Cardiovascular risks in hemodialyzed patients: could apelin have a role?

Apelin is a newly discovered adipocytokine and is produced by the white adipose tissue but is expressed, to a lesser extent in the kidney and heart. Apelin has recently been shown to be a potent positive inotropic agent in normal hearts. In addition, there is increasing evidence suggesting the role of apelin in the pathology of cardiovascular system. Cardiovascular disease is known to be a major contributor to the mortality and morbidity in patients with chronic renal failure. The aim of this study was to determine the apelin level in hemodialyzed patients and to assess its association to echocardiographic parameters among these patients. Forty uremic patients on maintenance hemodialysis were included in this study and compared with age and sex matched forty control subjects. Plasma apelin level, plasma nitrates and nitrites and routine biochemical investigations together with echocardiography were done for all subjects. Patients on hemodialysis showed significant lower level of apelin as compared to control group [5.59 +/- 2.97, 8.60 +/- 0.97 respectively, p<0.001]. Left ventricular internal end-diastolic dimension [LVIDd], Left ventricular internal end-systolic dimension [LVISd], interventricular septal thickness [IVS] were higher significantly among patients compared to control [p<0.001, <0.001, 0.02 respectively]. There was significant negative correlation between plasma apelin level and both LVIDd [p=0.003] and LVISd [p=0.046], suggesting the inotropic role of apelin. There was significant positive correlation between plasma apelin level and both plasma nitrates and nitrites [p<0.001] suggesting that apelin may mediate its effect via nitric oxide. Apelin level was significantly lower in hemodialysis patients. Apelin may be involved pathophysiology of cardiovascular disease in chronic renal failure. The therapeutic role of apelin as inotropic agent in uremic patients is to be investigated

Relationship between adiponectin, resistin and visceral obesity in type 2 diabetes mellitus in female Egyptians

The aim of this work was to study the possible physiological role of adiponectin and resistin as mediators linking obesity and insulin resistance in type 2 diabetes mellitus. Seventy-five female Egyptian subjects were enrolled in this study. They were divided into four groups as follows: obese nondiabetics [ONDM], obese diabetic type 2 [0DM], nonobese nondiabetic [NONDM] and nonobese diabetic [NODM]. Anthropometric measurements were taken. Abdominal ultrasound was also done to measure visceral fat [VF], subcutaneous fat [SCF] and visceral fat index [VFI]. Fasting blood samples were taken for analysis of serum insulin, blood glucose, plasma adiponectin and resistin. In the diabetic group adiponectin had an inverse correlation with resistin,VF and VFI [P < 0.01, P < 0.05, P < 0.01]. Resistin had a weak positive correlation only with VF, [P = 0.05] and RAI [resistin /adiponectin index] showed a positive correlation with VFI and SCF. In the nondiabetics adiponectin had no correlation with resistin, but had negative correlation with HOMA, age, VF and VFI, whereas resistin had no correlation with the same variables. RAI had a positive correlation with HOMA and SCF. In conclusion it can be said that resistin has no direct relation to insulin resistance either in diabetics or non diabetics. However, it may have a weak relation to visceral obesity only in diabetics. Hypoadiponectinemia is related to visceral obesity and increased resistin level in diabetics, while in non diabetics it is related to visceral obesity, insulin resistance and age. RAI is more informative than resistin which indicates a possible interaction between resistin and adiponectin especially in diabetics. RAI correlates positively with some anthropometrics but not to insulin resistance in diabetics, while it correlates positively with both variables in non diabetics

Role of simvastatin, tetrandrine and candesartan in experimental induced liver fibrosis in rats

