Etecp cytology and EUS-FNA cytology in the diagnosis of malignant distal biliary and pancreatic duct strictures

Endoscopic retrograde cholangio-pancreatography [ERCP] with ductal brushings and pancreatic juice cytology is widely used in suspected pancreatic cancer, despite its low sensitivity. In contrast the accuracy rates of endoscopic ultrasound [EUS]-fine needle aspiration [FNA] for diagnosis of pancreatic malignancy is high. Aim of the study: To compare diagnostic performance of ERCP cytology [ERCP-C] with EUS-FNA in suspected patients with malignant pancreatic duct stricture. Patients and A prospective study included 56 patients with pancreatic duct stricture was performed. ERCP-C and EUS-FNA were carried out for cytopathological diagnosis. The final diagnosis was pancreatic malignancy in 60.7% patients and benign pancreatic disease in 39.3% patients. The sensitivity, specificity, positive [PPV] and negative [NPV] predictive values and accuracy of EUS-FNA for malignant pancreatic ductal stricture were 87.9%, 100%, 100%, 84.6% and 92.7, respectively. The sensitivity, specificity, PPV, NP V, and accuracy of ERCP brush cytology alone [41.4%, 100%, 100%, 55.3%, 66%, respectively], and combined with pancreatic juice cytology [48.3%, 100%, 100%, 58.3%, and 70%, respectively] were inferior to EUS-FNA. Significant dfferences between post ERCP-C and post-EUS-FNA pancreatitis were detected [P<0.001]. EUS-FNA is more sensitive and safer for cytopathological diagnosis of pancreatic duct stricture than ERCP-C

Antimutagenic activity of egyptian propolis and bee pollen water extracts against cisplatin-induced chromosomal abnormalities in bone marrow cells of mice

Bee-collected pollen and propolis are apicultural products which are recognized as a well balanced food. These beehive products are composed of nutritionally valuable substances and contain considerable amounts of polyphenol substances which may have several useful pharmacological properties. The protective activity of Bee-collected pollen [BPE] and water-soluble derivative of propolis [WSDPE] aqueous extracts was studied on cisplatin[CDDP] induced genotoxicity in male albino mice [Mus mascullus]. The treatment of mice with Bee-collected pollen and propolis extracts at doses 140 and 8.4 mg/kg body weight/day, respectively for 14 days synergistically with the intraperitoneal administration of cisplatin at dose of 2.8 mg/kg b.wt exhibited significant chemoprotective activity. Genotoxicity and cytotoxicity was evaluated by the bone marrow chromosomal aberration assay and mitotic index, respectively. WSDPE and BPE, alone did not significantly induce chromosomal aberrations confirming their non-mutagenic effects. While, the animals in groups five and six [G5 and G6], that were injected i.p. with CDDP alone for one week and then for the next 14 days these animals were given WSDPE and BPE in synergistic with i.p. injection of CDDP, exhibited a significant decrease in cytogenetic damages induced by CDDP in bone marrow cells. The anti-cytotoxicity effects of WSDPE and BPE were also evident, as observed by significant increase in mitotic index, when compared to positive control group [G2]. Thus, results of the present investigation revealed that WSDP and BPE have chemoprotective potential against CDDP induced genotoxicity in bone marrow cells of male albino mice. Also, the present investigation indicated that the chemoprotective frequency of BPE was much greater than WSDPE

