Role of ureteric stents in relieving obstruction in patients with obstructive uropathy

The aim of this study is to evaluate the role of ureteric stents in relieving obstruction and improvement of kidney function in patients with obstructive uropathy. This study involved 138 patients with obstructive uropathy with age ranged from 2 months to 73 years. Patients classified into two groups: Group [I]: Includes 57 patients [41.3%], ureteric stents fixed to them; and Group [II]: Includes 81 patients [58.6%] managed by other treatment modalities. All patients underwent clinical assessment, Laboratory and radiologic investigations: At presentation and postoperative. These included: Complete urine analysis, urine culture and sensitivity, serum creatinine, serum urea nitrogen, serum uric acid, serum sodium [Na], serum potassium [K], Fasting blood glucose level and blood picture and plain X-ray [KUB], abdominal ultrasonography [US], diuretic renography and retrograde pyelography. Renal glomerular filtration rate [GFR] was used as an indicator for improvement of renal function after fixation of ureteric stent. In group I: 56 [71.8%] kidneys showed significant recovery compared to 61 kidneys [66.3%]. In group II, there is statistically significant relation between renal perfusion and renal recovery [P < 0.004], statistically significant relation between parenchymal thickness and recovery in both groups [P < 0.0002], statistically significant relation between degree of corticomedullary differentiation and recovery [P < 0.0003] and statistically significant relationship between hemoglobin levels at presentation and the recoverability [P < 0.002]. The predictors of renal recoverability revealed that ureteral stents alone can help in regaining renal function and significant improvement of clinical condition in patients with obstructive uropathy.

Physical and psychosocial stressors among caregivers of patients with cerebrovascular stroke

The present study was conducted to assess physical and psychosocial stressors among family caregivers of patients with cerebrovascular stroke . The study was carried out at the Outpatient of Neurophychiatric Clinic in Ain Shams University Hospitals . The sample included 100 caregivers of patients with cerebrovascular stroke . Tools used for data collection were 1] Questionnaire dealing with socio-demographic characteristics, general health condition of caregivers and, physical, economical psychological and social stressors. 2] Beck Depression Inventory Scale, 3] Social Dysfunction Rating Scale. Results revealed that 52% of caregivers females for 52% their age was >40. The most common physical stressor was 63% [general body joint pain and hand pain], economical stressors was [89% cost of medication and hospitalization] psychological stressors was [56% sadness about patient] and social stressors was [28% negligence of domestic work] . There were statistically significant differences in relation to age, sex, and availability of caregivers related stressors . The study'recommended in increasing awareness of family caregivers about community resources and how to gain access to them, this might be done through audiovisual media. [Improving social care services, to contribute as social support to caregivers.] Computer networks and hotline services should be available to immediately solve problems and link caregivers, doctors and local support organizations to each others

Role of avastin in management of central serous chorioretinopathy

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy [CSC]. Prospective interventional series non-comparative study. Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt. The study included 20 eyes of 20 patients with central serous chorioretinopathy [CSC], Out of them 10 eyes with acute CSC [group I], 6 eyes with chronic CSC [defined as symptoms present for longer than 6 months] and four eyes with recurrent [defined as more than one episode of the disease] chronic and recurrent cases are considered in one group [group II], all patients were injected with intravitreal Avastin [IVA] 1.25 mg [0.05 mL] of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity [BCVA], IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography [FA] and optical coherence tomography [OCT] imaging is used for measurement of central retinal thickness [CRT]. Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 [range 1-3 injections] 6-8 weeks intervals and follow up for 6 months [range 5-7 months]. All finding at baseline and each follow up visit were reported and compared. The mean age of all patients was 40.3 years +/- 6.5 [range 25-50 years], 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 [log MAR 0.48] and improved to 20/30 [log MAR 0.18] with statistically significance difference change [P<0.003] and in [chronic and recurrent group], the mean baseline VA was 20/80 [log MAR 0.60] and improved to 20/40 [log MAR 0.30] with statistically significance difference change [P<0.002]. The mean baseline CRT for all patients was 486 +/- 86 micro m [range, 386-580], decreased to 316 +/- 56 micro m [range, 276-368] after 1 months with statistically significance difference change [P<0.02] and to 272 +/- 52 micro m [range 220-338] at last follow up with statistically significance difference change from the baseline [P<0.001]. Intravitreal Avastin [IVA] injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC

