Assessment of humoral immune response to different COVID-19 vaccines in patients undergoing maintenance hemodialysis / Avaliação da resposta imune humoral a diferentes vacinas contra a COVID-19 em pacientes submetidos à hemodiálise de manutenção

ABSTRACT Introduction: The immune response to different Coronavirus Disease 2019 (COVID-19) vaccines is under-investigated in end-stage kidney disease (ESKD) patients, especially in the Middle East and North Africa. We carried out this research to estimate the effectiveness of COVID-19 immunization in ESKD patients on regular hemodialysis (HD). Methods: In this prospective observational study, we enrolled 60 ESKD patients on regular HD who had completed COVID-19 vaccination and 30 vaccinated healthy participants. Serum levels of severe acute respiratory syndrome coronavirus 2 immunoglobulin G (SARS-COV2 IgG) were quantified 1 month after completing the vaccination schedule, and all participants were followed up from October 2021 to March 2022. The vaccines used in the study were from Pfizer-BioNTech, AstraZeneca, and Sinopharm. Results: The median level of SARS-COV2 IgG was lower in HD patients than in healthy participants (p < 0.001). Regarding the type of COVID-19 vaccination, there was no statistical difference in SARS-COV2 IgG levels among HD patients. During the observation period, none of the HD patients had COVID-19. Conclusion: COVID-19 vaccination appeared to be protective in HD patients for 6 months and the side effects of vaccines were tolerable.

RESUMO Introdução: A resposta imune a diferentes vacinas contra a doença do coronavírus 2019 (COVID-19) é pouco investigada em pacientes com doença renal em estágio terminal (DRET), especialmente no Oriente Médio e norte da África. Realizamos esta pesquisa para estimar a eficácia da imunização contra a COVID-19 em pacientes com DRET em hemodiálise regular (HD). Métodos: Nesse estudo observacional prospectivo, inscrevemos 60 pacientes com DRET em HD regular que haviam concluído o esquema de vacinação contra a COVID-19 e 30 participantes saudáveis vacinados. Os níveis séricos de imunoglobulina G da síndrome respiratória aguda grave do coronavírus 2 (SARS-COV2 IgG) foram quantificados um mês após a conclusão do esquema vacinal, e todos os participantes foram acompanhados de outubro de 2021 a março de 2022. As vacinas utilizadas no estudo eram da Pfizer-BioNTech, AstraZeneca e Sinopharm. Resultados: O nível mediano de SARS-COV2 IgG foi menor em pacientes em HD do que em participantes saudáveis (p < 0,001). Com relação ao tipo de vacinação contra a COVID-19, não houve diferença estatística nos níveis de SARS-COV2 IgG entre pacientes em HD. Durante o período de observação, nenhum dos pacientes em HD teve COVID-19. Conclusão: A vacinação contra a COVID-19 pareceu ser eficaz na proteção de pacientes em HD por 6 meses e os efeitos colaterais das vacinas foram toleráveis.

Perinatal N(G)-Nitro-L-arginine methyl ester administration decreases anxiety- and depression-like behaviors in adult mice

ABSTRACT Objective: We hypothesized that perinatal manipulations of the nitrergic system would affect adult animal behaviors. Methods: We tested this hypothesis by perinatally administering N(G)-Nitro-L-arginine methyl ester (L-NAME), a non-specific antagonist of nitric oxide synthase for 15 days and assessed anxiety- and depression-like behaviors in adult mice. At 70 days of age, the mice were subjected to a battery of tests consisting of the open-field, light/dark box, forced swim, and tail-flick tests. The tests were performed at two-day intervals, and the order of the tests within the battery was determined according to the progressive invasiveness degree. Results: L-NAME-treated animals exhibited decreased anxiety-like behavior in the light/dark box and open field tests, with no change in locomotor activity. Additionally, they demonstrated decreased depression-like behavior in the forced swim test and no change in pain perception in the tail-flick test. Conclusion: The nitrergic system is possibly involved in neural circuitry development that regulates behaviors since blocking perinatal nitric oxide production decreases anxiety- and depression-like behaviors in adult mice.