Role of some mycotoxins in inducing kidney diseases in upper Egypt

Egypt has a climate that favors the growth of fungi specially those producing mycotoxins. Mycotoxins are found all over the world in human food and blood as well as in animal blood and tissues. The most threatening effects are their nephrotoxicity and carcinogenicity. The aim of this study was to identify the role of some mycotoxins namely; ochraloxin A [OTA] and fumonisin B[1] [FB1] in the occurrence of chronic renal disease of unknown aetiology in Upper Egypt. This study was carried out on 134 subjects who were classified as: 47 patients suffered from chronic renal failure of unknown aetiology before dialysis treatment [group A], 35 subjects who were relatives of patients in group A considering that they share them in the same environmental conditions [group B], 28 subjects working in the Middle Egypt Company [MEC] for grinding of cereals as an occupational risk group for exposure to inhalation of mycotoxins [group C] and 24 subjects with normal kidney functions as a control group. They exposed to a detailed history, their occupation, family history and kidney function tests. Indices of early kidney affection and levels of OTA and FB[1] in urine and serum for all subjects in all groups were also done. As regard group A, OTA was significantly increased while FBI was non-significantly increased in both serum and urine of patients compared to control group. There was positive correlation between the levels of OTA in both serum and urine versus the level of blood urea. It was found also that the patients with positive ochratoxicity had mild proteinuria. As regard group B, OTA and FB[1] were detected in urine and plasma, although with levels lower than that in group A but significantly higher than that of controls. As regard group C, OTA was found to be nearly equal to that in controls both in serum and urine which may indicate the low contamination levels of cereals in MEC due to good storage conditions. However, FB[1] was found in serum to be insignificantly higher than that in groups A and controls. Also FB[1] was detected in urine insignificantly lower than that in group A and insignificantly higher than that in controls. Although the results were statistically non significant but may indicate the increased risk of exposure to FB[1] in this group. We concluded that the presence of OTA and FB[1] in serum and urine of our control group may indicate the presence of these two mycotoxins as contaminants in the food in our locality. Also, these toxins may play a role in inducing chronic renal diseases in our locality. We advise a continuous follow up for all subjects exposed to these toxins, giving instructions about ways for protection and treatment as well as good storage for cereals and foods

Effect of increase in antioxidants supplementation on kidney tissue of mice subjected to fractionated dose of gamma-irradiation

Although there is little doubt that antioxidants are a necessary component for good health, no one knows if supplements should be taken and, if so, how much. To investigate the increase in antioxidants supplementation, a group of mice feeding on a diet containing 20% soybean was used as control group. The control group treated with 5% Nigella sativa and Antox drug [3 mg/mouse/day] either alone or in combination for 15 days. Another control group was treated with the same antioxidants and subjected to 1 Gy of gamma- irradiation x 5 times day after day. In kidney tissue the levels of malonaldehyde [MDA] and reduced glutathione [GSH] were estimated. Also, the histopathological changes were recorded. 5% Nigella sativa revealed a little decrease in MDA level and a highly significant decrease in GSH in kidney tissue while the exposure to fractionated dose of gamma-irradiation predicted a highly significant decrease in MDA and a highly significant increase in GSH level. Gastric intubations of Antox drug showed a highly significant increase in MDA and GSH levels in kidney tissue either alone or in addition to fractionated radiation exposure. Combined treatments of Nigella sativa and Antox drug showed a highly significant decrease in MDA level and a highly significant increase in GSH level in kidney tissue in comparison to the control group. Histopathological changes showed that treatment with 5% Nigella sativa and Antox drug either alone or in combination revealed toxic effect on kidney tissue. However, their treatments prior to radiation exposure showed ameliorating effect. Our findings indicated that we must use the antioxidants under control or under oxidative stress

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency

Some nutritional and clinicopathological studies in Japanese Quail exposed to a recently used pesticide [Copper oxychloride]

Thirty quails [80-100 g b. wt.] were divided into two groups to determine thenutritional and clinicopathological changes induced by 1% copper oxychloride. Blood samples were collected for determination of hemoglobin, PCV and somebiochemical blood parameters. Liver and kidney weight were increased and wereassociated with clinicopathological changes. Microbiological examination,revealed presence of Strept. pyogens, Klebsiella, Escherichia coli andanthracoids. A significant decrease in the value of Hb, PCV and iron wasdetected. There was significant increase in levels of ALT, AST, urea,creatinine, sodium, potassium, glucose, copper, cortisol hormone and insulinin treated groups in comparison with the control groups. Post-mortemexamination of scarified quails revealed hyperemia of internal organs [kidneyand liver]

