Selective immunoglobulin M deficiency in an adult with miliary tuberculosis: a clinically interesting coexistence: a case report and review of the literature

Selective immunoglobulin M [SIgM] deficiency is a rare form of dysgammaglobulinemia. Here we are reporting a 31 year old man with multiple cervical and testicular abscesses who was investigated and found to have miliary tuberculosis [MTB] with primary SIgM deficiency [Serum IgM: 17.4 mg/dL] and was treated aggressively with anti-tuberculous treatment

Evaluation of extracorporeal ultrafiltration in the management of refractory congestive heart failure

Refractory congestive heart failure [CHF] usually represents the end stage of cardiac disease in which hypotension and oliguria lead to progressive generalized edema. The aim of the present work was to assess the symptomatic response, hemodynamic benefits and side effects of extra-corporeal ultrafiltration [ECUF] therapy in patients with refractory CHF who failed to respond to conventional anti-failure measures. Sixteen patients with refractory CHF who belonged to class IV of the New York Heart Association [NYHA] classification were included in this study. They were 7 men and 9 women with ages ranging from 32 to 63 yr [mean 47 +/- 9 yr]. The causes of heart failure were: ischemic heart disease in 3 patients, rheumatic heart disease in 5 and dilated cardiomyopathy in 8. All patients had ECUF therapy, 1-6 sessions/patient, each lasting 4-6 hr with an average amount of ultrafiltrate 2.6 +/- 0.4 L/session. All patients had serial: echocardiography, hemodynamic monitoring, chest X-ray, serum electrolyte and hematocrit estimation in addition to routine laboratory tests both pre- and post ECUF. Response to ECUF was considered according to improvement of patients' clinical status, and cardiac and renal functions. Eleven patients were responders [68.5%], 3 were partial responders [18.5%] while 2 were non-responders [13%]. In responder group, edema disappeared, 5 patients [31%] became NYHA class III, with significant diuresis and decrease of body weight. In addition, there was a significant reduction in heart rate, central venous pressure and radiographic cardiothoracic ratio. After ECUF there was a significant increase of serum sodium concentration whereas no-significant changes were observed in serum calcium, potassium, urea or creatinine. By echo cardiography there was a significant reduction in all cardiac chamber dimensions with significant improvement of left ventricular contractility. ECUF offers a reasonably effective and relatively safe method in the therapeutic options of refractory CHF

Blood pressure variability in acute cerebral infraction and hemorrhage

This study included 115 patients with acute cerebrovascular stroke [63 patients with thromboembolic infraction, 28 patients with lacunar infarction and 24 patients with intracerebral hemorrhage] as well as 49 age and sex matched patients with other than acute cerebrovascular stroke were taken as a control group. There was a significant transient elevation of both mean systolic [SBP] and diastolic blood pressure [DBF] in the first day of admission in the various subtypes of stroke patients compared with the seventh day. The initial elevation of blood pressure was not due to stress of hospitalization because it was not present in the control group. There was a significant positive correlation between the elevation of systolic blood pressure and diastolic blood pressure in the first day in both thromboembolic and lacunar subtype. It was concluded that there was a spontaneous decline in both systolic and diastolic blood pressure after acute stroke; so, the use of antihypertensive drugs must be carefully judged in those patients

Microalbuminuria in smoking insulin-treated diabetics without manifest nephropathy

Urinary albumin excretion [UAE] was estimated in forty insulin- treated diabetic patients with a diabetes duration not exceeding twenty years. Twenty of them were cigarette smokers [all were males with mean age of 29.5 +/- 3 years and mean duration of diabetes of 8.3 +/- 5.1 years] and twenty were non-smokers [twelve males and eight females with mean age of 28.6 +/- 2.1 years and mean duration of diabetes was 7.8 +/- 3.8 years]. Microalbuminuria [UAE = 30-300 mg/24 h] was much more prevalent in smokers and significant at higher level than non-smokers [99.8 +/- 75.8 vs 26.9 +/- 15.1]. UAE was significantly higher in patients with long duration of diabetes [ten- twenty years] than patients with short duration [zero-nine years] [169.3 +/- 46 vs 42.9 +/- 36.8]. Smoking diabetes with increased UAE had significantly younger age at onset [20 +/- 3 years], longer duration of diabetes [10.7 +/- 4.7 years] and higher smoking index than smoking diabetics with normal UAE [177.3 +/- 117.9 vs 73 +/- 2.9]. This study suggested that smoking diabetics with younger age at onset and duration of diabetes more than ten years are at higher risk to develop microalbuminuria and hence nephropathy than nonsmoking diabetics

Right ventricular filling pattern in hypertensive patients: echo doppler study

Right ventricular filling pattern was assessed in thirty hypertensive patients, their ages were 52 +/- 10 years and thirty healthy age- matched non-hypertensive controls using pulsed Doppler echocardiographic study. Hypertensive patients had significantly thicker anterior right ventricular wall, higher ratio of late to early peak filling velocity and higher atrial filling fractions of both ventricles than normotensive control. In contrast to left ventricular filling, right ventricular filling pattern parameters correlated poorly with age in hypertensive patients. However, right ventricular filling parameters were closely related to left ventricular filling dynamic both in hypertensive patients and health controls. Thus, this study showed altered right ventricular filling dynamics in hypertensive patients in a pattern closely correlated to left ventricular filling dynamic

Nucleoside deaminases activity levels in diabetes mellitus, possible new indices for early detection of diabetic nephropathy

The clinical value of assaying the activity of the nucleoside deaminases-cytidine deaminase [CD], guanosine deaminase [GD] and adenosine deaminase [AD] was studied in thirty-nine type I and fifty- three type II diabetic patients together with fifteen completely healthy subjects as controls. The changes were presented in both types of diabetes. The degree of control did not affect the AD activity levels. However, patients with complicated disease had lower activity levels of AD than uncomplicated diabetes. This suggested that AD deficiency in diabetes is at least in part attributing to decreased immunity in diabetic patients. The possibility of being associated with inheritance of type I and type II diabetes could not be excluded. The increased activity levels of CD and GD could arise from evident or latent nephropathy, where the activity levels of both enzymes were significantly high in patients with nephropathy compared with those without nephropathy. The correlation between these two enzymes with either duration of diabetes or fructosamine supported this hypothesis. Thus, these enzymes could be valuable new indices in the early detection of diabetic nephropathy