Early avastin management in acute retinal vein occlusion

To evaluate the safety, functional and anatomical effects of intravitreal Avastin [bevacizumab] in treatment of recent retinal venous occlusion. Prospective interventional series non-comparative study. Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt. The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3 months duration 12 eyes [40%] of patients with central retinal vein occlusion [CRVO] and 18 eyes [60%] with branch retinal vein occlusion [BRVO] were injected with intravitreal bevacizumab 1.25 mg [0.05 ml] of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25 mg/ml as a primary treatment. The mean number of injections was 2.7 [range, 1-6 injections] 6-8 weeks intervals and follow-up for 12 months [range, 913 months]. Patients underwent visual acuity testing [VA] as functional assessment. Anatomically, optical coherence tomography [OCT] is used for measurement of central retinal thickness [CRT] to detect macular edema [ME], fundus photography and fluorescein angiography [FA] to detect venous tortuosity, optic disc edema and surface wrinkling rather than ME. All finding at baseline and each follow-up visit were reported. The mean age of all patients was 65.3 years +/- 8.5 [range, 55-82 years], 20 males and 10 females patients. The mean baseline VA was 20/240 [log MAR 1.08 +/- 0.52] and improved to 20/60 [log MAR 0.48 +/- 0.32] with statistically significance difference change [P<0.001]. The mean baseline CRT was 455 micro m +/- 126 [range, 386510], decreased to 356 micro m +/- 118 [range, 296-416] after 1 month with statistically significance difference change [P<0.02] and to 402 micro m +/- 170 [range, 338-468] after 6 months [P<0.067] and to 250 micro m +/- 48 [range, 200298] at last follow-up with statistically significance difference change from the baseline [P<0.001]. There were great proportional decrease in venous tortuosity, optic disc edema and surface wrinkling after 1 month of injection. Neither systemic nor intraocular adverse events were reported. Intravitreal Avastin [IVA] is safe well tolerated, effectively improve VA, fundus picture and stabilize anterior segment neo-vascular activity in patients with recent retinal venous occlusion

Counseling intervention for parents' coping patterns toward their children with ADHD

This study aimed to investigate the effect of counseling intervention on parents having children with Attention-deficit hyperactivity disorder [ADHD], to help parents to cope with their children's problem; through improving their knowledge, practices and attitudes toward their children. The sample included 100 parents' caregivers accompanying their children with ADHD, aged 6-12 years, who attended to the Out- Patient Clinic of the Institute of Psychiatry, Ain Sams University. The tool used in the study was an interviewing questionnaire which covered demographic data about parents and their ADHD children such as; age and sex, rank of child in family, marital status, educational level and occupation of parents, statements to assess the knowledge of parents about ADHD, statements to assess positive and negative attitudes toward their children and statements to measure their practice toward child's inattentive, impulsivity and hyperactivity behaviors. This scale was applied before and after the counseling sessions. The results of this study showed improvements, with highly statistically significant differences between before and after application of the counseling intervention program regarding to parents' knowledge, attitudes and practices toward their ADHD children. The study recommended that counseling clinic for parents of ADHD is needed to offer appropriate care and support through open dialogues between parents and mental health professionals in order to plan for intervention and guide families to know how to cope with their children's problems and difficulties. Further research is to be undertaken, for parents that emphasizes on assertive training to deal with their ADHD children and how to provide them opportunities for enhancing learning potentials

Role of nitric oxide and endothelin-1 in pathogenesis of primary open angle glaucoma

Aim: as a leading cause of blindness worldwide, glaucoma continues to be a clinical problem. In the era of neuroprotection as a new trend in the management of glaucoma today, the demand on more knowledge about the pathogenesis of glaucomatous optic neuropathy [GON] is increasing. So, the aim of our study is to get a deep insight about the role of nitric oxide [NO], and endothelin-l[ET-1] in the pathogenesis of primary open angle glaucoma [POAG]