Infectious etiologies of non-compressive myelopathy

This work was carried out to study various clinical presentations of myelopathy and clarify different suspected cord lesions. Twenty-nine males and nine females patients as well as ten age matched controls of both sex were chosen. All patients and controls were subjected for a set of laboratory investigation to verify different etiologies. About 47.4% of the cases had duration of illness less than three months and 36.8% had duration of illness more than six months. Over half of the patients were presented with a combination of motor, sensory and autonomic disturbance, while isolated motor affection was reported in 34.2% and about 55.3% of the studied cases had sensory level of hyposthesia [dorsal region in 34.2% and cervical region in 21.1%]. Serological and CSF laboratory studies revealed that most frequent organism was brucella [26.3%] especially among female patients, followed by bilharzia [15.8%]then toxoplasma and mycoplasma [10.5% for each] followed by cytomegalovirus [5.3%] and lastly infectious mono-nucleosis [2.6%]

clinicobiochemical approach to etiogenesis of immunocompromization in patients with chronic renal failure

Immunologic disturbance of T and B lymphocytes was reported in uremic patients. An approach to the etiology of such immunocompromization was made by determination of plasma adenosine deaminase [ADA], 5'-nucleotidase, IgG, zinc and vitamin B6 together with erythrocyte adenosine-5-phosphate deaminase [AMP], adenosine deaminase [ADA] and 5'-nucleotidase in 30 uremic patients before and after dialysis. The results were compared with their counterparts in 30 healthy controls which were age matched to patients. The results clarified that the immune disturbances in patients with uremia were multifactorial resulting from decreased ADA together with nutritional deficiency of zinc and vitamin B6. Therefore, supplement of these patients with deficient nutrients should be considered

Prevalence of symptomless proteinuria among school children in Assiut

In a trial to assess the prevalence of symptomless proteinuria among healthy rural and urban school children, 3029 subjects of both sexes, aged from 6-12 years were screened using sulphosalicylic acid method. The prevalence rate of proteinuria was 14.5%. It was significantly higher [P < 0.001] in subjects in rural than those in urban areas [16% versus 9.7%]. Within the groups of males, females, those > 8-10 and > 10-12 years of age there was a significant increase in the prevalence rate among chidren from rural areas. In addition, the prevalence rate was significantly increased with increasing age in rural areas. The highest rate was found among children aged > 10-12 years [21.3%] in rural and among those aged 6-8 years [11.8%] in urban areas. However, no significant differences were observed between males and females of the two communities. The prevalence rates of microscopic haematuria and positive urine for schistosoma ova among proteinuric children were significantly higher among subjects in rural than in those in urban areas and within groups of males and females of rural than of urban but no significant differences between both sexes of the two communities. We recommend routine urine analysis annually for all school children and further investigating those with proteinuria

Hepatitis B virus and HIV infection among hemodialysis patients and staff in Assiut renal dialysis units

Screening of 312 patients with chronic renal failure on regular hemodialysis and 64 staff members caring for them in three hemodialysis centers in Assiut for hepatitis B surface antigen [HbsAg], anti-hepatitis B core [anti-HBc] and antihuman immunodeficiency virus [anti-HIV] was done over a period of 2 years [1989 and 1990] by ELISA technique. HBs Ag was detected in 24 [7.69%] patients and anti-HBc in 59 [18.91%] patients, while 18 [5.76%] patients showed both markers. The prevalence of HbsAg was significantly related to the duration of hemodialysis but neither to the number of transfused blood units nor to the age of the patient. In staff members, HBs Ag was detected in 5 [7.81%], anti-HBc in 9 [14.06%] and both markers in 2 [3.13%]. High percentage [15.79%] of HbsAg was found among physicians and those with duration of employment over one year although the differences were statistically insignificant. We have found two seropositive cases for anti-HIV among hemodialysis patients by ELISA technique, but only one of them was positive by the confirmatory Western blot test. In staff members, no single positive case was detected. HBV and HIV infection are major problems in hemodialysis centers, thus infection control precaultions must be done