Hepatitis C-related membranoproliferative glomerulonephritis in the era of direct antiviral agents / Glomerulonefrite membranoproliferativa relacionada à hepatite C na era dos agentes antivirais diretos

Abstract Membranoproliferative glomerulonephritis (MPGN) is the most typical Hepatitis C virus (HCV)-associated glomerulopathy, and the available data about the utilization of direct-acting antivirals (DAA) in HCV-associated glomerulonephritis is inadequate. We evaluated the renal and viral response in two cases of HCV-related MPGN; the first caused by cryoglobulinemia while the second was cryoglobulin-negative. Both patients received immunosuppression besides DAA in different regimens. They achieved partial remission but remained immunosuppression-dependent for more than 6 months after DAA despite sustained virological response, which enabled safer but incomplete immunosuppression withdrawal. Both patients were tested for occult HCV in peripheral blood mononuclear cells and found to be negative. Hence, the treatment of HCV-related MPGN ought to be according to the clinical condition and the effects of drug therapy. It is important to consider that renal response can lag behind the virological response.

Resumo A glomerulonefrite membranoproliferativa (GNMP) é a glomerulopatia associada ao vírus mais típico da hepatite C (HCV), e os dados disponíveis sobre a utilização de antivirais de ação direta (AAD) na glomerulonefrite associada ao HCV são inadequados. Avaliamos a resposta renal e viral em dois casos de GNMP relacionados ao HCV; o primeiro causado por crioglobulinemia, enquanto o segundo era negativo para crioglobulina. Ambos os pacientes receberam imunossupressão além de AAD em diferentes esquemas terapêuticos. Eles alcançaram remissão parcial, mas permaneceram dependentes da imunossupressão por mais de 6 meses após os AAD, apesar da resposta virológica sustentada, que permitiu a retirada da imunossupressão mais segura, mas incompleta. Ambos os pacientes foram testados para HCV oculto em células mononucleares do sangue periférico e deram resultados negativos. Portanto, o tratamento do GNMP relacionado ao VHC deve ser de acordo com a condição clínica e os efeitos da terapia medicamentosa. É importante considerar que a resposta renal pode ficar aquém da resposta virológica.

Comparative study of root resorption between two methods for accelerated orthodontic tooth movement

Objective: the aim of this study was to assess apical root resorption (RR) following the application of micro-osteoperforation (MOP) and piezocision (PzC) assisted orthodontics for the acceleration of tooth movement (TM). materials and methods: a total number of 16 patients seeking orthodontic therapy were included in this study. all patients had undergone 1st premolars extraction and were indicated for canine retraction. these patients were divided into two groups; one was treated using MOP in one side while the other side served as control. in the other group PzC was performed in one side with no intervention done on the other side. cone-beam computed tomography (CBCT) scans were obtained for every patient before and after canine retraction in order to evaluate amount of RR. results: in the MOP group, there was no significant difference in canine root length between experimental and control sides. whereas, in the PzC group, there was a statistically significant decrease in root length in the experimental side compared with the control side. when comparing both groups, the experimental PzC side showed a statistically significant decrease in root length compared to experimental MOP side postoperatively. conclusion: experimental PzC showed statistically significant decreases in canine root length compared to both experimental MOP and control side after canine retraction.

