ABSTRACT
Abstract Ulcerative colitis is one of the IBDs. Its etiology and pathogenesis remain undefined with an interaction between environmental, genetic and immunological factors is the most accepted explanation. Several recent studies have examined microRNA expression in the peripheral blood and tissues from IBD patients. The study aims at assessing the expression of serum miR-16 in ulcerative colitis patients and its correlation with disease extent, activity and severity. It included 30 treatment naïve ulcerative colitis patients of different presentations. Serum miR-16 expression was assessed using reverse transcriptase quantitative real time PCR (RT-qPCR), and then correlated with that of a group of 20 healthy subjects to assess its role in diagnosis of ulcerative colitis. Also, it was correlated with disease extent (proctitis, left sided colitis, extensive colitis) and disease activity and severity indices (Truelove and Witts criteria, fecal calprotectin and UCEIS). Thirty ulcerative colitis patients were enrolled, 53% had mild, 37% had moderate, while 10% had severe disease. Concerning endoscopic extent, 8 had proctitis, 14 had left sided colitis and 8 had extensive colitis. Serum expression of miR-16 in the 30 patients were compared to that of the healthy control subjects. The patients' group showed median serum miR-16 expression of 1.91, 1.13 for the control group with a significant difference between both groups. Correlation between serum miR-16 expression with disease extent, activity and severity showed no significant relation. From the current study we can conclude that increased serum expression of miR-16 is associated with ulcerative colitis despite no significant relation to disease activity extent or severity.
Resumo A colite ulcerativa é uma das DII. Sua etiologia e patogênese permanecem indefinidas; a interação entre fatores ambientais, genéticos e imunológicos é a explicação mais aceita. Vários estudos recentes avaliaram a expressão de microRNA no sangue e tecidos periféricos em pacientes com DII. O presente estudo teve como objetivo avaliar a expressão do miR-16 sérico em pacientes com colite ulcerativa e sua correlação com a extensão, atividade e gravidade da doença. Foram incluídos 30 pacientes de colite ulcerativa, com diferentes apresentações, que ainda não haviam sido submetidos a nenhum tipo de tratamento. A expressão sérica de miR-16 foi avaliada usando transcrição reversa seguida de reação em cadeia da polimerase quantitativa (RT-qPCR) e, em seguida, correlacionada com a de um grupo de 20 indivíduos saudáveis para avaliar seu papel no diagnóstico de colite ulcerativa. Além disso, foi feita uma correlação com a extensão da doença (proctite, colite do lado esquerdo, colite extensa) e com os índices de atividade e gravidade da doença (critérios de Truelove e Witts, calprotectina fecal e UCEIS). Trinta pacientes com colite ulcerativa foram incluídos no estudo, classificada como leve em 53%, moderada em 37% e grave em 10%. Quanto à extensão endoscópica, oito apresentavam proctite, 14 apresentavam colite do lado esquerdo e oito apresentavam colite extensa. A expressão sérica de miR-16 nos 30 pacientes foi comparada à dos indivíduos controle saudáveis. No, grupo de pacientes, a expressão sérica de miR-16 foi de 1,91 (grupo controle: 1,13), uma diferença estatisticamente significativa entre os dois grupos. Não foi observada relação significativa entre a expressão sérica de miR-16 e a extensão, atividade e gravidade da doença. A partir do presente estudo, pode-se concluir que o aumento da expressão sérica do miR-16 está associado à colite ulcerativa, apesar de não haver relação significativa com a extensão ou gravidade da atividade da doença.