Liver fibrosis which insidiously and frequently develops to cirrhosis showed implications of manymitogenic and fibrogenic cytokines such as tumor necrosis factor a [TNF alpha] and transforming growth factor beta [TGF- beta] respectively. Moreover, the chemoattractant effect of reactive oxygen metabolites which recruit Kupffercells, hepatic stellate cells [HSCs]and other inflammatory cells makes more cytokine release and production ofextracellular matrix [ECM] proteins and myoflbroblast mitogens.In this study, three drugs were chosen, each of them is supposed to act by a quite differentmechanism in thioacetamide [TAA] experimental model of hepatic fibrosis in rats. Simvastatin, an example ofHMG Co A reductase inhibitor. Tetrandrine, an alkaloid with calcium channel blocking property and Candesartanas a receptor blacker for angiotensin II.This study was carried out on 40 male albino rats,8 rats served as normal controls, while in the other32 rats liver fibrosis was induced by intraperitonial TAA injection. The incidence of fibrosis or its protection wasassessed by intrasplenic pressure measurement, spleen /body weight ratio, liver hydroxyproline [HPO] contents,serum TNF alpha and TGF- beta levels, oxidative stress parameters as reduced glutathione [GSH] and malondialdehyde [MDA] levels were measured. In addition to liver transaminases and tissue inhibitor of matrix metalloproteinase [TIMP-1] activities.In the present study Six weeks administration of TAA resulted in significant rise in portal blood pressureas compared to saline control rats; associated with a significant reduction in hepatic GSH contents and asignificant increase in hepatic HPO and serum MDA concentration in TAA group as compared to all groups.Meanwhile, there were significant increases in serum levels of TNF- alpah, TGF- 01, and TIMP-lactivity in TAA ratsas compared to control group . There were also statistical significant reduction in the cytokine levels and inhibitorof metalloproteinase activities in Simvastatin, Tetrandrine and Candesartan groups as compared to TAA nontreated group.The same was the effect on liver function tests; there were significant higher serum activities of aspartateaminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase [ALB] and y - glutamyl transferase [GGT] in TAA group as compared to saline control group. However, these serum enzymes activities showedsignificant reduction in the drug treated groups Simvastatin, Tetrandrine and Candesartan respectively. The studyfailed in detecting any significant statistical difference between the degree of protection against TAA inducedfibrosis that had been exerted by the three drugs used in the study.It was concluded that both Tetrandrine and Candesartan have marked protective effects in TAAinduced liver fibrosis by more than one mechanism .Simvastatin had a modest effect that may be by its antioxidanteffect. Clinical trials are recommended to support or disprove these results

Circulating biomarkers of oxidative stress and endothelial cell dysfunction in preeclampsia

To investigate the role of E-selectin, xanthine oxidase, the anti-oxidant enzyme catalase, and endothelial nitric oxide synthase [eNOS] activity and gene polymorphism in the pathophysiology of preeclampsia. Design: Case control study. Setting: Department of Obstetrics and Gynaecology and Department of Medical Biochemistry, Faculty of Medicine, Alexandria University. Subjects: Thirty preeclampsia patients [15 mild, and 15 severe] and fifteen normotensive controls. Interventions: Plasma samples were assayed for E-selectin and xanthine oxidase. Erythrocyte catalytic activity and eNOS activity in polymorphonuclear leucocytes were determined followed by screening for the Glu 298 Asp eNOS gene variant. Plasma xanthine oxidase and E-selectin were significantly increased and eNOS activity significantly decreased in the pre eclamptic groups compared to controls. Erythrocyte catalase did not differ significantly between groups. The frequency of Glu 298 Asp gene variant was significantly increased in severe preeclampsia. E-selectin, xanthine oxidase and eNOS may be used as clinically useful biomarkers for preeclampsia. The presence of Glu 298 Asp eNOS gene could be a marker for increased risk of developing severe preeclampsia

Role of aspase-3 and soluble fas in neuronal apoptosis in the pilocarpine model of limbic system seizures in rats