Fetal renal volume and renal artery doppler in normal and intrauterine growth restricted fetuses

Objective: To evaluate the difference between fetal renal artery Doppler and fetal kidney volume in normal and intrauterine growth restricted fetuses

Design: A prospective cross sectional study

Setting: Obstetrics and Gynecology department, Al-Azhar University

Sample: One hundred pregnant women, 50 with normal fetal growth parameter, and 50 with restricted fetal growth

Methods: Fetal renal volume was measured using 3-dimensional ultrasound. Umbilical artery and fetal renal artery Doppler indices were examined

Main outcome measures: Correlation of Doppler parameter to fetal kidney volume, and association of fetal biometric indices to combined fetal kidney volume

Results: Combined fetal renal volume was significantly reduced in growth restricted fetuses than in normally grown fetuses as the Mean of combined renal volume in IUGR was [21.0 +/- 0.1] while in normal fetuses was [31.24 +/- 2.31]. All fetal biometric indices were positively associated with combined kidney volume. Concerning the umbilical artery Doppler and fetal renal artery Doppler there was significantly difference between the two groups as the intrauterine growth restricted fetuses have a high Doppler

Conclusion: Intrauterine growth restriction appears to be associated with a statistically significant decrease in the renal volume than the normally growth fetuses. The renal artery Doppler shows also significant difference between the two groups, which matches with other studies. This study supports the hypothesis that intrauterine growth restriction may be linked to renal disease and hypertension in late life and renal volume can be used as a parameter for diagnosis of IUGR

use of single versus double dose of intra-vaginal prostaglandin E[2] "misoprostol" prior to abdominal myomectomy: a randomized controlled clinical trial

The study aimed to investigate the effectiveness of a single versus double dose of prostaglandin E[2] "misoprostol, 400 microgram" prior to myomectomy for multiple uterine fibroids. This was a prospective randomized controlled trial comprised of 69 patients with multiple myomas undergoing myomectomy. Patients received either an intra-vaginal single dose of 400 microgram misoprostol 1 hr pre-operatively [group A, 34 cases] or 2 doses, 3 and 1 hr prior to surgery [group B, 35 cases]. Operation time, intra and post-operative blood loss, hemoglobin concentration, blood pressure and body's temperature were estimated and compared in both groups. The data were statistically analyzed using chi-square test. The p<0.05 was considered significant. In group B, the mean operative time was significantly [p<0.001] shorter than in group A [25.8 +/- 4.14 vs. 35.4 +/- 5.6 min respectively]. The mean value for operative blood loss was significantly [p<0.001] smaller in group B [101.4 +/- 25.5 vs. 200.16 +/- 18.8 ml]. There was a significant [p<0.01] rise of the body temperature in group B [38.5 +/- 0.7 vs. 37.18 +/- 0.84°C]. There were no differences between the two groups regarding hemoglobin levels, post-operative febrile morbidity or length of hospital stay. In this study, two doses of pre-operative intra-vaginal misoprostol were more effective than one dose in reducing intra and post-operative blood loss and shortening of operation time during abdominal myomectomy

Laparoscopic cholecystectomy as a day surgery procedure: is it safe?-an Egyptian experience

Major surgery performed as a day surgery procedure is not uncommon. The aim of this study is to evaluate the feasibility of day surgery procedures in laparoscopic cholecystectomy [LC]. A total of 210 patients scheduled for elective LC between 2006 and 2008 were included in our study. The mean age was 40.63 years [range, 25 - 70 years]. The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography without clinical or radiological evidence of acute cholecystitis. All patients were informed about the same-day discharge policy and received the postoperative instruction form on discharge. Preoperative work-up included history taking and physical examination in addition to standard laboratory and radiological tests. Patients above 35 years of age had an ECG done. All patients were examined in the outpatient clinic by a consultant anesthesiologist the night before surgery. Operative time, hospital stay, and complications were recorded. Telephonic feedback, on the morning after surgery was routinely done as an early follow-up. Out of the total number of patients, 140 patients were ASA [I] and 70 were ASA [II] [40 patients were controlled hypertensives and 30 were controlled diabetics]. Conversion rate was 1.4%. The mean hospital stay was 6.7 hours [range, 6-8 hours]. The mean operative time was 31.2 minutes [range, 20 - 60 minutes]. None of the patients required an abdominal drain. No morbidities or mortalities were reported in this series. LC may be done as a day surgery procedure with optimal patient satisfaction and without complications

