Study of neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory marker for diabetic nephropathy in type 2 diabetic patients

Background: Diabetes mellitus [DM] is a systemic disease having serious microvascular and macrovascular complications. DN in T2DM has an inflammatory pathology. Many inflammatory markers have been found to be related to DN, such as interleukin1 [IL1], IL6, IL8, transforming growth factor beta 1[TGF-Beta1] and tumor necrosis factor alpha [TNF Alpha]. However, their measurement is not used routinely as it is not easy to do it, in this respect. Search for inflammatory markers for the disease is a continuous process to enhance the diagnostic and treatment process

Aim of the Work: To assess neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory markers for diabetic nephropathy in type 2 diabetic patients

Patients and Methods: This study is a prospective one that was carried out on one hundred [100] type 2 Diabetes mellitus [T2DM] patients attending to internal medicine outpatient clinic and inpatient department of internal medicine at Al-Azhar university hospital, Damietta and twenty five [25] apparently healthy volunteers as a control. The populations of the study were classified into three groups according to their level of albuminuria. All were subjected tofull history and Clinical examination, Laboratory tests include Fasting mid-stream urine samples were obtained and examined for complete urine analysis and albumin/creatinine ratio [UACR],Complete blood count [CBC], HbA1c,Fasting blood sugar, Renal Function Tests,eGFR and Abdominal ultrasonography, Fundus examination and ECG and Assessment of NLR and PLR

Results: Our study showed that there was high statistically significant increased NLR, PLR and UACR in group IB when compared to group IA, II and III. Also there was statistically significant increased NLR,PLR and UACR in group IA in comparison to group II and also there was statistically significant increased NLR,PLR and UACR in group II in comparison to group III

Conclusion: Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] was significantly associated with diabetic nephropathy [DN] and high Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] values may be considered as a predictor and a prognostic risk markers of diabetic nephropathy [DN]

Abrogation of carbon tetrachloride-induced hepatotoxicity in Sprague-Dawley rats by Ajwa date fruit extract through ameliorating oxidative stress and apoptosis

Ajwa, a variety of date palme Phoenix dactylifera L., has long been used and considered as one of the most popular fruits in the North Africa and Middle East region. For Muslims this fruit is of religious importance and is mentioned several times in Quran. Besides being a part of the Arabian essential diet, dates have been used traditionally for number of complications. This study aimed to evaluate the possible potential of Ajwa date extract to guard against carbon tetrachloride [CCL[4]-induced liver damage in rats. Adult male Sprague-Dawley rats were given Ajwa date extract and silymarin [a standard reference drug] at doses of 300 and 50mg/kg, p.o., respectively for 2 weeks before CCU [2 ml/kg, s. c., twice weekly for 8 consecutive weeks], and concomitantly administered with CC1[4] for 8 consecutive weeks. Like silymarin, Ajwa date extract produced significant decrease in serum levels of alanine transaminase [ALT], aspartate transaminase [AST], alkaline phosphatase [ALP], total cholesterol, triglycerides [TG] and LDL-cholesterol as well as lipid peroxides measured as malondialdehyde [MDA], hydroxyproline and caspase-3 contents of liver tissue with marked increase in serum albumin, HDL-cholesterol and reduced glutathione [GSH] content as well as enzyme activities of super oxide dismutase [SOD], catalase [CAT] and glutathione-S-transferase [GST]. In conclusion, Ajwa date extract afforded significant protection against CCLrinduced hepatocellular injury; an effect that could be attributed to its antioxidant, antiapoptotic and antifibrotic activities

Lactoferrinsupplementation for prevention of sepsis in preterm neonate

Background: Sepsis related morbidity and mortality is a concern in neonatal intensive care units [NICUs]specially in preterm and Low birth weight [LBW] infants who are more vulnerable due to immaturity of immune defenses and protective barriers. Lactoferrin is an iron binding glycoprotein presents in mammalian milk and involved in innate immunity. Recent data suggest that bovine lactoferrin[BLF] might prevent late onset sepsis in preterm and LBW neonates

Objective; To evaluate the effectiveness of oral bovine lacoferrin in prevention of neonatal sepsis in Egyptian preterm neonates

Patients of Methods: A randomized clinical trial, double blind, placebo-controlled study was conducted on 135 preterm neonates [born before 37 weeks of gestation] admitted to the NICUs of Ain Shams University and Manshiet El Bakry Hospitals from February 20l3 to January 2015. Infants were randomly sub-divided into two groups: Group 1 consisted of 45 infant received oral lactoferrm supplementation [100 mg/day] within a day of starting feeds for 4 weeks. Group 2 consisted of 90 infants matching group 1 neonates, received placebo in the form distilled water in the same schedule. History and physical examination were carried out laying stress on signs of sepsis, severity [classified according to Tollnerscore], laboratory investigations were done: CBC with blood film [classified according to hematological scoring system], CRP, Blood culture upon admission and on suspicion of sepsis, other cultures and arterial blood gases when clinically indicated. Radiological investigation were done when clinically indicated, Data were analyzed using the Statistical Package for Social Sdences SPSS