Subject(s)
Humans , Male , Female , Colitis, Ulcerative/genetics , Colitis, Ulcerative/pathology , MicroRNAs , Inflammatory Bowel Diseases , Reverse Transcriptase Polymerase Chain Reaction , Reverse Transcription , Real-Time Polymerase Chain ReactionABSTRACT
Background: Diabetic macular edema is one of the most significant causes of blindness and severe visual impairment in patients with diabetes, which can result in reduced quality of life. Three commonly used intravitreous VEGF inhibitors aflibercept, bevacizumab and ranibizumab have been shown to be beneficial and relatively safe for the treatment of diabetic macular edema, but only aflibercept and ranibizumab are approved by the Food and Drug Administration [FDA] for this indication
Aim of the Work: To compare between the effect of ranibizumab and aflibercept in patients with diabetic macular edema as a diabetic retinopathy complication that leads to visual impairment
Patients and Methods: A prospective study of 20 patients [20 eyes] was conducted in Al-Mouneer diabetic eye center with three times injection one month apart. The patients were divided into two groups, Group A was consisted of 10 patients who received ranibizumab as 0.5 mg [0.05ml of 10mg/ml solution] an intra vitreal injection. Group B was consisted of 10 patients who received aflibercept 2 mg [0.05mL of 40mg/ml solution] as an intra vitreal injection with follow up for three months
Results: A statistically significant difference over the time through BCVA and central macular thickness with ranibizumab. There was also a statistically significant difference over the time through BCVA, central macular thickness and IOP with aflibercept
Conclusion: There was more improvement in BCVA which was significant and more reduction in central macular thickness with ranibizumab than with aflibercept
Recommendations: Larger group studies to confirm our results; longer term study for the effect of ranibizumab and aflibercept injection on the central macular thickness and IOP and comparing the effect of single injection versus multiple injections. Searching for the causes of resistance or delayed response to the intravitreal injections in some patients
ABSTRACT
Background: Urolithiasis is the third most frequent urological disease in the world, affecting both males and females. It is one of the most common conditions encountered in Emergency Departments [ED] worldwide
Objective: To evaluate the frequency of visits and hospital admissions related to urolithiasis. Design: A Retrospective Review. Setting: Emergency Department, King Hamad University Hospital, Bahrain
Result: Four hundred eighty-six patients were diagnosed for the first time with urolithiasis. The mean number of the patients is 40.5 per month; the highest was 70 [14.4%] patients in May 2014 and the lowest was 23 [4.7%] patients in December 2014. Four hundred four [83.1%] males were diagnosed with urolithiasis. There was almost no difference between the number of Bahraini patients and non-Bahraini patients, 237 [48.8%] and 249 [51.2%] respectively. The age group frequently affected are those between 20 to 49 years. The majority of the stones were located in the ureter and/or in the kidney. Two hundred thirty-six [48.6%] patients had ureteric stones, and 109 [22.4%] patients had kidney stones. One hundred twenty [24.7%] patients had both kidney and ureteric stones. Thirteen 13 [2.7%] patients had stones in the bladder and 3 [0.6%] patients in the urethra. Two [0.4%] patients had stones in the bladder and the kidney. Three [0.6%] patients had stones in the bladder and ureter
Conclusion: This study is the first to address urolithiasis incidence in emergency department and trends of hospitalization. Further multicentric studies investigating contributing factors and prevalence of urolithiasis are needed
ABSTRACT
Objectives: Gastrointestinal symptoms are a common feature in children with pervasive developmental disorders, drawing attention to a potential association with celiac disease or gluten sensitivity. However, studies to date regarding the immune response to gluten in Pervasive Developmental disorders and its association with celiac disease have been inconsistent
Subjects and Methods: This cross sectional case control study included 45 patients aged 3 to 12 years [with or without gastrointestinal symptoms] diagnosed with Pervasive Developmental Disorders according to DSM- IV TR, Childhood Autism Rating Scale [CARS] and Gallium test for autistic characters. EEG was done to diagnose epilepsy. They had been regularly attending out patient clinic of center for care of children with special needs, institute of postgraduate childhood studies; Ain shams University, Egypt for at least one year. Forty five apparently healthy children of matched age and sex were recruited as a control group. Serum levels of IgG, IgA, IgM class antibodies to gliadin were measured by using EL1SA methods
Results: A total of forty five autistic children with confirmed diagnosis aged between 3 to 12 years were studied. They were 36 males and 9 females with male to female ratio 3.5:1. The mean age of introduction to cereals was 6 months [range 4- 8 months]
The main gastrointestinal symptoms as abdominal distension was present in 20 patients [44.4%], constipation in 16 patients [35.6%], chronic diarrhea in 8 patients [17.8%], vomiting in 9 patients [20%], anorexia in 19 patients [42.2%], iron- deficiency anemia that does not respond to iron therapy in 24 patients [53.3%], feeding difficulties in 10 patients [22,2%]. None of the autistics examined were positive for IgA and IgG antibodies tested, and 60% patients showed high serum levels of IgM antibodies to gliadin