Paraumbilical hernia repair during cesarean delivery

Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum complications, hospital stay, hernia recurrence, and patient satisfaction. The combined procedure took significantly longer than cesarean delivery alone [75.2 minutes versus 60.5 minutes, P < .001]]. There were no major complications. Wound infection occurred in 6 patients [4.1%]. Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two patients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months [range, 6-36 months]. All hernia patients reported that they preferred the combined operation. Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single incision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted

pattern of pulmonary tuberculosis in Damanhour Chest Hospital over the period 2005-2007

The study of the pattern of pulmonary Tuberculosis [T.B] during the three years 2005-2007 in Damanhour Chest Hospital [D.C.H] revealed the following: Out of 10332 attendants examined by mass miniature radiography [M.M.R] there were 471 [4.5%] cases were suspected to have pulmonary T.B .436 patients [4.7%] out of 471 were having bronchogenic T.B and only 35 [0.3%] were having pleural effusion. Sputum analysis revealed 291 [66.5%] were positive sputum for acid fast bacilli [A.F.B] and 145 [33.5%] were sputum negative for [A.F.B]. Bronchogenic pulmonary T.B cases were classified radiologically as unilateral lesion in 430 patients [98.64%], and only 6 patients [1.3%] as bilateral pulmonary T.B. All the extra pulmonary T.B cases were pleural effusion. The commonest age incidence for the pulmonary T.B was in the age group 16-30 years [200 patients 42.4%] from total number 471 suspected cases. The study of the epidemiological pattern for T.B inpatients presented in the hospital during the study revealed that T.B was more prevalent among males age group [16-30] years, lower level of education, farmers sailers and labourers most of them were smoker especially Goza. The comparative study between these three years 2005-2007 there was a decrease in total number of tuberculous patients 7.3%, 4% and 3.1% respectively .Also this study showed that males 312 [71.5%] were more prone to T.B infection than the females

Paraumbilical hernia repair during caesarean section; maternal and neonatal outcome

A prospective study to evaluate the outcome of combined cesarean section and paraumblical hernia repair in tertiary referral university hospital. Patients and methods: 48 patients undergoing Cesarean section combined with paraumbilical hernia repair versus 100 patients undergoing cesarean section alone. Main Outcome Measures: Operation time, Apgar Score, blood loss, uterine atony, breast feeding initiation, pain sensation, periparturn complications, prolonged lochia [more than 42 days], deep venous thrombosis, hospital stay, hernia recurrence, and patient choice. The combined procedure consumed significantly longer time than cesarean section alone in the mesh hernioplasty subgroup. There were no major complications. Apgar Score, uterine atony, initiation of breastfeeding, prolonged tochia, wound infection and hospital stay did not differ significantly from those of controls. Pain at hernia site repair in two patients, one hernia recurred in the primary repair subgroup during follow up period which reach up to 3 years. All hernia group patients reported that they prefere the combined operation. Combined cesarean section and paraumbilical hernia repair had the advantage of single incision, single anesthesia, and single hospital stay. The combination approach proved to be safe, effective, and well accepted

Treatment of subglottic stenosis with CO2 laser excision and topical application of mitomycin C

Twenty patients were gathered from El Menoufiya university hospital with subglottic stenosis caused by laryngoscleroma. The patients were divided into two groups group [A] and [B] .Patients were treated by CO2 laser excision of subglottic stenosis and topical application of mitomycin C high concentration 10 mg/ml group [A] and low concentration 0.4 mg/ml group [B]. seven patients in group [A] and six patients in group [B] get improved after single surgical procedure. One patient in each group get impoved after two surgical procedures. Two patients in group [A] and three patients in group [B] undergone three surgical procedures with no improvement