Results: Lactoferrin group [45 preterm neonates] with mean gestational age [33.11 +/- 1.81 weeks]. 32 males [71%] and 13 females [29%]. Placebo group [90 preterm neonates] with mean gestational age [33.28 +/- 1.89 weeks], 45 males [50%] and 45 females [50%]. Lactoferrin group showed a significantly lower incidence of late onset sepsis according to Tollner score and Rodwell score and blood cultures [6.7%] compared to placebo group [17.8%]. E coli and Soureuswere the most common organisms found in septic neonates in the current study [28.6% for each]

Conclusion: BLF supplementation would be a suitable preventive tool for late onset neonatal sepsis in preterm neonates

Some optimal culture conditions for production of cyclosporin a by Fusarium roseum

A suitable chemically defined culture medium was selected and some optimal conditions for the production of the highly immunosuppressive compound, cyclosporin A (Cyc A) are reported. Medium of the following composition was favorable for the production of Cyc A by Fusarium roseum: glucose, 30; NaNO3, 2; KH2PO4, 1; MgSO4.7H2O, 0.5 and KCL, 0.5 (g/l). Maximum productivity of Cyc A was achieved at pH 6.0 when 50 ml of the fermentation medium/250 ml flask, inoculated with five fungal agar discs (6 mm, diameter) of 7-days old F. roseum culture after incubation at 30 ºC at 120 rpm for 7 days.

L-arginine augments the antioxidant effect of garlic against acetic acid induced ulcerative colitis in rats

Garlic contains many sulfhydryl compounds that act as antioxidants. However, the role of nitric oxide [NO] in inflammation is controversial. The aim of the present study is to investigate the possible protective effect of garlic against acetic acid-induced ulcerative colitis in rats, as well as the probable modulatory effect of L-arginine [NO precursor] on garlic activity. Intra-rectal inoculation of rats with 4% acetic acid for 3 consecutive days caused a significant increase in the colon weight and marked decrease in the colon length. In addition, acetic acid induced a significant increase in serum levels of nitrate as well as colonic tissue content of malondialdehyde [MDA]. Moreover, colonic tissue contents of glutathione [GSH], superoxide dismutase [SOD] and catalase [CAT] were markedly reduced. On the other hand, pre-treatment of rats with garlic [0.25g/kgbwt, orally] for 4 consecutive weeks and 3days during induction of colitis significantly reduced the increase in the colon weight induced by acetic acid and ameliorated alterations in oxidant and antioxidant parameters. Interestingly, oral co-administration of garlic [0.25g/kgbwt] and L-arginine [625mg/kgbwt] for the same period of garlic administration mitigated the changes in both colon weight and length induced by acetic acid and increased garlic effect on colon tissue contents of MDA and GSH. In conclusion, L-arginine can augment the protective effect of garlic against ulcerative colitis; an effect that might be mainly attributed to its NO donating property resulting in enhancement of garlic antioxidant effect. Further studies will be needed to determine which one of the active ingredients of garlic has the main antioxidant effect to be used with L-arginine

Cytogenetic study in juvenile myoclonic epileptic patients

The association of chromosomal imbalance and neurological abnormalities is well known. These chromosomal abnormalities may indicate that chromosomal sites where atypical neurological characteristics could be mapped. The purpose of our study was to search for cytogenetic abnormalities in patients with juvenile myoclonic epilepsy. This work was carried out on fifteen patients presenting to Epilepsy Centerof Neurology Department of Alexandria Main University Hospital. The age of juvenile myoclonic patients ranged from 16 to 38 years. Ten patients have myoclonic and generalized Tonic-Clonic seizures, 3 patients have myoclonic, absences, and generalized tonic-clonic seizures, and 2 patients have myoclonic seizures only. All patients were cytogenetically normal as all of them had normal karyotypes

