Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes

Our Study Aimed: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on obese T2DM patients, its effect in remission of diabetes and role of gastrointestinal Glucagon like peptide 1(GLP1) and Peptide tyrosine tyrosine (PYY) hormones.Metabolic surgery should be recommended as an option in type 2 diabetic patients (T2DM) with body mass index (BMI) ≥40 Kg/m2, in patients who have BMI ≥35 Kg/m2and in selected patients with BMI < 35 Kg/m2, if not achieving diabetes control with maximum tolerated anti-hyperglycemic treatment. Methods:30 T2DM patients with BMI ≥ 40 kg/m2underwent laparoscopic sleeve gastrectomy after full clinical evaluation, routine blood tests, glucagon like peptide 1, Peptide tyrosine tyrosine (fasting, 0.5-hour post-mixed meal test (MMT) serum levels) and upper GIT endoscopy. Follow-up visits were at 3, 6and 9 months postoperatively to evaluate body weight, BMI and glycated hemoglobin (HbA1C) and at 18thmonth for confirmation of diabetes remission. Gut hormones were measured at 15 days and 9 months postoperatively.Results: (53.3%) of patients had partial remission of T2DM according to HbA1C remission criteria. There was significant increase in fasting and post-MMT levels of peptide tyrosine tyrosine, glucagon like peptide 1 postoperatively. The only independent predictors for remission of T2DM were the baseline serum low density lipoprotein cholesterol (LDL-Ch), duration of diabetes, preoperative post MMT Peptide tyrosine tyrosine plasma level, serum thyroid stimulating hormone (TSH) and age. Conclusions: laparoscopic sleeve gastrectomycan induce partial remission of diabetes in younger patients who had shorter duration of diabetes, higher level of preoperative post-MMT peptide tyrosine tyrosine,lower levels of preoperative serum LDL-Ch and thyroid stimulating hormone

Occult hepatitis B infection in blood donors at Zagazig university hospitals, Sharkia governorate

Although, the incidence of transfusion-transmitted hepatitis B virus [HBV] has been reduced over last four decades, HBV remains the most frequent transfusion-transmitted infection .The aim of this study is to determine the percentage of anti-HBc positivity in HBsAg negative blood donors' samples and to estimate the frequency of HBV-DNA in HBsAg negative/anti-HBc positive and in some HBsAg/anti-HBc negative samples and to assess the presence of this OHBI in HBsAg negative HCV positive samples. Randomly selected 500 blood donors referred to Blood Bank, Zagazig University Hospitals at Sharkia Governorate were included, after routine blood bank serological tests, ALT and AST, total anti-HBc were done for blood samples that were negative for HBsAg. Samples were divided into two main categories according to their HCV Ab status [450 were negative for HBsAg, HCV Ab, HIV Ag/Ab and RPR and 50 were negative for HBsAg, HIV Ag/Ab and RPR but HCV positive], anti-HBs quantification, HBV-DNA by real-time PCR was performed for all samples anti-HBc positive and some randomly selected anti-HBc negative samples. The percentage of total anti-HBc among HBsAg negative blood donors, [HCV Ab negative] was 20.8% [94/450] and in [HCV Ab positive] was 26% [13/50]. The frequency of HBV-DNA in [HBsAg/HCV Ab negative] was 6/94 [6.4%] of anti-HBc positive blood donors and not detected in the randomly selected anti-HBc negative donors [0/16]. The percentage of HBV-DNA was higher in HCV Ab positive [13.3%] than HCV Ab negative donors [5.5%]. Most Occult Hepatitis B Infection [OHBIs] are asymptomatic, only be detected by systematic screening of large populations, detection of OHBI requires addition of anti-HBc tests along with HBsAg ending with NAT to donated blood screening tests for improving blood safety

Study of slow ultrafilteration as a therapeutic modality for chronic refractory congestive heart failure