Nocturnal enuresis in children with adenotonsillar upper airway obstruction

Adenotonsillar hypertrophy is the most common cause of sleep related upper airway obstruction [UAO] in childhood. Recently there is growing consensus that upper airway obstruction is a causative factor in nocturnal enuresis [NE] in many cases .So the aim of this study was to determine the relationship between nocturnal enuresis and upper airway obstruction caused by chronic adenotonsillar hypertrophy in children and the value of their surgical treatment, One hundred children suffering from symptoms of upper airway obstruction [UAO] caused by adenotonsillar hypertrophy were included in this study and divided into two groups 24 with enuresis and 76 without enuresis, Patients with organic neurological or urological causes of NE were excluded. During sleep, at the night of the day before the operation, one month and three months after the operation; arterial blood gases were measured using the Blood Gas Analyzer. Follow up was done through parental questionnaire about the degree of improvement of NE before and after surgery at first, third and sixth months after the surgery. Blood gas analysis in patients with and without NE revealed: Decrease O2 and increase CO2 saturations that were more in the group with NE. It was found that there were significant statistical improvements in the PaO2 and decrease in the PaCO2 after the operation in both groups That were also more in the group with NE. There were no significant differences between patients with or without NE as regard to 02 saturation, PaO2 and PaCO2 before and after the operation [P>.005]. Parental questionnaire in patients with NE revealed complete cure in 58.6%, 16.7% had partial improvements while no improvements in 25%. So in Conclusion the authors suggest that UAO is probably a more common etiologic factor in NE than previously recognized and appropriate number of cases improved after adenoidectomy and or tonsillectomy

Adenotonsillar upper airway obstruction and nocturnal enuresis in children

Adenotonsillar hypertrophy is the most common cause of sleep related upper airway obstruction [UAO] in childhood. Recently there is growing consensus that upper airway obstruction is a causative factor in nocturnal enuresis [NE] in many cases. So the aim of this study was to determine the relationship between nocturnal enuresis and upper airway obstruction caused by chronic adenotonsillar hypertrophy in children. Also to evaluate the effect of surgery on enuretic patients with UAO caused by adenotonsilar hypertrophy. One hundred children suffering from symptoms of upper airway obstruction [UAO] caused by adenotonsillar hypertrophy were included in this study and divided into two groups 24 with enuresis and 76 without enuresis. Patients with organic neurological or urological causes of NE were excluded. During sleep, at the night of the day before the operation, one month and three months after the operation; arterial blood gases were measured using the Blood Gas Analyzer. Follow up was done through parental questionnaire about the degree of improvement of NE before and after surgery at first, third and sixth months after the surgery. Blood gas analysis in patients with and without NE revealed: Decrease O2 and increase CO2 saturations that were more in the group with NE. It was found that there were significant statistical improvements in the PaO2 and a significant decrease in the PaCO2 after the operation in both groups that were also more in the group with NE. There were no significant differences between patients with or without NE as regard to O2 saturation, PaO2 and PaCO2 before and after the operation [P>.005]. Parental questionnaire in patients with NE revealed complete cure in 58.6%, 16.7% had partial improvements while no improvements in 25%. So in Conclusion the authors suggest that UAO is probably a more common etiologic factor in NE than previously recognized and appropriate number of cases improved after adenoidectomy and or tonsillectomy

use of iso-shunt lines and calculation of venous admixture for controlled oxygen therapy in the post-operative period

Thirty patients undergoing elective abdominal and thoracic surgery were studied. Parameters of hypoxemia [PaQ2, [P[A-a]O2, Qs/Qt] were measured mixture preoperative, postoperative and after oxygen therapy. All the patients showed postoperative hypoxemia, which was more evident in cases of thoracic surgery. The iso-shunt lines graph was used to determine the optimal F1 O2 to be administered for correction of postoperative hypoxemia. The graph assumption of virtual shunt lead to underestimation of venous admixture. Application of the iso-shunt lines graph proved to be a useful practical method for prediction of the optimal F1 O2 required for correction of postoperative hypoxemia. The iso-shunt lines graph is inaccurate in the range of 25% venous admixture