Haploidentical stem cell transplantation

The feasibility of stem cell transplantation across the major histocompatibility [MHC] barrier-as in haploidentical stem cell transplantation [SCT]-has been proved for some time in several studies. The main limitations include a higher graft failure rate, delayed immune reconstitution after transplantation with high rates of life-threatening infections, a higher incidence of post-transplant lymphoproliferative disease [PTLPD], and severe acute and chronic graft-versus-host disease [GVHD]. In an attempt to reduce the transplant-related morbidity/mortality, several techniques had been evaluated involving conditioning regimen intensity, graft engineering, post-transplant cellular therapy and immunosuppression. This review will describe the current situation. It will also discuss initiatives and strategies to overcome the limitations associated with transplant across the MHC barrier

effect of oral testosterone undecanoate replacement therapy used in treating hypogonadal men on the development of prostate cancer

Objective: To evaluate the effect of oral testosterone undecanoate replacement therapy on the development of prostatic cancer in hypogonadal men of the fifth, sixth, and seventh decades

Patients and Methods: From September 2002 to September 2007, 172 hypogonadal men [44 of the fifth, 60 of the sixth, and 68 of the seventh decade] were treated with oral testosterone undecanoate at the outpatient departments of Urology and Dermatology, Andrology, and Sexually Transmitted Diseases of Alnoor Specialist Hospital, The Holy Makkah, Kingdom of Saudi Arabia. Before starting treatment and every 6 months during the treatment period, all patients underwent routine laboratory investigations in addition to total serum testosterone level. Serum prolactin level was measured only before treatment. They were also evaluated by digital rectal examination [DRE], total prostatic specific antigen [PSA], and transrectal ultrasound [TRUS] of the prostate to exclude prostatic cancer and BPH [with lower urinary tract symptoms, LUTS]. Prostatic biopsy was done in selected cases. Comparative statistical analysis of pretreatment and posttreatment results was done

Results: The mean change of PSA values was insignificant and no patient developed clinical prostatic cancer. However, one patient with evident PSA level change was diagnosed as prostatic intraductal neoplasia [PIN] on prostatic biopsy. In addition, significant prostatic volume mean change of 34.9% +/- 5% was reported. LUTS were encountered in 4 patients

Conclusions: From the current study, it could be concluded that oral testosterone undecanoate replacement therapy does not increase the risk of prostate cancer in selected patients, but may increase prostatic volume or increase the incidence of benign prostatic hyperplasia manifestations

Aminoglycoside ototoxicity and antioxidant protection

Sensory hair cells are mechanotransducers of the inner ear that are essential for hearing. The normal function and integrity of hair cells may be altered by endogenous factors such as liberation of free radicals during normal cellular functions or environmental factors as ototoxic drugs. Aminoglycosides are commonly used antibiotics combination with high efficacy and low cost, they are the antibiotics of choice in developing countries. Although highly efficacious, their use is limited due to their severe toxicity to the inner ear. It is well established that reactive oxygen species are generated in hair cells exposed to aminoglycoside. So, enhancing antioxidant levels promotes hair cell survival while preserving function. Thirty healthy adult guinea pigs used in this study were divided into three groups, control, and tow experimental groups. Group [A] animals received antioxidant treatment one week prior to and concomitant with one week of gentamicine treatment. Group [B] animals received gentamicine by intramuscular injection for one week and control group received oral and intramuscular saline instead of drugs. A joined formula of dietary antioxidants was used. Mitochondrial activity was used as an index for cellular vitality and activity in organ of Corti cells. There was a highly significant [p<0.0001] mitochondrial activity in organ of Corti cells with group A animals. On the other hand mitochondria1 activity was significantly lower in organ of Corti cells of group B animals [p> 0.05] compared to group A and control group. In conclusion the results of this study suggest that, the introduction of free radical scavengers might help to ameliorate and protect against aminoglycoside ototoxicity, as free radicals play an important role in gentamicine ototoxicity

Epidemiological and clinical study of Kawasaki disease in a tertiary hospital in Makkah