HLA system in schistosomal and non-schistosomal nephrotic syndrome

The human leucocyte antign [HLA] phenotypes [HLA, A-A, -B and -C antigens] were typed in 62 Upper Egyptian nephrotic patients and the results were compared with 400 ethnically similar normal controls. Patients were classified into 2 clinicopathological groups. Group I of 24 schistosoma hematobium associated nephrotics and group II of 38 non schistosomal nephrotic patients. Schistosoma-associated nephrotic patients showed significant association with HLA-A9, -B15 and CW3, while non schistosomal nephrotic patients showed significant association with HLA-A9, -B5, -B27 and CW3 in comparison with the control group. Nephrotic patients showed significant association with the haplotypes A9 CW3, B5 CW3 and B27 CW3 when compared to the control group. Also we found a significant linkage disequilibrium between HLA-CW3 and - HLA-A9, B5 and B-27 in the control group. We suggest that HLA-CW3 is the genuine antigen associated with nephrotic syndrome in Upper Egypt, and the associated increase in HLA-A9, -B5 and -B27 was due to their linkage disequilibrium with HLA-CW3

effect of hemodialysis on some acute phase proteins

The acute phase proteins, c-reactive protein [CRP], Alpha-antitrypsin [AAT], complement 3 [C3] and fibrinogen were studied in 35 patients with chronic renal failure [CRF] after 1,6 and 12 months of regular hemodialysis [RHD] and also in 15 healthy subjects age and sex matched for comparison. Estimation of serum CEP was done by ELISA technique. Serum AAT, serum C3 and plasma fibrinogen were performed by immunodiffusion technique. Serum CRP levels after 1,6 and 12 Ms of RHD were significantly elevated compared to control. Furthermore, serum levels revealed significant increase when comparing 6 Ms to IM and 12 Ms to 6 Ms of RHD. Serum AAT was significantly elevated after 1 M and RHD compared to control. The serum levels gradually decreased after 6 and 12 Ms of RHD but still insignificantly higher than the controls values. Comparing 6 and 12 Ms with 1 M significant decrease is found. Serum levels of C3 showed significant reduction after 1, 6 and 12 Ms of RHD compared to controls and also when comparing 6 Ms to 1 M of RHD. No significant difference was found between 1 M and 12 Ms of RHD. Plasma fibrinogen was significantly elevated after 1 and 6 Ms of RHD but no significant difference after 12 Ms of RHD as compared to controls. The plasma levels revealed significant reduction when comparing 6 Ms to 1 m and 1 Ms to 6 Ms of RHD

Diagnostic value of ultrasonography in chronic renal failure

Seventy patients [140 kidneys] with chronic renal failure were studied. Sonographic examination of these kidneys revealed, 101 of them were small medically diseased, 27 were enlarged hydronephrotic kidneys, 4 showed pyohyrdronephrosis, another 4 were polycystic kidneys and two kidneys were pyonephritic. Two kidneys could not be visualized by plain X-ray, ultrasonography or by intravenous pyelography

Autoreactive lymphocytotoxic antibodies in sensitised ureamic patients

We have studied 60 end stage renal disease patients, their age ranged between 2040 years. The sera of these patients were screened for the presence of lymphocytotoxic antidodies against peripheral blood lymphocytes of a random cell panel. Lymohocytotoxic antibodies were demonstrated in 25 patients [40%]. Those patient, with positive lymphocytotoxic antibodies were divided into groups. Those who undergoing maintenance heamodialysis and have recieved several blood transfusion [Group A].Those who have diagnosed for the first time and have not recieved blood [Group B]. The serum of those patients which were reactive with 30-100% of the above cell panel were then tested against autologous peripheral blood lymphocytes for detection of autoreactive lymphocytotoxic antibodies [AlcAs]. Autoreactive antibodies were detected in 50% of patients of group A and 18.8% of group B