The participation of specific pathway [s] in the mechanism of seizure induced brain injury remains poorly defined. Recent studies have implicated apoptotic process in this seizure related injury. Caspases are the final executioners of apoptotic cell death programme. Engagement of the cell death surface receptor Fas by Fas ligand [FasL] results in apoptolic cell death, mediated by caspase activation. Cell death mediated via Fas/Fasl interaction is blocked by soluble forms of Fas receptor [sFas]. Soluble Fas are produced by alternative splicing of Fas gene and by proteolytic cleavage of membrane Fas [mFas] receptor. The role of caspases in seizure-induced brain injury remains little explored. Therefore, the present study was designed to assess the role of caspase-3 enzyme activity and serum sFas level in the mechanism of neuronal apoptosis in the pilocarpine model of limbic system seizures in rats. Pilocarpine induced seizures reproduce most of the features of human temporal lobe epilepsy. Limbic seizures were induced in adult male rats by intraperitoneal [ip] injection of polocarpine [310-320mg/kg] and were terminated after 2-4 hours by diazepam [10-12mg/kg, ip] administration. Control rats were given an equal volume of saline, ip. Seizures were monitored behaviorally, most of rats developed seizures characterized by salivation, forelimb clonus, rearing and hindlmb clonus. After 6-8 hours of diazepam administration, blood was withdrawn for estimation of sFas level. In addition, brain limbic structures [Bilateral hippocampi and cingulate gyri] were quickly dissected and handled to estimate levels of caspase-3 enzyme activity and% DNA fragmentation in neurons within the vulnerable limbic areas. The results revealed a significant increase of caspase-3 protease activity expressed as fold increase of induced/non induced ratio as well as a significant increase of% DNA fragmentation detected in neurons of limbic structures of serizure rats as compared to control rats. In addition, a significant decrease of sFas serum level was found in epileptic rats compared with controls. The decrease serum sFas level may suggest decreased Fas mRNA splicing variants and increased full length Fas mRNA and membrane Fas, and may promote Fas mediated apoptosis. The increased receptor mediated consumption of Fas/Apo-1 in induction of apoptosis may further contribute to decreased serum sFas level. Our findings implicate increased caspase-3 protease activity in the mechanism of seizure-induced neuronal death within limbic structures possibly triggered by enhanced Fas mediated apoptosis. Therefore, control of factors regulating apoptosis may facilitate future attempts to decrease delayed brain damage induced by seizures

Steriod microdose therapy in rheumatoid arthritis patients: impact on bone metabolism

The anti-inflammatory and immuno-suppressive properties of GCs have prompted their extensive use in the management of various diseases including RA. However, the benefits derived from the use of GCs may be offset by the occurrence of GCs related side effects. One of the most important side effects of long-term use of GCs is osteoporosis. Steroid microdose therapy [simply called Microdose Therapy], a university-spin-off technology, is a physician-supervised, 3-step, education program for teaching patient control of GCs for controlling chronic inflammation in arthritic patients. This Microdose Therapy uses very low dose of prednisone [

Direct versus nonrefluxing ureteroileal anastomosis in ileal neobladder

Does the theoretical benefit of reflux prevention in low-pressure bladder substitutions outweigh the potentially high rate of anastomotic stricture? Over 6 years, 120 renal units in 60 patients were reimplanted in orthotopic ileal neobladder following radical cystectomy. They were classified into 3 groups: 60 renal units were reimplanted by direct end to side technique, 30 units by extramural serous lined technique and 30units by Le Duc technique. Pre and postoperative bacteriologic study, blood chemistry, IVU, renal isotope scanning and postoperative micturating pouchogram were done in all cases after 3, 6months and then annually for 6-60months [mean, 36months].The following data were recorded in the 3 groups respectively: Rate of anastomotic stricture; 1.66%, 13.33% and 26.66%. Reflux; 15%, 3.33% and 6.66%.Upper tract dilation; 11.66%, 13.33% and 30%.Significant decrease in GFR; 11.66%, 13.33% and 30%.Azotemia; 3.33%, 6.66% and 13.33%. Asymptomatic bacteriurea; 26.66%, 20% and 20%.Pyelonephritis; 6.66%, 6.66% and 10%.Upper tract stone formation; 1.66%, zero and 3.33%. Nonrefluxing methods of ureteroileal anastomosis resulted in statistically significant higher rate of anastomotic stricture and upper tract dilation than direct end to side anastomosis. This is a high cost for any theoretical benefits of preventing pyelonephritis, azotemia or stone formation. In low-pressure bladder substitutions, direct ureteroileal anastomosis may be the technique of choice as it preserves kidney function and morphology, simple and time saving technique