Method: the present study was carried out on forty subjects of both sexes and different age groups, where they were classified into two groups: group I: Included twenty glaucomatous patients diagnosed as having POAG and scheduled for surgical intervention [subscleral trabeculectomy]; where fourteen patients were selected from those patients attended the Ophthalmology Outpatient Clinic in Minia University Hospital and six patients were selected from those patients attended the glaucoma unit in El-Nour Eye Hospital [Cairo]. The degree of glaucomatous drainage was categorized .according to the clinical state of the optic disc and visual field examination into 4 stages: mild [grade l]; moderate [grade 2]; severe [grade 3] and end stage [grade 4]. The degree of glaucoinatous damage in the examined patients was ranging from moderate to severe. The other group [group II]: Included 20 healthy subjects with senile cataract admitted to the Ophthalmology Outpatient Clinic in Minia University Hospital to do cataract surgery as a control

Results: table 2 shows the demographic and biochemical data of the studied groups, where the results were expressed as mean +/- SD. In addition, it shows comparison of the statistical significance [P- value] of all parameters in the studied groups, where there was highly statistically significant difference in the aqueous levels of NO [p = 0.02] between group I [31.23 +/- 5.29 [micro]Ml/L] and group II [16.42 +/- 2.75[micro]M/L], and on the other hand, there was highly statistically significant difference in the aqueous levels of ET-1 [p = 0.001] between group I [32.47 +/- 3.33 pg/ml] and group II [18.12 +/- 1.9 pg/ml]. Moreover, there was no statistically significant difference as regard age between group I and group II [P= 0.58]. . Table 3 shows Comparison of the statistical correlation coefficient [r] of the aqueous levels of NO and ET-1 between the studied groups where there was a significant positive correlation between aqueous levels of NO and ET-1 in the glaucoma group [P=0.0001]

Conclusion: our results have clearly shown that elevated ET-1 and NO levels in POAG may occur as a response to elevated IOP or the high levels of these parameters could be the cause of glaucoma, so elevated ET-land NO could be a cause or an effect

MRI diagnostic value in pregnant patients with acute abdominal and pelvic pain

The use of ultrasonography during pregnancy provides a tremendous amount of valuable information about fetal and maternal well-being. However, in some cases the image quality may be poor. Excellent soft-tissue contrast resolution and multiplanar imaging capability, in combination with lack of ionizing radiation, make magnetic resonance imaging a promising modality for use in pregnant women. The purpose of this study was to show the usefulness of magnetic resonance imaging in the evalluation of pregnant women with acute abdominal or pelvic pain. in Alyamamah Maternity Hospital and Hammadi General Hospital. prospective observational study. 25 pregnant patients were referred for magnetic resonance imaging examination because of acute abdominal or pelvic pain with insufficient ultrasonographic findings between September 2003 and August 2005. Multiplanar multisequence magnetic resonance imaging of the abdomen and pelvis were obtained in each patient. The magnetic resonance imaging interpretations were compared with follow-up medical, surgical and obstetric final diagnosis to determine the correctness of the interpretation. Correlation of magnetic resonance imaging interpretations with final diagnosis showed correct identification of disease entities in all but one patient with acute appendicitis, falsely diagnosed by magnetic resonance imaging as normal findings. Magnetic resonance imaging showed an accuracy rate of 96% in diagnosing acute abdominal and/or pelvic pain in pregnant women with unclear ultrasound diagnosis. The Specificity and positive predictive value were 100% but sensitivity was 94.7% and negative predictive value was 85.7 Abdominal and pelvic diseases in pregnant patients can be well evaluated by magnetic resonance imaging, when it is an available modality. It can provide important information that may influence a patient's treatment options, which range from operating emergently to delaying treatment until after delivery. Magnetic resonance imaging should be reserved for cases in which results of ultrasonography are inconclusive and patient care depends on further imaging.

Does triplet chemotherapy [gemcitabine, oxaliplatin and etoposide] have an impact on treatment outcome in advanced/metastatic non-small cell lung cancer?

