from October 2004 to January 2006, 10 patients with degenerative spondylolisthesis [7 females, 3 males; mean age 43.0 year] underwent lateral retroperitoneal trans-psoas approach for screws and plate fixation of the lumbar spine. All cases [2 with prior posterior surgery and 8 without] had instability at one level which was L3-4 in 2 patients and L4-5 in 8. Spinal stenosis, large disc protrusion, and L5-S1 instability were excluded from this study. Average operative time was 3.2 hours; average blood loss was 450CC, and average postoperative hospital stay was 4.3 days. Clinical and radiological outcome after one year follow-up were satisfactory in the 10 patients. Neither mortality nor massive blood loss were encountered. Complications were in the form of temporary weak painful left hip flexion in all the patients, transient ileus in 4, inadvertent lumber sympathectomy in 2, incisional hernia in 1, and mild wound infection in 1

Distal femoral fractures in elderly patients. Results of retrograde intramedullary interlocking nailing

Distal femoral fractures constitutes about 7% of all fernoral fractures [4]. In elderly patients, these fractures are mostly low energy fractures predisposed to by increase in porosity with aging, decrease in strength and osteoporosis. Different technique were used for surgical stabilization. In this series 34 fractures were stabilized using the interlocking retrograde nail. The outcome was% excellent and good in 80% of the cases. We concluded that the retrograde femoral nailing is a safe and reliable implant for fixation of type A distal femoral fracture in low demand elderly patients

Tumor and Tumor-like conditions causing painful Ankle and foot: MRI findings

Accurate diagnosis of non-traumatic causes of painful ankle and foot is important so that proper medical and surgical management can be applied. The purpose of our study was to report the efficiency of MRI in the diagnosis of these cases and to correlate MRI diagnosis with the surgical and pathological results. This study included 10 patients suffering from painful ankle region and foot not related to trauma. They were 5 male and 5 female. Their age ranged from 11 to 42 years with an average of 26 years. All these patients were surgically managed, and we found good correlation between the MRI findings and the pathological diagnosis

Scalp reconstruction after extirpation of large advanced tumor [experience in 10 cases]

This study was conducted on ten patients with large scalp tumors Seven patients [70%] were advanced basal cell carcinoma eroding calvarium and reaching the dura matter in 2 patients. The other patients were sqamous cell carcinoma [30%]. Wide local excision was done with minimum safety margin [>/= 1cm] the eroded bones and dura mater was excised by neurosurgeon. Immediate reconstruction of the dura and bone was done using fascia lata and bone cement. Cutaneous coverage was achieved by free lattissimus dorsi in 3 patients. radial forearm flap in 1 patient, local bilobed and trilobed flaps in 5 patients and split-thickness skin graft in the remaining one. No flap loss occurred, infection occurred in 2 patients, gaping in one patient that required secondary procedure and donor site seroma in one patient. Mortality was 20% and recurrence in one patient. in spite of the relative risk of mortality and morbidity yet surgical excision offers the only remaining chance for those desperate patients with extensive tumors for whom no adjuvant measures are available. Those patients were always ready to get rid of offensive odor, repeated bleeding and disfigurement associated with the tumor

Role of duplex arterial mapping in the evaluation of lower extremity arterial lesions in patients for vascular reconstruction

This study was designed to determine the value of colored Doppler sonography in the preoperative evaluation of lower extremity arterial lesions before vascular intervention to emphasize the value of such technique in providing information on both the anatomical site and hemodynamic impact of individual atherosclerotic lesions. Eighty lower limbs in 41 patients were evaluated by color duplex scanning and angiography. The lower limb vasculature was divided into fifteen segments [common iliac artery, external iliac artery, common femoral artery, proximal, middle and distal third of the superficial femoral artery, profunda femoris artery, proximal and distal half of the popliteal artery, anterior, posterior tibial arteries and peroneal artery]. In studying different arterial lesions, the sensitivity of CDS at the iliac arteries was 83.8%, at the femoropopliteal arteries 93.75% at the popliteal arteries 91.9%, at anterior tibial arteries 83.8%, at posterior tibial arteries 85.9% and at peroneal arteries 81.4%

Renal blood flow in neonates with perinatal asphyxia: quantification with color flow and pulsed doppler ultrasound

The aim of this work was to evaluate renal blood flow in asphyxiated newborns using Doppler ultrasonography and assess its value and accuracy in the early detection of renal dysfunction in such cases, thus permitting an early management hence a full recovery of any affected kidney. Twenty-six asphyxiated newborns with a mean gestational age of 39.62 +/- 0.94 weeks and a birth weight of 3.29 +/- 0.60 kg were studied. Twenty clinically healthy neonates matched for sex, gestational and birth weight were included as a control group. The studied cases were classified according to the absence or presence of renal involvement into two groups. The findings of this study suggested that the hypoxic ischemic insult was exerting an effect on the kidneys. Therefore, the presence of documented hypoxic-ischemic insult had an impact on the renal Doppler ultrasonographic measurements despite the absence of clinical and laboratory indices. This highlighted the value of renal Doppler US, with the measurement of RI, as a sensitive noninvasive technique for the early detection of renal dysfunction

randomized controlled study of the immunosuppressive versus of whole blood transfusion versus packed red blood cells transfusion in patients undergoing elective colorectal surgery

In a randomized study, the effect of whole blood transfusion versus packed RBCs transfusion on CD4+:CD8+ ratio, the levels of soluble interleukin 2 receptor [sIL-2R] and interleukin IL-6 as well as on the development of the postoperative wound infection and intra-abdominal abscess, was assessed in 45 patients undergoing elective colorectal surgery. The patients were subdivided into three groups: Group A included 13 patients who were randomly selected received whole blood transfusion when blood transfusion was indicated, group B included 13 patients who were randomly selected received packed RBCs when blood transfusion was indicated and group C included 19 patients who did not receive any blood transfusion. The samples were obtained prior operation and 3, 7 and 30 days postoperatively. The study demonstrated that transfusion with whole blood in elective colorectal surgery was followed by a significant depression in immunocompetence and this depression is attenuated by the use of packed RBCs transfusion

Surgical management of paralytic valgus ankle

The aim of this work is to determine the. protocol of treatment of paralytic valgus ankle secondary to poliomyelitis in twenty two patients. Hindfoot valgus can occur at subtalar joint, ankle joint or at both sites. Valgus ankle is characterized clinically by prominent medial malleolus and radiologically by a triade of: Fibular shortening, lateral wedging of the distal tibial epiphysis and lateral talar tilt. Sixteen cases were treated by supramalleolar osteotomy, four cases by fibular achilles tenodesis and three cases by internal fixation for fibular pseudarthrosis [one of them was followed by supramalleolar osteotomy]. There was improvement of hind foot valgus and talar tilt in all cases