Refractory heart failure usually represents the end stage of congestive heart failure in which hypotension and oliguria, lead to progressive generalized edema. The purpose of this study was to assess the efficacy of extracorporeal ultrafilteration [ECUF] as a modality for treatment of patients with refractory congestive heart failure who failed to respond to conventional anti failure measures. The study was carried out at a period for about six months and it included 40 patients, 18 men [45%] and 22 women [55%], they were selected from patients admitted to the intensive care of Internal Medicine Department and cardiology Department of Tanta University Hospital. Selection criteria were NYHA class III and IV heart failure, resting left ventricular ejection fraction [LVEF] <35, normal or mild elevated serum creatinine [patients with chronic renal failure were excluded from the study], lack of satisfactory response to conventional therapeutic regimen. All patients were subjected To ECUF ranged from 3 sessions in 12 patients and 4 sessions in 28 patients [mean 3.7 session/ptn] and between [4-6 hour/session]. It was initated at a rate of 0.5L/h to be readjusted subsequently according to the hemodynamic parameters available. Average amount of ultrafilterate/session ranged from 2.5-3 liters [mean2.6 +/- 0.4]. Both number and repition frequency were decided empirically on the basis of evolution of symptoms and response to drugs. All patients were subjected to the following assessment before and after ECUF: Daily morning checking of body weight [kg], hematocrit value [HTC%], urin output [ml/24h], serum electrolytes [Na[+], K[+]], blood urea and serum creatinine, hemodynamic monitoring including [heart rate, blood pressure and CVP], chest x-ray P-A view for measurment of CTR, E.C.G and transthoracic echocardiography for evaluation of cardiac function. Our results showed that there was significant increase of diuresis from [0.3410.14 to 2.0 +/- 0.7L/day] [p<0.001], significant reduction of mean H.R [120+5.0 to 98 +/- 11.0 beat/min] [p<0.001], significant CVP reduction [28.5 +/- 2.o to 15.5 +/- 7.0 cm water] [p<0.001], decrease of intravenous volume as assessed by significant increase of HCT value from [33.8 +/- 2.3% to 37.6 +/- 2.0%] [p<0.001] after ECUF, significant decrease of S. urea from [105.7 +/- 55.2 to 91.3 +/- 63.o4 mmol/L] and S. creatinine from [1.9 +/- 0.6 to 1.5 +/- 0.9 mmol/L] after ECUF. ECHO repeated after ECUF revealed highly significant reduction in the mean LVEDD from [7.0 +/- 0.2 cm to 6.4 +/- 0.6 cm] [p<0.001], reduction of LVESD from [6.5 +/- 0.4 cm to 5.5 +/- 0.8 cm] [p<0.001], reduction in mean LA dimension from [5.3 +/- 0.3 cm to 4.8 +/- 0.6 cm] [p<0.001], reduction of RV dimension from [4.7 +/- 0.4 cm to 4.0 +/- 0.8 cm] [p<0.001], significant increase of LVEF from [23.8 +/- 4.1 to 31.2 +/- 8.2] [p<0.001]: ECUF offers a reasonable effective and relatively safe method in the treatment of refractory heart failure. The relative ease of the procedure and low incidence of complications denote that this technique is a useful one in selected cases of heart failure, refractory to the conventional therapy with oliguria and fluid overload

Genetic role in recurrent acute otitis media

There is increasing interest that a strong genetic component is involved in the predisposition to recurrent acute otitis media [rAOM]. Study of human leucocyte antigens [HLA], as a genetic marker, by microcytotoxicity test and polymerase chain reaction [PCR] of 31 patients of rAOM was done to find out the relation between them for clarifying the pathogenesis of recurrence. The study showed HLA B21 antigen of class I and HLA DR2 antigen of class II were significantly increased p value. This supports the presence of an immunogenetic factor in pathogenesis of rAOM

Nosocomial bacterial pneumonia in mechanically ventilated newborns: incidence and causative micro-organisms

This study was conducted on 120 mechanically ventilated newborns in two different neonatal ICU [NICU] at two different countries. The patients were classified into two groups: Group [A] included 62 patients and group [B] included 58 patients. All newborns were mechanically ventilated for at lest 48 hours due to various indications and were subjected to full history, thorough clinical examination and routine laboratory investigations. Blood cultures and bronchial aspirates were done for all patients at time of onset of mechanical ventilation and repeated for those patients who developed clinical, radiographic and laboratory criteria of nosocomial pneumonia and subject to gram staining and culture sensitivity. It was found that the incidence of nosocomial bacterial pneumonia was high in both groups [16% in group A and 19% in group B]. Gram negative bacteria represented the most common causative organism in both groups [60% in group A and 72.2% in group B]. Klebsiella pneumonia was the most common gram negative bacteria in group A [40%], followed by Pseudomonas aeruginosa [20%]; while in group B, Pseudomonas aeruginosa was the commonest gram negative bacteria [45.45%], followed by Klebsiella [27.27%]. Staphylococcus aureus was common in group A [30%] which was not the case in group B [9.1%]

Changes in blood serum and milk contents during gradually obligatory restricted diet in lactating dairy cows

The effect of extended gradually obligatory underfeeding on milk yield, some milk and blood contents was studied in lactating Friesian cows. The animals were firstly fed on basal lactating diet. The diet was then gradually and weekly restricted for a period of 8 weeks. Blood serum contents showed restriction and thereafter. There was a significant decrease of total serum protein, glucose, calcium and inorganic phosphorus in the second week. Serum magnesium began to decrease in the third week. A significant elevation of total serum lipid recorded in the first week and thereafter. It could be concluded that a physiological response [of milk yield and its fat%] and biochemical alterations [of blood serum contents] indicated the change in metabolism when feed supply was gradually restricted in lactating cows fed on low levels of nutrition

Effect of prolonged administration of magnesium sulphate on general health condition and kidney function in calves