Role of laparoscopy in management of the impalpable testis

The impalpable testis may be a real problem in its diagnosis as well as in its treatment. This study was done for 25 boys having 28 impalpable testes [3 bilateral] through 4 years duration. Their ages ranged from 2-18 years. Preoperative ultrasonography was accurate in 25% only. At laparoscopy; 10 testes were intra abdominal, two of which were atrophied and were excised. Of the remaining 8 testes; the vessels were short in 6; which were managed by 2 stage Fowler-Stephen procedure. The first stage was by proximal clipping and transaction of the vessels. After six months the second stage of testicular descent was done; surgically in 3 testes and laparoscopically assisted in the other 3. In two abdominal testes the vessels were long, these together with 5 peeping inguinal testes were managed by one stage laparoscopic orchiopexy. When no testis was detected abdominally, inguinal exploration was done we found 13 testes; 7 were atrophic and were excised and biopsed, in the 6 viable testes surgical orchiopexy was done. Biopsy was done from the 3 viable testes of those patients above the age of 12, no malignancy was detected. In the excised [9] atrophic testes; no parenchymatous testicular tissue was detected. Follow up for 6 months revealed normal sized testes except in one of the cases managed by surgical 2[nd] stage Fowler-Stephens orchiopexy. From this study it is concluded that, laparoscopy is a very good procedure for accurate diagnosis of the impalpable testis. It is also of great value in treatment of the intraabdominal testis. It is preferred to use it in the 2[nd] stage of Fowler-Stephens operation. Health education about the complication of the undescended testis is very important because most of our patients are older than the proper age for testicular descent

Evaluation of sensitivity, accuracy and predictive values of selective magnetic resonance imaging and arthroscopy in the diagnosis of meniscal and cruciate ligaments injuries of the knee

In a prospective study of 50 patients suffering from acute knee injuries, where knee arthroscopy was indicated and performed, the results of selective magnetic resonance imaging were compared with those of arthroscopy. With the patient's foot was in 20 degrees of external rotation, TI sagittal images were used and this technique called selective magnetic resonance imaging and provided excellent study of posterior cruciate ligament, medial meniscus and lateral meniscus in all the patients and in 94% of the patients the anterior cruciate ligament was well visualized. The sensitivity, specificity, accuracy, positive and negative predictive values of selected magnetic resonance imaging compared with knee arthroscopy were 97%, 87.5%, 94%, 94.3% and 93.3%, respectively, for the medial meniscus tears and 87.5%, 94.3%, 94%, 87.5% and 97% for lateral meniscus, while in posterior cruciate ligament were undefined, 100%, 100%, undefined and 100% and were 80%, 90.9%, 84%, 80% and 93.8% for tears of anterior cruciate ligament where the ligament was well visualized. In this study, it was found that selective MRI for knee joint in acute knee injury was found to be sensitive, valuable adjunct to clinical evaluation of the knee, noninvasive, required no exposure to ionizing radiation and could be considered as an aid to efficient preoperative planning

Isolated post-traumatic rotary sub-luxation of the scaphoid: Management by triscaphoid arthrodesis

Eight patients with unilateral chronic wrist pain were operated upon by triscaphoid arthrodesis [scaphoid fused to both trapezium and trapezoid]. All the patients had a history of trauma and clinically had a positive scaphoid shift test. Radiologically all the patients were proved to have static [type 2] rotary subluxation of the scaphoid. The average postoperative follow up period was three years and two months. Evaluation of the results showed that in spite of postoperative decreased range of motion of the wrist, a significant improvement of pain and function was observed