Non-small-cell lung cancer [NSCLC] is the leading cause of cancer-related death. The combination of Vinca alkaloid and cisplatin represents a standard option for the initial therapy of patients with advanced NSCLC. A number of new anticancer agents have been tested and approved for the treatment of advanced NSCLC. Triplet agent chemotherapy has entered clinical practice in treatment of advanced cases of NSCLC. 28 evaluable patients of NSCLC with stage III-B or IV were enrolled in this study. One group received doublet regimen of cisplatin [120mg/m 2 D1, 22] and etoposide [120mg/m 2 D1-3 and recycle every 21 days]. Other group received triplet regimen of gemcitabine [800mg/ m 2 D1, 8] then oxaliplatin [80mg/ m 2 D1] and VP16 [120mg/ m 2 D1-3] with recycling every 21 days. Evaluation of response, toxicity and survival was performed. Age ranged from 36-75 years with a median age of 61 years. The main side effects were nephrotoxicity, neurotoxicity and gastrointestinal tract toxicity in doublet regimen, while hematological toxicity, orthostatic hypotension and neurotoxicity in triplet regimen group. Febrile neutropenia occurred in 37.5% in triplet regimen compared to 8.3% in doublet regime. Partial response was higher in triplet agent chemotherapy group. It occurred in 25% and 50% of cases

Histological study of the effect of leptin hormone on the maturation of ovarian follicles of albino rats

Leptin is an adipocyte secreted hormone with a well documented metabolic role causing body weight loss. Leptin hormone has been further implicated in fertility regulation and it appeared to be a permissive factor for puberty. The present study focused on the assessment of the histological changes that might occur in the ovaries of immature female albino rats in response to the repeated injections of leptin hormone. Fifty seven just-weaned, immature female albino rats [22days old] were divided among control groups that had received daily subcutaneous injections of HC1/NaOH solvent; and experimented groups that had received daily 5pg of subcutaneous leptin hormone till the age of 44days [total experimental duration was 22 days]. The body weights of rats were daily recorded. The females were subjected to daily vaginal smears stained by Giemsa stain for assessment of the onset of the oestrus cycle. Three animals from both groups were sacrificed by decapitation every two days after the injections until reaching the expected age of maturation in female albino rats [42-44 days old]. The weights of the dissected ovaries were recorded. Sections from the ovaries and uterus were examined histologically by routine hematoxylin and eosin [H and E], trichrome and periodic acid Schiff's stains PAS]. Counting of the large growing antral follicles in all ovarian H and E sections was done, statistically analysed and represented. The endometrium in selected groups was labelled for the immunohistochemical detection of the expression of the nuclear alpha oestrogen receptor. The ovaries were also examined by the transmission electron microscope for the assessment of the maturation changes at the cellular level within the different structural components of the ovaries. Revealed that, in addition to the reduction in the total body weight, leptin hormone accelerated the maturation of the ovarian follicles and stromal tissue in immature female rats as early as the age of 26 days with enhancement of the early onset of the oestrus cycle and the associated changes in these females. These results were highly significant compared to the equivalent control female rats, which started to show ovarian maturation changes only on approaching the age of 42-44 days. It was suggested that leptin hormonal therapy could be beneficial for the management of delayed puberty in young females and maybe in related reproduction disorders particularly f associated with overweight problems

Myringosclerosis incidence among children with acute otitis media in relation to the isolated pathogens

Patients with acute otitis media [AOM] or otitis media with effusion [OME] and treated with tympanostomy tube insertion can develop myringosclerosis. The aim of this study was to investigate and compare the incidence of myringosclerosis among children with acute otitis media in relation to the isolated aerobic and anaerobic pathogens in their ear discharge. This study as conducted on two groups of patients. Group [1] included 23 subjects of OME had been treated with tympanostomy tubes and some of them had the complication of otorrhea, and group [2] included 48 subjects with AOM with or without otorrhea. Otorrhea of discharging ears of both groups was cultured and the status of their tympanic membranes was followed regularly by otoscopic examination during follow-up duration in scheduled visits to detect the incidence rate, time of appearance and severity of myringosclerosis in relation to the type of isolated pathogens. [GI] had 6 cases [10 ears] of myringosclerosis detected at 2-3 months average duration, and [G II] had 11 cases [20 ears] of myringosclerosis detected at 1-2 months average duration. The highest number of isolated pathogens was Streptococcus pneumoniae [S.P] and Haemophilus influenzae [H.I], and they were the only pathogens accompanied the incidence of myringosclerosis with more incidence and severity in [S.P] infected ears. These findings support the inflammatory theory of development of myringosclerosis. Our study considered myringosclerosis an inflammatory condition rather than to be traumatic reaction from tympanostomy tubes insertion, where Streptococcus pneumoniae is the most liable organism can induce myringosclerosis in improper treated cases of AOM .Anaerobic organisms cannot afford the hyperoxic environment which is suggested by some researchers to be a necessary factor in the development of myringosclerosis and proper treatment of cases of AOM diminishes the chance of incidence of myringosclerosis