Magnesium is a nutrient required for all animals, but it is especially critical for ruminants. Its functions primarily as an enzyme cofactor, it also competes with Ca ++ in excitation secretion coupling processes. Toxicity of magnesium is not known to be practical problem. However, one of the major effects of excess magnesium intake is diarrhea and excessive loss of body fluids. On the other h and, excessive sulfur may overload the urinary excretion system, also interferes with the metabolism of certain other minerals, especially selenium. Acute toxicity resulting from ingestion of large amount of magnesium sulfate causes gastrointestinal irritation, manifested clinically by severe abdominal pain, watery or bloody diarrhea accompanied by severe dehydration, muscle twitching depression of cardiac contractility, lung congestion and respiratory failure of death from anoxia. Owing to frequent and haphazard use of this drug and its side effect, this work was done in an attempt to study further fundamental basis of magnesium sulfate in animals, calves were used to study the effect of prolonged administration of magnesium sulfate on general health condition and some biochemical constituents particularly those related to kidney function, so that oral administration of magnesium sulfate was continued for eight days. The dose was increased gradually. Initial dose [100 g], medium [150 g], higher [200 g], then final doses [250 g/day], respectively. Each dose was repeated for two successive days. The obtained results revealed that the initial dose failed to produce laxative effect at first two days which began to appear at the third and fourth days after administration of 150 g [medium dose]. The higher dose [200 g] produced a purgative effect at fifth and sixth days. Superpurgation, manifested by frequent painful evacuation of bowel which by turn leads to excessive loss of body fluids and biochemical disturbances, was clear at the seventh and eighth days by using 250 gm [final dose]. The excessive loss of body fluids manifested clinically by profuse water diarrhea, sunken eyes, dryness of skin, oral cavity and muzzle as well as severe dehydration, bradycardia and decreases of respiratory rate. Biochemically, significant decrease in the level of both serum sodium, chloride and glucose was observed while levels of total serum protein, creatinine, serum urea nitrogen and potassium were significantly increased. Alteration of serum magnesium level was clear. It could be concluded that, continuous oral administration of magnesium sulfate till overpurgation is contraindicated owing to its dangerous effect on the general health condition, also to avoid frequent body fluids losses, dehydration and renal dysfunction as revealed from clinical symptoms and results of biochemical analysis

Analytical applications using aunintricanboxyIic acid for spectrophotometric determination of iron [III], copper [II] and peridium [II] estimation of iron in some pharmaceutical preparations

A spectrophotometric study of the reaction between aurintricarboxylic acid and Fe[3], Cu[2], and Pd[2] ions showed that 1: 1 and 1: 2 violet water-soluble-complexes were formed at pH 8. The organic reagent was found to be very suitable for spectrophotometric determination of Fe[3] and Pd[2] up to 10.8, 6.4 and 12.5 ppm, respectively. The application of the ligand as an indicator in the spectrophotometric titration of Fe[3], Cu[2], and Pd[2] with EDTA and the interference of various cations and anions were reported. This method was applied to some pharmaceutical preparations for estimation of iron

Studies on hypovitaminosis A in frezian calves with special reference to some hematological and biochemical alterations

A nutritional deficiency problem was born in growing calves feeding on rice straw and commercial concentrate mixture [Tanta Company for oil and Soap] during winter season, in which clinical signs of lacrimation, thickness, cloudness and opacity of cornea, appearance of bran-like scales on rough dry skin, coughing, diarrhea, incoordination, stunted growth and inability of vision in dim light, were observed and attributed to vitamin A deficiency. Haematological and biochemical studies on affected animals revealed nonsignificant changes of haemoglobin content, haematocrit percentage, erythrocytic and leucocytic counts, as well as serum total protein, albumin and globulin. Although serum levels of vitamin A, sodium, chloride and glucose were significantly decreased, on the other hand, serum urea nitrogen, creatinin, potassium and serum transaminases were significantly increased. Disappearance of clinical signs as well as corrections of the different haematological and biochemical alterations were observed following therapeutic administration of vitamin A. It could be concluded that, the addition of vitamin A or green food is recommended for growing calves fed on rice straw and commercial concentrate mixture during winter to avoid vitamin A deficiency as well as hepatic and renal dysfunction and general health disturbances

Studies on some urine and serum analysis of healthy, sub and clinical ketosis cows

Urine analysis with "Combi nine urine strip" as well as ketone bodies, glucose, sodium, potassium and transaminases of serum were done for healthy, sub. and clinical ketotic dairy cows within six weeks after parturition from eight farms of dairy friesian cattle, in Dakahleia Governorate. In subclinical ketosis, ketonuria was associated with ketonaemia, less for hypoglycaemia and acidduria, the least for serum transaminases, sodium and potassium, in addition to slight reduction of milk production without apparent physical disturbance. While in ketotic cows ketonuria was highly correlated to aciduria, hyperketonaemia, hypoglycaemia, hyponatraemia and hypokalaemia together with elevation of serum transaminases, as well as severe drop of milk production and appearance of clinical symptoms. The urine concentration of blood, urobilinogen, bilirubin, protein, nitrite and glucose was negative in the three groups. It could be concluded that the "combi nine test" is a simple and reliable diagnostic tool for sub, and clinical ketosis and must be supported by analytical data concerning ketone bodies, glucose, sodium, potassium and transaminases of serum, however, false positive ketonuria only can contribute to overfeeding or underfeeding in healthy cows of the large dairy herd