Diabetic foot syndrome: a relevant growth factor

The role of different growth factors in both micro and macroangiopathic complications of diabetes had not been explored enough. One of the most relevant growth factor in diabetic foot syndrome patients [DFU] is the vascular endothelial growth factor [VEGF]. Some therapeutic trials has been started based on the hypothesis that administration of VEGF will lead to stimulation of angiogenesis and increased collaterals both in peripheral arterial disease [PAD] and coronary artery disease [CAD] specially in inoperable patients. To study plasma VEOF levels in diabetic patients and its relation to PAD in the different subtype of Diabetic foot ulcer whether isehemic, neuropathic or neuroischemic. Sixty nine patients with type 2 diabetes were recruited into this study; 38 had DFU and 31 patients without foot ulceration [diabetic group], together with 24 healthy subjects of matched age and sex as a control group.Ankle brachial pressure was assessed by Doppler ultrasound. The diagnosis of peripheral neuropathy was based on complete neurological assessment of both lower limbs with special stress on pressure perception evaluated by using 10 gram monnfllament [5.07 SW monofilament]. Angiography examination of lower limb vessels was done. Plasma level of VEGF was estimated. Serum VEOF was significantly increased in DFIJ patients and in patients with ischemic ulcers. The increase was more pronounced in latter than the former group. The elevated plasma VEOF levels are unlikely to be explained by other confounding variables such as variability in metabolic control, concomitant retinopathy or increased urinary albumin excretion. Whether the high plasma levels of VEGF could affect clinical outcome or have an impact on response to therapy as it is the case in patients with acute coronary syndrome will definitely merit further studies

Oral prednisolone or dexamethasone, which one to be prefered for preventing relapse of acute asthma exacerbations in childhood?

In this prospective, randomized, clinical trial, 68 asthmatic patients, between 6 and 12 years were followed-up for 2 weeks after their acute exacerbation had been stabilized by the standard acute asthma treatment protocol. They were assigned to receive either 2 mg / kg / day of prednisolone divided on 3 doses for 5 days [PRED group], or 0.5 mg / kg / day of dexamethasone as a single morning dose for 3 days [DEX group]. The primary outcome measure was the rate of relapse within the follow-up period assessed by a Peak Expiratory Flow Rate [PEFR] < 70% of the predicted value, and a clinical asthma severity score more than 3. The secondary outcome measures included persistence of symptoms, quality of life, medication use, and adverse effects. There was no significant difference in relapse rates between the two groups [13.3% For PRED group and 15.2% for DEX group, P= 0.87].Compliance to medication was significantly higher in DEX group compared with PRED group[P= 0.04], and more children vomited their medication in the PRED group than in DEX group, but the difference was non-significant [P=0.32]. There was no significant difference between the two groups in the prevalence of persistent symptoms, quality of life, or adverse effects other than vomiting at the time of follow - up [P< 0.05]. We concluded that dexamethasone was as effective as prednisolone, with better compliance and less adverse effects, for preventing relapse of acute asthma exacerbations in childhood

Risk of adrenal suppression and posterior subcapstilar cataract in asthmatic children on inhaled corticosteroids

To investigate some of the expected side effects of corticosteroid therapy, 20 asthmatic children on low dose Belcomethasone dipropionate [BDP] [<400 micro g / day] and another 20 asthmatic children on high dose BDP [= or > 400 micro g / day] were enrolled in this study. They have been compared with 20 asthmatic children who have never been treated with inhaled corticosteroids. Only high doses of inhaled corticosteroids caused significant reduction of 24 hours urinary cortisol excretion. [P<0.01]. Asthmatic children who used BDP directly through Metered Jose inhaler [MDI] showed more suppression of the adrenal function than those who received it by spacers. Posterior subcapsular cataract [PSC] was not detected in any of the patients

Some predictors of variceal bleeding in patients with bilharzial hepatic fibrosis

This work was conducted on 35 patients with schistosomal periportal fibrosis and portal hypertension compared with 10 healthy controls to search for some risk factors associated with variceal bleeding such as endoscopic findings, some vasodilator humoral agents in addition to echo-Doppler flowmetry findings. Full clinical examination and routine laboratory investigations were done. Humoral vasodilators included glucagon, enkephalin and prostaglandin E2 [PGE2]. Upper gastrointestinal endoscopy and echo-Doppler duplex study were done to all cases for evaluation of portal venous hemodynamics, superior mesenteric artery dilatation and coronary vein visualization and/or dilatation. Results showed a biochemical profile of hyperglucagonemia is usually associated with a higher portal pressure, larger variceal diameter and a hyperdynamic splanchnic state and if associated with high enkephalin level, there will be a higher chance of bleeding

Manometric evaluation of continence after surgery for imperforate anus

Functional results after surgical correction of anorectal anomalies were assessed in 45 patients clinically and manometrically, in addition to 5 control children. The clinical assessment followed Kelly score. Continent patients had marked high pressure zones. Thus, anorectal pressure profile was found to correlate well with continence. Patients with high anomalies had lower pressure zones whatever the operation done if compared to patients with intermediate or low anomalies yet the results varied according to the operation done. Manometry was compared to defecography and was found to be more accurate