This study involved 36 Kawasaki Disease patients diagnosed during the period from September 2000 to August 2004 at Al-Noor Specialist Hospital, Holy Makkah. Collected data included clinical features, laboratory results, echocardiogram findings, treatment, complications, and outcome. The average of 9 patients were diagnosed yearly, their age ranged from 6 months to 11 years and male to female ratio was 3.5:1. The clinical presentations were fever, skin rash and oral mucosa abnormalities [100%], desquamation of finger tips [88%], edema of palms and soles [77%], conjunctivitis [66%], and cervical lymphadenopathy [58%]. Seventy eight percent of cases presented in the summer and spring. Laboratory data showed leucocytosis, thrombocytosis, and high ESR. Echocardiography showed left coronary artery dilatation in 15 patients [42%], 10 of them [28%] had also right coronary artery dilatation. Coronary artery lesions had regressed in 11 cases [31%], while 4 patients [11%] progressed to giant aneurysms. Intravenous immunoglobulins [IVIGs] and aspirin were given. Neither cardiac dysfunction, nor valvular affection was observed; also, no recurrence and none died. In conclusions; although Kawasaki disease is a rare disease, 36 cases were diagnosed in Holy Makkah in 4 years, 4 of them progressed to giant coronary artery aneurysms. Increased awareness of the disease could help in early diagnosis and treatment and lower the rate of complications

Egyptian coronary arteries: are they small?

Coronary size is one of the factors influencing the outcome of coronary interventions. This study was planned to screen main coronary arteries size in Egyptians in order to prove or disprove that Egyptians have small coronary arteries and to compare them to other races. 524 patients referred for coronary angiography were included in this study with no proximal local atheroma, spasm complete obstruction, stenosis nor multiple stenosis in the same vessel. Patients were divided into 3 age groups and were subjected to QCA for determination of the diameters of different segments of each coronary artery. The reference vessel diameter and cross sectional area were calculated for each, artery. In our study the influence of age, sex, hypertension [HTN] diabetes mellitus [DM], dyslipidemia and body surface area on coronary artery size were variable. The left main diameter was influenced by NTN, DM. and smoking; the left anterior descending diameter big age, HTN, and sex; the left circumflex diameter by age and RCA diameter by age and DM. Comparing our results to other races in different studies, we found the same range of Egyptian coronary artery size as other Caucasians, larger than Indo-Asians and comparable to the Americans. So, we concluded that Egyptians have large coronary arteries not small ones as we had expected

Exercise electrocardiogram in asymptomatic middle-aged Egyptian smokers

50 asymptomatic middle-aged smokers and 15 non-smokers [as a control group] were included in our work. All were males, and their ages ranged from 35 to 55 years with a mean of 42 +/- 6.52 years for the smokers and of 42.3 +/- 6.36 years for the non-smokers. All our subject were free of any suspicion of being cardiac patients. All were subjected to careful history taking including detailed smoking history, thorough physical examination, resting surface ECG and exercise testing using the electric bicycle ergometer. Our results were analysed using the [Chi-square] and the mean [t] student tests. In our study, the relative body weight was significantly lower [P<0.05] in smokers with an inverse relation between it and the smoking rate and duration. The prevalence of latent ischaemia was 6% in smokers and 0% in non-smokers. The incidence of exercise induced arrhythmia was also higher in smokers with a significant difference [P<0.05] achieved only by those consuming >40 cig./day. Smokers consuming >40 cig./day and those with smoking duration >20 years acheived maximal exercise systolic BP which was significantly higher [P<0.05] then, non-smokers. Also, smokers with more than 40 cigarettes smoked per day showed a significantly lower exercise duration than non-smokers [P<0.05]. Our results prove that cigarette smoking is deleterious to CVS, and this is more pronounced in heavy smokers. Using only ST segment depression as a criterion for abnormal ECG response, the incidence of latent ischaemia was 6% and 0% for smokers and non-smokers respectively. Thus, it is clear that exercise ECG test is not an appropriate "screening" test for asymptomatic subjects, especially those without CAD risk factors

Analysis of QT interval in patients with mitral valve prolapse

20 patients with mitral valve prolapse were subjected to full clinical examination, 12 lead electrocardiogram [speed 25 mm/sec] followed by a rhythm strip on lead II or V4-V6, echocardiographic examination including doppler study and 24-hours ambulatory Holler monitoring. Twenty normal age and sex matched to the individuals with no cardiac complaints were subjected to the above mentioned investigations except echocardiographic examination which was not done in all the patients. In both groups both the mean and maximum QT intervals were measured and corrected using the formula derived from Bazelt by dividing the measured QT interval by the square root of the corresponding R-R interval. The aim of this study was to determine the relation between the abnormalities of the QT interval and the occurrence of arrhythmias. In this study it was found that the incidence of QT prolongation in patients with MVP varied between 20% by using the mean QT interval and 70% with the maximum QT interval. Higher incidence of arrhythmias were found in patients with MVP in whom the maximum QT interval were prolonged compared with those with normal maximum QT interval. Also we found a trend toward longer QT intervals and higher heart rates in patients with MVP