Conclusion: The increased anti- gliadin antibody response and its association with GI symptoms points to a potential mechanism involving immunologic and/or intestinal permeability abnormalities in affected children. Immunological detection of, IgA, IgM and IgG antibodies dass to gliadin are useful tool in the diagnosis and follow-up of the disease
ABSTRACT
Diffusion weighted imaging [DWI] offers molecular information that complements the morphologic information obtained with conventional magnetic resonance imaging [MRI] and can reflect the functions and structures of the body without trauma. To assess the role of DWI as a routine sequence in a MRI study to help in differentiating liver lesions. The study included 50 patients referred to do a MRI study to diagnose and/or to confirm the ultrasonographic or CT findings of focal hepatic lesions. The examination was done on 1.5T superconducting magnet MRI machines; Philips Gyroscan Intera version 12.1.1.2 [Best, The Netherlands] and Siemens Magnetom Avanto [Erlangen, Germany] machine. All studied patients had a focal hepatic lesion either on top of cirrhotic liver or non cirrhotic liver. DWI was found to be helpful with the routine MRI sequences to reach the diagnosis. The final diagnosis was confirmed by histopathological examination or follow up. A cutoff value of ADC for benign lesions was found to be 1.25 x 10[-3] mm[2]/s. DWI should be included as a basic sequence in the routine MRI study of the liver as it helps in diagnosis and so reaching a final diagnosis or at least trying to narrow the list of differential diagnosis
ABSTRACT
The study aims not only to determine the value of preoperative MRI of perianal fistula but also to detect MRI fallacious results, if any. Also, it aims to suggest how we can limit such false positive MRI results that may lead to unnecessary surgery. This was a prospective comparative study, included 100 patients. Fifty of them [group A] were operated following the guidance of preoperative MRI, while the other 50 patients [group B] directly operated without MRI. The study protocol was approved by the ethics committee in Al-Mana General Hospital. Group A: surgically proven 24 patients grade 1, 13 grade 2, 4 grade 3, 4 grade 4 and 3 grade 5. MRI grading was 26 grades I, 13 grade 2, 4 grade 3, 4 grade 4 and 3 grade 5. Two patients were false positive. Postoperative complications: 2 recurrences, 1 incontinence and 1 both recurrence and incontinence. Group B: surgically proven 22 patients grade 1, 11 Grade 2, 8 grade 3, 3 grade 4 and 3 grade 5. Clinical preoperative grading was 42 patients grade 1 and 8 grade 2. Three patients were false positive. Postoperative complications: 17 recurrence, 6 incontinence, 3 concomitant recurrence and incontinence. MRI is a very helpful tool of preoperative imaging of perianal fistula. Its fallacious preoperative positive results - that may lead to unnecessary surgeries - can be corrected by standardizing IV gadolinium contrast as routine protocols or using complementary Color Doppler US examination of the fistulous track
Subject(s)
Humans , Female , Male , Magnetic Resonance Imaging , Preoperative Care , Rectal Fistula/surgery , Postoperative Complications , Recurrence , Follow-Up StudiesABSTRACT
Percutaneous mitral balloon valvuloplasty [MBV] was introduced in 1984 by Inoue who developed the procedure as a logical extension of surgical closed commissurotomy. Since then, MBV has emerged as the treatment of choice for severe pliable rheumatic mitral stenosis [MS]. With increasing experience and better selection of patient, the immediate results of the procedure have improved and the rate of complications declined. When the reported complications of MBV are viewed in aggregate, complications occur at approximately the following rates: mortality [0-0.5%], cerebral accident [1-2%], mitral regurgitation [MR] requiring surgery [1.6-3%]. These complication rates compare favorably to those reported after surgical commissurotomy. Several randomized trials reported similar hemodynamic results with MBV and surgical commissurotomy. Restenosis after MBV ranges from 4% to 70% depending on the patient selection, valve morphology, and duration of follow-up. Restenosis was encountered in 31% of the author's series at mean follow-up 9 +/- 5.2 years [range 1.5-19 years] and the 10, 15, and 19 years restenosis-free survival rates were [78 +/- 2%] [52 +/- 3%] and [26 +/- 4%], respectively, and were significantly higher for patients with favorable mitral morphology [MES
Subject(s)
Humans , Mitral Valve Stenosis/surgery , Mitral Valve/surgery , Mitral Valve Insufficiency/surgeryABSTRACT
In challenging working environment, one way to empower staff is to allow them to make decisions about their tasks of care delivery or get them involved in a participative way. These management practices not only enhance the contributions or productivity of nurses in an effective manner but also enable nurses to exercise their autonomy, to sense their value of work and satisfaction. Empowerment is the interactive process of building, developing and increasing a person's ability to set and attain goals. Employee empowerment may be influenced by the perception that the organization cares about its employees' wellbeing and that their work is valued. Empowering nurses may increase job satisfaction and improve patient care. Leadership style and empowerment influence job satisfaction among workers. Transformational leadership processes have also been suggested