Hepatic Hypertransaminasaemia of unknown Etiology Aclinico-pathological study

Hepatic aminotransferases are sensitive indicators of liver cell injury. In some patients with persistent elevation of such enzymes; routine clinical, laboratory and serological data cannot establish the underlying causes. This study was designed to evaluate such patients both clinically and pathologically as a trial to reach the underlying etiology. Thirty patients with hepatic hypertransaminasaemia of unknown cause [18 females and 12 males], aged 18-50 years [mean age 37.7 +/- 4.6 years], together with ten controls [5 males and 5 females] [matched in age and body mass index with patients]; were included in this study. Both patients and controls were subjected to full history taking, clinical examination, estimation of blood glucose and lipid profile, liver function tests, serum iron and ferrtin estimation, hepatitis viral markers [HBs Ag HCV-Ab], anti Epstien Barr [EBV] and cytomegalovirus [CMV] antibodies, abdominal ultrasonography [U/S]and needle liver biopsy [done only for 15 patients who approved undergoing it. The study revealed that 18 patients had nonalcoholic fatty liver disease NAFLD [bright liver on U/S], eleven patients out of them underwent liver biopsy that showed simple hepatic steatosis in four of them and non-alcoholic steatohepatitis [NASH] in the other seven patients. Most of the eighteen patients with NAFLD were obese, diabetic and hypertensive. Four patients had positive serology for autoimmune hepatitis and two patients had positive serology for cytomegalovirus infection. All patients had normally ranged serum iron and ferritin. The remaining six patients had normal hepatic U/S and negative serology for different hepatic viruses; four of them underwent liver biopsy that revealed simple hepatic steatosis in two of them and non-alcoholic steatohepatitis [NASH] in the other two patients. Conclusion and recommendation: Nonalcoholic fatty liver disease [NAFLD] was found to be the commonest cause of unexplained hepatic hypertransamina-saemia. However, we must be minded with less frequent causes like autoimmune hepatitis and cytomegalovirus infection. Needle liver biopsy and possibly MR imaging of the liver are important investigational techniques for patients with hepatic hypertransaminasaemia associated with normal serum iron and ferrtin levels, negative serology of [autoimmune hepatitis and various hepatic viruses], normal hepatic ultrasonography; to diagnose those with occult hepatic steatosis among them. Estimation of HBV-DNA and HCVRNA by [PCR] could be required for precise exclusion of HBV and HCV infection. Large-scale studies are recommended to verify these findings

Risk Factors in Cerebral Stroke [A case Control Study in Kasr-El Aini Hospital]

Stroke is the third leading cause of death in the world, it is the first leading cause of adult disability. Many clinical and laboratory risk factors are accused to be predisposing for the occurrence of stroke such as hypertension, diabetes cardiac diseases and hypercholestrolemia. The current study is a case control study, conducted on 450 subjects attending Kasr El Aini hospitals [150 stroke patients and 300 control subjects]. The objective of this study is to detect these risk factors, and assess their relation to the disabling effects of stroke to be used in the future as alarming signals for early diagnosis. Tools of the study included physical examination, dietary pattern, lab investigations, duplex, ECG and Echo cardiography. Patients group was subjected to additional investigations such as Neurological assessment scales including: Mini Mental State Examination [MMSE], Motoricity Index, Barthel Index and Modified Rankin out come scale. CT scan was also performed. Results showed a statistical significant difference between patient and control groups regarding most clinical and laboratory risk markers. Hypertension, smoking and transient ischemic attacks [TIAs]were considered among the most predominant risk markers among the patient group with a poor outcome on cognitive, motor deficits, and disability. Hypercholestrolemia recorded the worst outcome as regards Modified Rankin disability scale. Moreover, prompt control of these risk factors are associated with lowering these disabilities. Dietary habits played a major role in stoke. The most frequent food categories consumed by the patient group were fats, proteins, and caffeine; yet vegetables, and carbohydrates were the most frequently consumed by control subjects. It is recommended that knowledge about risk factors together with their effects on the outcome of the stroke attack be used in planning of a national preventive program directed to the risk groups and also be included in the primary care facilities for early detection and proper management of such risk markers

Epidermal growth factor [EGF] receptors expression in myometrium and leiomyomas

Fifty patients were included in this work, they all were premenopausal women who underwent hysterectomy at Ain Shams University Maternity Hospital. They were divided into two main groups Group [1] [The study group] : 30 patients who underwent hysterectomy for symptomatic uterine fibroids; Group [2] [The control group] : 20 patients who underwent hysterectomy for other gynecological problems than myoma. After pathological examination, tissue samples of myomas and myometria were collected for immunohisto-chemical study for epidermal growth factor receptors assay. As regards the relation between age of women distributed according to their groups and the EGF receptors expression; it was found that there was no relation between age of women and the expression of EGF receptors. Also for the relation between parity and the expression of EGF receptors; it was found that there was a relation between parity of women in the study group [with leiomyoma] and the expression of EGF receptors [P < 0.01] i.e. highly significant difference, and this may be attributed to the elevated estrogen regulated genes in leiomyomas when the uterus is exposed to circulating levels of estrogen that are many-fold higher through subsequent pregnancies than those seen during menstrual cycle As regards the relation between the receptor level and the phase of menstrual cycle; it was found that there was no cyclic variation of EGF receptors either in the proliferative phase or in the secretory phase and hence estrogen and progesterone play an important equal role in the expression of EGF receptors whether in myometrium or in the growth of leiomyomas. As regards the relation between the receptors level with different pathological subtypes of leiomyomas; it was found that there was no significant difference between these types and the expression of EGF receptors. Concerning the relation between EGF receptors expression in leiomyomas compared to normal myometrium; it was found that although both leiomyomas and myometria showed expression for EGF receptors and may be the expression was slightly elevated in leiomyoma, but we could not find any significant difference [P > 0.05] between EGF receptors expression in leiomyoma compared to myometrium. These findings suggest EGF receptors as a potential regulator for uterine leiomyoma and also suggest that estrogen and progesterone effects on leiomyomas may be partly mediated by EGF receptors