Injuries encountered during rigid ureteroscopy in training centers

Objective: To analyze the peroperative injuries encountered during ureterorenoscopy [URS] in two training centers in Egypt over a four-month period

Patients and Methods: A prospective computerized database of 88 patients [38 males and 50 females] who underwent URS at two urologic university training centers [Al-Azhar University Hospital, Cairo and Assiut University Hospital, Assiut, Egypt] between July and October 2003 was analyzed. The procedures were elective in all cases. The indication for URS, the state of the ureter, associated pathologies, intraoperative injuries encountered and their management were recorded for analysis

Results: All but seven patients were operated for therapeutic indications, mainly stone disease and ureteric strictures. Peroperative injuries were encountered in 14 patients [15.9%] with the commonest type being mucosal laceration [57%] followed by minor ureteric perforations. Major injuries in the form of ureteric avulsion, laceration and extravasation were noted in 2% of the cases. The procedure was associated with inadvertent bladder or urethral injury in three patients. In all cases the diagnosis of the ureteric injury was prompt and confirmed by intraoperative ureterography. Treatment was started immediately

Conclusion: URS, although an important tool in the management of upper tract pathology, is an invasive procedure, especially for therapeutic indications. It may result in significant complications that may jeopardize the integrity of the concerned renal unit. Recent technology in the design of ureteroscopes and their accessories may minimize injuries, especially if applied in teaching hospitals where the learning curve of URS is a demanding task

Does Intermittent low weekly doses of docetaxel-estramustine have an impact on treatment outcome in hormone refractory prostate cancer?

Although the majority of men with metastatic prostate cancer respond initially to and rogen ablation, most of them will eventually develop hormone-refractory progressive disease; with generally median survival less than one year from that point. The management of hormone refractory prostate cancer [HRPC] is challenging, as there is no uniformly accepted strategy. Combinations of estramustine and taxanes produced objective responses in soft tissue, reductions in serum PSA levels, and relief from bone pains. Different dosing and frequency of palliative chemo-hormonal therapy [docetaxel-estramustine] was evaluated in HRPC in relation to overall response, toxicity and survival. 21 patients with progressive, metastatic HRPC were r and omized to receive either [I] estramustine 280 mg PO tid, [Dl-5] with docetaxel as 70 mg/m[2] [1 hour infusion- D2] and recycling 3 weeks or [II] docetaxel 35 mg/m[2] [1 hour infusion] weekly for 3 consecutive weeks and estramustine 140 mg PO tid on days [Dl-3], [D8-10] and [D15-17] with recycling every 4 weeks. Primary endpoint was time to progression. However secondary endpoints were response rate, toxicity and survival. Twenty one patients were presented with a median age of 69 years [range, 49-78 years], median Gleason score of 8 [range, 6-10]. Metastases to bones and lymph nodes were present in 85.7% and 38.1% of total cases respectively. PSA response was statistically higher in weekly regimen than conventional schedule [75% vs. 44.4%], while partial response and pain relief was [22.2% vs. 33.3%] in conventional schedule compared to [44.4% vs. 50%] in weekly regimen respectively [p>0.05]. Median time to progression was [6.1 months vs. 5.6 months]; median survival [18.2 months vs. 16.5 months] and overall 1 year survival [77.8% vs. 66.7%] in conventional schedule vs. weekly regimen respectively. Grade III/IV of neutropenia occurred in 44.4% vs. 25% in conventional schedule treatment and weekly regimen respectively [p<0.05]. Neutropenic fever occurred only in one patient [11.1%] in conventional schedule group. Docetaxel-estramustine is a good effective combination of chemo-hormonal treatment used for hormonerefractory prostate cancer. Even though administration of lower weekly doses of doctaxel-estramustine does not seem to have statistically significant effect on time to disease progression and survival, but criteria of objective response rate with increase PSA response and measurable disease response and subjective improvement of pain are promising. Hematological toxicity, fatigue, fluid retention, attacks of thrombosis and neurotoxicities were lower in weekly regimen compared to conventional schedule. Nevertheless, the data presented here suggest that additional larger r and omized studies of [docetaxel plus estramustine] in lower doses and intermittent schedule are needed to better evaluate the efficacy and survival outcome of this regimen in men with HRPC