Asymptomatic bacteriuria in haemodialysis patients

This study was designed to assess the frequency significance and possible pathogenic factors of asymptomatic bacteriuria in chronic haemodialysis patients. A hundred patients suffering from endstage renal failure under regular haemodialysis treatment [divided into 3 groups according to the underlying cause of renal failure whether primary glomerulonephritis [forty cases] tubulointerstitial nephritis [thirty cases] or diabetic nephropathy [thirty cases] were randomely selected from the dialysis unit of Ain Shams University Hospital, El Sahil Teaching Hospital and Cairo Kidney Centre. None of these patients suffered symptoms nor signs suggestive of urinary tract infection and all were subjected to full history and clinical examination, clean catch midstream urine analysis with culture [aerobic and anaerobic]. Bacterial isolates were identified by bacteriological methods and sensitivity [when needed] in addition to microscopic examination for pus cells. Also, assessment of blood urea and serum creatinine were done. A subgroup of patients [proved to have asymptomatic bacteriuria 10 cases] as well as an equal subgroup of those having no significant bacteriuria were further studied by assessment of residual kidney function, total and differential WBCs counts, serum Ig[G], Ig[A] level, urinary Ig[A] level, opsonophagocytic function and migration inhibition test. Though we had high prevalence of significant bacteriuria in our patients [50%]. Pyuria was detected in only 14% of cases, all except one were associated with significant bacteriuria and the most prevalent organism was Staphylococcus aureus followed by Staph. saprophyticus. We didn't detect any significant correlation between significant bacteriuria and either age of the patients, duration, frequency of dialysis, blood urea or serum creatinine but female patients and chronic interstitial nephritis were associated with significant high prevalence of assymptomatic bacteriuria. In the two subgroups studied no correlation was detected between significant bacteriuria and either W.B.Cs count, residual kidney function, macrophage migration inhibition test, opsonophagocytic activity, Ig[A] or Ig[M] level. Though low Ig[G] level was associated with higher prevalence of asymptomatic bacteriuria. It is conducted that local factors may be more important than systemic factors in the pathogenesis of asymptomatic bacteriuria in haemodialysis patients and that routine urine analysis should be regularly performed in these patients to detect and possibly treat such cases especially female patients and cases of chronic interstitial nephritis

Critical analysis of radical or total removal of craniopharyngiomas in children

Total removal of craniopharyngioma in children is one school of surgical treatment of this lesion. This procedure is unsafe and highly risky and should not be regarded as the primary goal of surgery in such cases. 13 children with craniopharyngoinas were treated from January 1975 to January 1995. Total removal was feasible in 5 cases, subtotal or partial excision in 7 cases and only a biopsy was taken from the remaining case. Recurrent tumors were treated by aspiration or subtotal excision. Irradiation was done to 7 cases of partial or subtotal excision, one of them was a recurrence. 5 cases died postoperatively [3 from intraoperative complications, one from meningitis and the last case most probably from endocrinological deficit]. The study aimed in all cases to do total or radical removal. Certain clinical data are presented to challenge and dissuade against the school of total removal of craniopharyngioma

Assessment of a rapid method of pneumococcal antigen detection in routine sputum bacteriology

Sputum samples were obtained from 60 outpatients and inpatients admitted to Ain Shams University Hospitals with chest troubles as pneumonia, bronchopneumonia, acute bronchitis, asthmatic bronchitis and chronic bronchitis. Some of them [29] were collected before administration of treatment for at least 7 days before admission the other [31] were collected after initiation of treatment. Each group included different ages and sexes and examined thoroughly clinically and radiologically. Sputa of each group were examined by three method for detection of Streptococcus pneumoniae which is the cause of the most fatal chest diseases. These methods were Gram film, culture and latex agglutination test for pneumococcal antigen detection. In the first group the highest positive results were obtained by Gram film 69% while culture and antigen detection were apparently equal% 55In the second group the highest positive results were obtained by antigen detection latex agglutination test 80.6%, Gram film was positive in 51.6% and culture was positive in only 32.2%. As regard susceptibility of pneumococci to different penicillin generations we found that it is still the drug of choice for the treatment of pneumococcal infections

