Study of the level of copeptin in patients with diabetic retinopathy

Background: the prevalence of Diabetic retinopathy in Egypt among adult diabetic patients in 2010 was around 20.5%. 90 percent of all cases of blindness from diabetes can be prevented. Copeptin, a novel biomarker [a surrogate to arginine vasopressin was found to increase with diabetic nephropathy

Objectives: to study the level of copeptin in patients with diabetic retinopathy

Methods: the study was conducted on 96 individuals divided into 4 groups. Group I 24 patientswith proliferative diabetic retinopaty [PDR], Group II 24 patients with non-proliferative diabetic retinopathy [NPDR], Group III 24 diabetic patients with no evidence of retinopathy and Group IV 24 healthy non diabetic individuals. All participants were subjected to full medical history taking, slit lamp biomicroscope fundus examination and measurement of serum fasting blood sugar, 2 hour post prandial blood sugar, glycated hemoglobin, serum creatinine, serum copeptin and urinary albumin creatinine ratio

Results: the study shows a statistically significant rise in the level of copeptin in patients with PDR [Group I] and NPDR [Group II] when compared with those with no diabetic retinopathy [Group III] and the control group [Group IV] P value < 0.001. There was a statistically significant positive correlation with duration of diabetes [r = 0.589] and level ofalbumin/creatinine ratio [ACR] [r = 0.540] P value < 0.001

Conclusion: copeptin was found to be higher in proliferative diabetic retinopathy and non-proliferative diabetic retinopathy when compared to diabetics with no retinal complications and healthy individuals with a statistically significant difference. It was found to be significantly higher in diabetic patients in comparison with the normal population. There was a statistically significant positive correlation with ACR and duration of diabetes

Effect of sildenafil adminstration on ischemia/ reperfusion of the testis in adult albino rat light and electron microscopic study

Testicular torsion is a pathologic condition that renders the testis ischemic and surgical intervention is usually required to reestablish blood flow. To evaluate the role of sildenafil administered half an hour before reperfusion [detorsion] in preserving spermatogenesis and minimizing germ cell apoptosis. Thirty adult male albino rats were divided equally into three main groups. Group I as a control, group II subjected to left testicular torsion for 1 hour followed by detorsion and group III was injected intraperitoneally [I/P] with a single dose of 0.14mg/1ml of sildenafil solution 30 min before detorsion. All animals were sacrificed after 24 hours. Both testes of each group were extracted and processed for light and transmission electron microscopic study. Immuno-histochemical study using Fas-Ligand stain was done for detection of apoptotic cells. Morphometric measurements of the diameters of seminiferous tubules, number of germ cells and apoptotic cells as well as Leydig cells were performed and subjected to statistical analysis. Revealed that unilateral testicular Torsion/Detorsion [T/D] induced marked damage of both testes with more affection of the ipsilateral side. Both testes revealed defective spermatogenesis with wide areas of cell loss and absence of early spermatids. Morphometric results of both testes revealed significant increase of number of apoptotic germ cells together with a significant decrease of the number of both germ cells and Leydig cells as compared to control. Ultrastructurally, Sertoli cells of both sides revealed large cytoplasmic vacuoles with interrupted inter-sertoli junctional specialization. Primary spermatocytes of both sides exhibited shrunken nuclei with dense clumped chromatin and damaged cytoplasmic organelles. The early and late spermatids showed abnormal appearance. On the contrary, sildenafil-treated group revealed a protective effect of sildenafil on both sides. This was proved ultrastructurally and by the morphometric results, which showed significant increase of the number of both germ and Leydig cells with significant decrease of apoptotic germ cell number as compared with T/D group. Sildenafil pretreatment could be promising as an adjuvant therapy to surgical repair for rescuing the testis from ischemia/reperfusion. Hence, orchidectomy could be avoided

Plasma Ghrelin level; anorexigenic and orexigenic mediators in patients with end stage renal failure on hemodialysis

Anorexia-associated malnutrition is a severe complication that increases mortality in hemodialysis [HD] patients. Ghrelin is a recently-discovered orexigenic hormone with actions in brain and stomach. We analyzed, in 22 HD patients, the possible relationship between ghrelin and appetite regulation with regard to other orexigens [NO3] and anorexigens [cholecystokinin [CCK], leptin, glucose-dependent insulinotropic peptide [GIP]. All orexigens and anorexigens were determined in plasma. Eating motivation was evaluated using a visual analog scale [VAS]. The patients were divided into three groups: those with anorexia [n = 8], those with obesity associated with high intake [n = 5], and those with no eating behavior disorders [n = 9]. A control group of 10 healthy volunteers was also evaluated. Mean plasma levels of ghrelin were high [4101 +/- 1233 mg/mL], with the patients showing values above the control group range [1920 +/- 451mg/mL]. Patients with anorexia had lower ghrelin level and higher CCK and GIP levels than did the other patients. Patients with anorexia also had an early satiety score and low desire and pleasure in eating on the VAS and diet survey. We observed significant positive linear correlations between ghrelin and albumin [r = 0.43, p < 0.05], growth hormone [r=0.66, p < 0.01], NO3 [r = 0.36, p < 0.05], and eating motivation [VAS]. At the same time, negative relationships were observed between blood ghrelin and GIP [r = -0.42, p < 0.05], insulin [r = -0.4, p < 0.05], and leptin [r = -0.45, p < 0.05]. Ghrelin levels were not related to levels of CCK. Ghrelin plasma levels are elevated in HD patients. Uremic patients with anorexia show relatively lower ghrelin plasma levels than the levels seen in obese patients or in patients with normal appetite. The role of ghrelin in appetite modulation is altered in uremic HD patients, and that alteration is possibly associated with disorders in insulin and growth hormone metabolism

use of bone graft in reconstruction of the acetabulum in primary hip replacement

Material: Between 1995 and 1998, 28 total hip replacements were performed. Autografting of the acetabulum was performed in all cases. Nineteen patients were females and 9 were males. The youngest patient was 38 years old and the oldest 83. Morselized bone graft was used in 15 hips [53.6%], bone graft and one plate in 8 hips [28.6%] and bone graft and titanium mesh in 5 hips [17.8%]. Acetabular defect was medical cavitary in 15 hips [53.6%], medial cavitary and medial segmental in 3 hips [10.7%], segmental superior in 6 hips [21.5%], segmental superior and anterior in 2 hips [7.1%], and segmental superior and posterior in 2 hips [7.1%]. Method: Posterior approach was used in all cases. Bone graft from the patient's own femoral head was cut into small pieces about 0.5 - 1.0cm manually using bone nibbler after removing the articular cartilage, or as a segment of cortico-cancellous graft. Follow-up period: The average follow up period was 3.9 years. The average modified Harris Hip score was 31.7 points and at the end of follow up 69.8. In 26 cases [92.86%] the graft appeared to be incorporated securely to the acetabulum as determined by radiographic examination. There were two failures [7.14%]. In one hip the cup was migrated 22 mm superiorly and the other cup showed upward migration of 8 mm. Femoral head autograft appears to provide a useful technique for the reconstruction of a severely deficient acetabulum during primary hip arthroplasty