A randomized trial of endoscopic variceal ligation versus cyanoacrylate injection for treatment of bleeding junctional varices.

Background : There is scarcity of data concerning the management of bleeding junctional gastroesophageal varices. Aim: Our aim was to compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding junctional varices. Methods: One hundred fifty patients with bleeding junctional varices were included in the study. Patients were subjected after randomization to either EVL of junctional varices (group l: 75 patients) or cyanoacrylate injection (group ll: 75 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients. Results: Control of active variceal bleeding was achieved in 61 patients (81%) in group I and in 68 patients (91%) in group II with no significant difference (p =0.07). Re-bleeding was seen in 12 patients (16%) in group I and 5 patients in group II (6%). Junctional varix obliteration was achieved after one session in 33% of patients in group I and 52% of patients in group II, however after 2 sessions it was achieved in 67% in group I and 93 % in group II. After 3 sessions variceal obliteration was achieved in 99% in group l. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I. Conclusion: EVL may be a good alternative to cyanoacrylate injection in treatment of bleeding junctional varices.

Normative bone mineral density in values Isfahani women

The correct interpretation of bone mineral density [BMD] measurement by dual energy x ray absorptiometry [DEXA] requires a population specific reference range. We collected data on age 20-35 years to obtain reference values of BMD for Isfahani women in order to make a population specific diagnosis of osteoporosis. In 660 healthy Isfahani women Volunteers [20-35 years] without illness, use of drugs or predisposing conditions to osteoporosis, the BMD [gr/cm 2] of lumbar spine and non-dominant femur was measured by lunar DPX -IQ machine. The mean BMD and its standard deviations at each site were calculated and compared with normative data from Caucasian US/North European women. No significant differences were detected between them. Bone mineral density measurements of these 660 healthy Isfahani women can serve as a reference guide for the diagnosis of osteoporosis in Isfahani women

Health assessment for chronic liver disease

Assessment of health related quality of life [HRQOL] is not routinely reported in the literature on chronic liver disease [CLD]. Few studies have examined quality of life [QOL] in those patients despite its significant functional impact. The aim of this work is to evaluate HRQOL in patients with chronic liver disease and to examine the correlation between chronic liver disease questionnaire [CLDQ] and the severity of liver disease, and their impact on the well being of these patients with the chronic illness. Subject and methods:-Th study included 75 patients having CLD [aged 45.18 +/- 6.5 years 40 male and 35 female] and 20 apparently healthy subjects as a control group [aged 42.11 +/- 5.2 ,12 male and 8 female]. Both groups were evaluated thoroughly and were asked to complete the CLD] questionnaire which is designed to assess HRQOL in CLD patients. We found significant impairment of HRQOL in patients versus controls. The study also showed significant decrease in HRQOL in patients with higher Child Pugh [CP] class. We also found significant impairment in HRQOL in patients more than 50 years old compared to those younger than 50 years for all grades of CP classification. The study also revealed significant-ye correlation between HRQOL and clinical manifestation of liver decompensation, bilirubin and prothrombin time. There was significant+ve correlation between HRQOL And plasma albumin. As regard hepatic transaminases we found significant ve correlation between AST and worry domain and significant-ve correlation between ALT and activity domain of CLD questionnaire. From the previous results, it appears that chronic liver diseases substantially reduce HRQOL. Further, this impairment increases with disease severity. The ability of the CLDQ to detect associations with disease severity and its applicability to all types of liver diseases that it can be an additional, important outcome in clinical trials designed suggest to evaluate health changes due to disease progression and provide therapeutic measures suitable for patients

Glucagon like peptide-I [GLP-I] and type 2 diabetes mellitus in the elderly

The most common type of diabetes in the elderly is type 2 diabetes which has a hereditary association and is aggravated by obesity and diabetogenic drugs; its prevalence increase with aging from 6% among those aged 45-54 years to more than 20% among those aged 75 years or older. Glucagon like peptide-I [GLP-I] is a hormone secreted from gut endocrine cells in response to nutrient ingestion and plays multiple roles in metabolic homeostasis as stimulation of glucose-dependent insulin secretion and insulin biosynthesis, inhibition of glucagon secretion and gastric emptying and inhibition of food intake. The objective of this study is to compare between the levels of GLP-I in diabetics and non diabetic elderly and to predict the possible role of GLP-I in the development of type 2 diabetes mellitus in the elderly. The presentawork assessed the postprandial serum level of GLP=I in 30 elderly patients with type 2 diabetes mellitus 15 males and 15 females Their age'ranged between 65-74 years. Their mean age is 68.27 years in comparison to 30 control non-diabetic elderly of matched age and sex. The radioimmunoassay of GLP-I is based upon the competition between labeled I 125 peptide and unlabeled peptide binding to a limited quantity of GLP-I antibody, as the concentration of standard or unknown in the reaction increases the amount of I 125 peptide able to bind to the antibody decrease. By measuring the amount of I 125 peptide bound as a fraction of the concentration of the unlabeled peptide in standard reaction mixture the standard curve is constructed and from which the concentration of the peptide in the samples can be determined. Serum GLP-I shows a statistically marked significant decrease in diabetic elderly group when compared to the control group with mean value of [7.56 ng/ml] in diabetic group versus [16.99 ng/ml] in control group P value <0.001 with no gender difference in the diabetic group with mean value of [8.24 ng/ml] in males diabetic versus [6.88 ng/ml] in females diabetic with P value 0.20. Also there is a highly significant negative correlation between GLP-I and insulin and glucagon levels in diabetic group with P value <0.001. These results indicate that GLP-I decrease in elderly type 2 diabetics and this decrease may be a cause of the high prevalence of type 2 diabetes in the elderly population

Closed mitral valvotomy in patients with rheumatic mitral stenosis and associated aortic regurge

This work comprised 300 patients with tight mitral stenosis [MS] who underwent closed mitral valvotomy [CMV] operation and subdivided into two main subgroups: Subgroup A with MS and without associated aortic regurge [AR] [MS group] and comprised 100 patients and subgroup B with MS and associated AR [MS-AR group] and comprised 200 patients [130 patients had AR grade up to I/IV and 70 had AR grade ranged from >1/IV to II/IV; 180 patients had normal preoperative left ventricular, LV, dimensions and 20 patients had mild increased LV dimensions] [end systolic diameter, ESD, up to 4.2 cm and end diastolic diameter, EDD, up to 6.2 cm]. All patients were subjected to CMV operation, preoperatively and postoperatively [within three months, one year and three years]; clinical and Doppler echocardiographs evaluation. The study concluded that CMV operative can be done safely for patients with tight MS and associated AR up to grade II/IV and even among those patients having mild increased LV dimensions [ESD up to 4.2 cm and EDD up to 6.2 cm]. A longer follow up period [up to ten years] was recommended for these patients to evaluate the rate of the progression of AR and the need of AV replacement among them

Varicocele infertility in Abu Dhabi [UAE]

A group of 40 subfertile men with mild or moderate varicocoele attending Al Jazeira Hospital [Abu Dhabi, U.A.E.] had previously been treated medically with no response. After correction of the varicocoele by high ligation and excision, there was a definite improvement of sperm motility, with an increase in the total count followed by 17 pregnancies after an average period of 11 months