Measurement of non-specific antibodies in renal transplant patients and the incidence of certain postoperative viral infections

In this study we assess the level and incidence of panel reactive antibodies which are the main cause of hyperacute rejection in renal transplant. The patients sera were tested against the lymphocytes of standard individuals. The lymphocytes panel had adequate representation of most of known antigens. 11 out of 20 patients [55%] gave positive standard panel test utilizing the microlymphocytotoxic assay. The positivity was recorded at 20°C suggesting that those patients were sensitized. When the recipient sera were treated with Dithiothreitol [DTT] 2 cases showed false cytotoxic antibodies as shown in thee-negative panel obtained after the DTT treatment. The other nine positive cases showed true cytotoxic by not reacting with DTT. 80% of active CMV infections occurred concomitantly to acute rejection episodes and/or its treatment suggest a chronologic, possibly causal link between rejection and CMV infection

Schistosomiasis affection of the kidney as a possible cause of renal stone formation

Nowadays, renal stone is one of the medical complaints. Many theories have been suggested to account for its formation. The present work aimed to find out a correlation between schistosomiasis affection of the kidney and the formation of renal stones. Three groups of patients with renal stones were selected. They had Schistosoma mansoni infection [1st group], with Schistosoma haematobuim infection [2nd group] and Schistosoma free [3rd group or control]. The results showed pathological changes in the kidney biopsied materials, particularly the glomerulus, ranging from periglomerular fibrosis to complete atrophy and lymphoid follicles in the interstitium. Sometimes, distal-tubular atrophy was seen. The serum and tissue immunoglobulins, particularly the IgA, in schistosomiasis patients were above normal as compared to control ones. It is concluded that the schistosomiasis affection of the kidney, and the resulting immunopathological changes were factors predisposing, in one way or another, to the formation of renal stones

Effect of adenoidectomy on nocturnal enuresis

This research work aims to find the relationship between adenoidectomy and nocturnal enuresis. Forty-five children were chosen from the outpatient clinic of pediatrics and otolaryngology of Al-Hussein University hospital and El-Sahel teaching hospital. All were suffering from adenoid hypertrophy and nocturnal enuresis at the same time. Fifteen of them were primary enuretics and 30 were secondary enuretics, their age ranged between 3 and 15 years; 10 were females and 35 were males. Full history was taken, and they were subjected to clinical examination including examination of the back and genitalia and otolaryngilogical examination to detect the enlarged adenoid and tonsils. All of them were also subjected to plain x-ray of the nasopharynx lateral view to detect the hypertrophied adenoid, and complete urine analysis to exclude urinary tract infection. All the 45 children were then subjected to adenoidectomy or adenotonsillectomy and were followed up after one month from the operation for the frequency of the enuresis. They showed a decrease in the average of wet nights per week where they went from a collective average 4.4 wet nights per week preoperatively to 1.2 wet nights per week postoperatively

Audiometric study among carpenters

The aim of this study was to investigate the hearing threshold among a group of 60 carpenters, exposed to saw machine noise and impulse noise of nail hammering. The study has been carried out at ATICO Factory for furniture at Abou-Zaabal. It has been found that the maximum impairment of hearing of the exposed workers was at the 6 KHz. No statistcally significant difference could be found between the hearing threshold of the exposed workers and the control group. However, there ia a considerable permanent shift in their hearing threshold. This may be due to the short duration of the exposure [5 years], the intermittent nature of the exposure [about 20 minutes per working hour], or relatively not high level of noise