Aerodynamic analysis of hoarseness of voice pre and post-antireflux therapy in GERD cases with reflux posterior laryngitis

To evaluate the hoarseness of voice by aerodynamic analysis in cases of GERD with reflux posterior laryngitis before and after empiric therapy of omeprazole. Out of 154 newly diagnosed GERD cases with posterior laryngitis, sixty four patients with persistent hoarseness were evaluated clinically, examined by digital videolaryngoscope and underwent aerodynamic analysis in comparison to 22 controlled patients before and after empiric therapy of omeprazole. First group involved 52 patients showed improvement by following the pre and post- hoarseness scores, pre and post endoscopic laryngeal findings scores, and the pre and post- aerodynamic parameters in comparison to the normal controlled group. Second group involved 12 non improved patients. Hoarseness patients in our study fall predominantly into the atypical GERD group [silent refluxers]. It seems that the main value of aerodynamic measurements is to evaluate the levels of hoarseness in GERD cases and monitoring the pre and posttherapeutic changes of voice disorders, and they have limitations in identifying which patient will respond or not to empirical treatment

Effects of neuropeptide derivative FPF 1070 [cerebrolysin] administration on experimental acute spinal cord injury: a histological study

Cerebrolysin is a neuropeptide-derived synthetic preparation produced by enzymatic breakdown of lipid-free animal neuroproteins. It regulates the neuronal energy metabolism and is supposed to afford brain protection by its neurotrophic stimulation. The present study aimed at assessing the possible neuroprotective effects of Cerebrolysin on an experimentally induced spinal cord injury in dogs depending on clinical and histological bases. The experiment was conducted on 20 adult male dogs, which were divided among five groups: A sham operated control group [subjected only to laminectomy of the midthoracic vertebrae], a positive control group [subjected to laminectomy with subsequent daily Cerebrolysin administration for 15 days], an acute spinal cord injury group [injury was induced by compression using an inflated balloon of the Folleyis catheter over the mid-thoracic spinal cord segments] and the animals were killed 24 hours after the surgery, a spinal cord injury group with subsequent daily administration of isotonic saline for 15 days and a spinal cord injury group with subsequent daily Cerebrolysin administration for 15 days. Clinical follow up of the experimental animals was daily recorded for 30 days, after which serial sections were prepared from the injured spinal cord segments of the different sacrificed groups. They were examined histologically by routine haematoxylin and eosin and by toluidine blue stains. The end results proved that Cerebrolysin achieved satisfactory protection to the nervous tissue. It prevented the setting in of degenerative changes in the majority of the anterior horn neurons of the injured spinal cord segments and subsequently its propagation in the axonal nerve fibers in the white matter. Therefore, Cerebrolysin administration was recommended as a successful treatment during the management of acute spinal cord injuries. It was also suggested that studies should be extended to investigate a possible similar effect in the case of human spinal cord injury as well as in chronic lesions

[Ocular findings in megaloblastic anemia associated with diabetes. A case report]

Ocular involvements of Biermer's anaemia are rarely reported in literature. We present a case of Biermer's anaemia associated with diabetes. Ocular examination showed important conjinctival paleness, diffuse retinal ischemia, Roth's tasks, macular oedema and ischemic optic neuropathy. The patient was treated with vitamin B12 intramusculary. A month later, on examination, we noted a regression of optic neuropathy, the aggravation of ischemic retinopathy and persistence of macular oedema. The patient was treated with laser photocoagubation. The majority of ocular manifestations are reversible if treatment is undertaken early. The combination of diabetes with Biermer's anemia deteriorates the ischemic retinopathy and aggavates its prognosis

protective effect of silymarin on the suprarenal gland in chlorpyrifos intoxicated rats