to enhance followers' work-oriented values and shape the self-efficacies of followers. Transformational leadership is viewed as an interactive relationship based on trust that impacts positively on the leader and employees. Is to explore the relation between Leaders Empowerment behavior and Its Effect on Nurses Empowerment and Job Satisfaction in two hospitals [Shebin Elkom University Hospital and Alhelal Insurance Hospital units. This study descriptive comparative study has included 97 staff nurses working and 57 head nurses in two hospitals. Measure empowering leader behavior utilizing Leader questionnaire Empowerment Motivation for employees, Measure job satisfaction for staff nurses utilizing Work Quality Index and measure empowerment for staff nurses utilizing Psychological Empowerment questionnaire sheet. The majority of specialty units staff nurses at Shebin El Kom University Hospitals and El helal Hospital perceived level of empowerment. A positive, moderate correlation was found between job satisfaction of registered staff nurses and their leaders Empowerment Behavior. Leaders empowering and motivating were positively related to job satisfaction, as was empowerment. Staff nurses perceived their leaders' behaviors to be somewhat empowering and their work environment to be moderately empowering. Leader empowering behaviors had an indirect effect on satisfaction through structural empowerment. It is recommended to direct leader how to empowering and motivation for staff nurses to empowerment and job satisfaction. Designing interventions that allow for the relative influence of leadership style as well as empowerment on varying classifications of nursing personnel may be a more effective strategy and have a greater effect on staff attitudes and behaviors
Subject(s)
Humans , Female , Job Satisfaction , Nurses , Surveys and QuestionnairesABSTRACT
Imaging diagnosis of small bowel diseases has long been technically challenging. Imaging techniques included plain radiography, contrast studies, computed tomography [CT], magnetic resonance imaging [MRI], sonography, scintigraphy and angiography. Multi-row detector CT [MDCT] enterography is a new technique that improved depiction and characterization of small bowel pathology. To assess the role of multi row detector computed tomography [CT] enterography in evaluation of small bowel disorders. The study was conducted on 30 patients suffering from known or suspected small intestinal disease and subjected to CT enterography using multi-detector row CT and iso-osmotic mannitol as neutral enteric contrast material. CT showed symmetrical mural and mucosal changes in 12 patients, seven of them associated with comb sign and creeping fat sign proved to be Crohn's disease and five patients without specific features due to Crohn's, ulcerative colitis, typhoid colitis, ileitis sequel to complicated appendicitis and typhlitis with ileitis. CT showed symmetrical thickening, grey attenuation pattern and aneurysmal dilatation proved to be lymphoma in three patients. CT showed vascular occlusion and mural changes in two patients. CT showed hyperattenuating lesion in two patients due to bowel wall hematoma, CT showed asymmetrical thickening in four patients, two of them showed infiltrative mesenteric mass with calcifications and desmoplastic reaction proved to be due to carcinoid tumour. One patient with asymmetrical thickening showed strongly enhancing lesion in the enteric phase in the second part of duodenum proved to be periampullary carcinoma. The fourth patient with asymmetrical thickening showed heterogeneous enhancement in the venous at distal heal loop with mesenteric stranding, lymph adenopathy and liver deposit proved to be due to adenocarcinoma. CT showed dilated bowel loops with transitional zone in two patients proved to be due to intestinal obstruction, There were five patients with unremarkable CT features that were followed up without definite lesion. CT enterography with iso-osmotic mannitol is a simple, non invasive, economic, effective method for assessing small bowel disease and can replace other imaging modalities
Subject(s)
Humans , Male , Female , Tomography, X-Ray Computed , Intestine, SmallABSTRACT
Long-term echocardiographic follow-up studies of mitral balloon valvuloplasty [MBV] are scarce. The study aim was to assess the long-term results [up to 18 years] of MBV and to identify predictors of restenosis and event-free survival. The immediate and long-term clinical and echocardiographic results for 531 consecutive patients [mean age 31 +/- 11 years] who underwent successful MBV for severe mitral stenosis [MS] and were followed up for a mean of 8.5 +/- 4.8 years [range: 1 .5 to 18 years] after MBV are reported. Immediately after MBV, the mitral valve area [MVA] was increased from 0.92 +/- 0.17 cm[2] to 1.95 +/- 0.29 cm[2] [p< 0.0001]. Restenosis occurred in 165 patients [31%], and was less frequent [19%] in patients with a low mitral echo score [MES 8 [p< 0.001]. Event-free survival [death, redo MBV, mitral valve replacement, NYHA class III or IV] at 10, 15 and 18 years was 88 +/- 1%, 53 +/- 4%, and 21 +/- 5% respectively, and was significantly higher for patients with MES 8 [p< 0.0001] and previous surgery [p= 0.043] as predictors of restenosis, and MES >8 [p< 0.0001] and baseline atrial fibrillation [p=0.03] as predictors of combined events. MBV provides excellent long-term results for selected patients with MS. The long-term outcome of this procedure can be predicted from the baseline clinical and echocardiographic characteristics of the mitral valve