Chlorpyrifos [CPF] is a widely used organophosphorous insecticide that induces toxic effects in man and animal through its inhibitory action on acetyl choline esterase enzyme. The present work aimed to evaluate the toxic effect of chlorpyrifos on the function and structure of the suprarenal gland and to investigate the possible protective effect of silymarin antioxidant against such toxicity. The study included twenty four adult male rats they were equally divided into four groups as follows: a control group [n=6] received the oral vehicle only [corn oil], a Silymarin group [n=6] received Silymarin in a dose of 6mg/kg b. w orally twice weekly for four weeks, the intoxicated group [n=6] received CPF 5mg/kg b. w, orally twice weekly for four weeks and the protection group [n=6] receivied silymarin orally 6mg/kg b. w. half an hour after chlorpyrifos, administration in a dose of 5mg/kg b. w. orally twice weekly for four weeks. By the end of the experiment, estimation of the following biochemical parameters was done: plasma choline esterase enzyme activity level, serum cholesterol, serum cortisol and serum testosterone. The suprarenal gland was examined by the light microscope using routine H and E stain and chromaffin stain reaction as well as by the Transmission Electron Microscope. The measured biochemical parameters showed significant variation in CPF group compared to the control. The chlorpyrifos intoxicated group revealed affection of the cells of the suprarenal cortex and medulla with variable degrees of degenerative changes. The protection group showed improvement of the levels of the biochemical parameters with partial restoration of the normal histological features of the suprarenal structure compared to the CPF intoxicated group. Accordingly, it was proved that silymarin is a reliable antioxidant that could protect against the toxic effect of chlorpyrifos on the suprarenal gland

Evaluation study of tuberculosis risk in patients with end stage renal disease undergoing haemodialysis

Because of Immunity defect patients with end stage renal disease [ESRD] are at increased risk of developing infections, tuberculosis [TB] in particular. The incidence of TB is higher in dialysis patients than in general population, the aim of this study was to evaluate the prevelance of TB among ESRD patients undergoing haemodialysis and to assess its risk factors and clinical features. The present study controlled 203 patient: on haemodialysis. They were subjected to history taking clinical examination chest x-ray routine laboratory investigations, mycobacteriological examination, BACTEC culture, PCR for a valuable samples. The results showed that the prevalence of tuberculosis in patients undergoing haemodialysis was 10.96%. Total tuberculin positivity was detected in [13.6%] with [75.1%] positive in tuberculous cases versus [7.2%] in non tuberculous patients. This difference was statistically significant [P < 0.05]. The sensitivity and specificity of tuberculin test was [75.12%], [78%] respectively, while for ZN stain it was [85.7%], [100%] respectively, anti for PCR it was [95.24%]. [96%] respectively Diabetus mellitus as found to be the aetiology of renal failure in patients who developed tuberculosis in [47.69%], Hepatitis B was found in [28.56%], and hepatitis C in 42.86%. TB screening of patient population's undergoing dialysis is advisable. The ESRD population has an increased risk of TB with a greater frequency of extrapulmonary presentations and fever. Enhanced a awareness of TB in the ESRD population, early diagnosis and treatment are very important in order to improve the outcomes

Evaluation of a rapid assay for detection of rifampicin resistance in my cobacterium tuberculosis; a microbiological, clinical and epidemiological study

The aim of the present study was to portray the clinical and epidemiological features of mycobacterium tuberculosis [MDR-TB] patients and to determine the ability of a commercial kit [fast plaque TB-RifTM test] to correctly identify, within 48 hours, rifampicin susceptibility on the strains of Mycobacterium tuberculosis cultured on solid media and compare it with a conventional method of susceptibility testing. Sputum specimens were collected from hospitalized patients with known or suspected pulmonary tuberculosis. They were examined microscopically after Ziehl-Neelsen staining. Specimens that were 1+ smear +ve were inoculated on LJ medium and incubated for eight weeks. Forty-five cultures were tested for rifampicin susceptibility, employing both the proportion and the fast plaque TB-RifTM test. The study concluded that fast plaque TB-RifTM test offers a performance comparable with the standard conventional method of rifampicin susceptibility testing. Furthermore, it has the advantage of quick results [within 48 hours] without the need for specialized equipment. This makes it a reliable rapid diagnostic tool in testing for rifampicin resistance and as an indicator of MDR in TB

Urodynamic assessment of sacral root neuromodulation in patients with intractable storage and voiding dysfunctions

Objective: Sacral root neuromodulation is becoming one of the standard options for the treatment of intractable voiding dysfunction. The current report presents the urodynamic changes supporting the subjective improvement achieved by sacral root neuromodulation in patients with both voiding and storage problems

Patients and Methods: Out of 50 patients being candidates for peripheral nerve evaluation [PNE] for various voiding and storage problems, 38 patients agreed to be subjected to urodynamics before, during and after subchronic PNE. Seventeen patients presented with an urgency-frequency syndrome, 9 with urge incontinence and 12 with chronic idiopathic urinary retention. All patients had failed to respond to various previous oral and intravesical treatments. The protocol included a four-day voiding diary and urodynamics before, during and after subchronic PNE

Results: Significant changes in the urodynamic results of the patients during PNE were noted. Urodynamics of the urge incontinence and urgency-frequency patients showed an increased volume compared to the first urge cystometric bladder capacity after sacral root neuromodulation. The cystometrograms of patients with chronic idiopathic urinary retention did not show any difference during PNE when compared to the pre-PNE tests. Pressure-flow studies that were not possible before PNE became normalized during PNE. The urodynamics of all patients one week after PNE showed variable degrees of deterioration. The urodynamic findings of 7 patients who had an implantation of permanent programmers still showed the same results as after PNE testing

Conclusion: There is a definite correlation between both subjective and objective improvement of patients on neuromodulation proved by urodynamic studies. However, this needs to be further evaluated as a predictor for success

Clinical prognostic factors in patients with advanced stage of prostate cancer

Objectives: To determine the prognostic factors that could predict patient outcome in patients with advanced stage prostate cancer

Patients and Methods: In this study we retrospectively evaluated the medical record data of 222 patients with advanced stage prostate cancer treated by hormonal therapy [either castration or total androgen blockade [TAB]]. All pre- and post- treatment data records were evaluated with respect to patient age, prostate and tumor size, tumor grade, stage, PSA, alkaline and acid phosphatase and the number of bone lesions. The response to the hormonal treatment was evaluated either early [12 months after treatment] or late [over all follow-up visits until the last visit or death]. Descriptive statistics, student T test, multivariate and Kaplan Meier's curve were used for data analysis

Results: Within 12 months of treatment 70% of the cases showed an improvement with a significant decrease of their pre-treatment values after hormonal therapy. Patient age, tumor stage, the number of bone lesions, serum alkaline and acid phosphatase levels in the pre-treatment data were significantly independent predictors of the overall survival outcome [p= 0.0015, 0.002, 0.001, 0.0002 and 0.028, respectively], while the pre-treatment PSA serum level, tumor grade and the type of hormonal treatment used [either castration or TAB] were no predictors of patient outcome [p= 0.18, 0.82 and 0.47, respectively]. Importantly, the PSA serum level and the number of bone lesions in the first 12 months of patient follow-up were significant predictors of the overall disease survival status [p=0.001 and 0.028, respectively]. The mean follow-up period of alive cases was 39.42 months ranging from 6 - 171 months. Of the 222 cases 110 [51.6%] had overall disease progression during a mean of 59.4 months, while mortality was reported in 118 cases [53.2%] in the course of a mean of 59.9 months

Conclusion: The pre-treatment patient age, tumor stage, serum alkaline and acid phosphatase, as well as the post-treatment PSA level and the number of bone lesions were significant independent predictors of the overall patient outcome in patients with advanced stage prostate cancer. However, a survival analysis in relation to the treatment type did not reveal a statistically significant difference between the outcomes of castration and TAB