Allelic variance among ABO blood group genotypes in a population from the western region of Saudi Arabia

BACKGROUND: Characterization of the ABO blood group at the phenotype and genotype levels is clinically essential for transfusion, forensics, and population studies. This study elucidated ABO phenotypes and genotypes, and performed an evaluation of their distribution in individuals from the western region of Saudi Arabia. METHODS: One-hundred and seven samples underwent standard serological techniques for ABO blood group phenotype analysis. ABO alleles and genotypes were identified using multiplex polymerase chain reaction, and electrophoretic analysis was performed to evaluate the highly polymorphic ABO locus. RESULTS: A phenotype distribution of 37.4%, 30.8%, 24.3%, and 7.5% was found for blood groups O, A, B, and AB respectively in our study cohort. Genotype analysis identified 10 genotype combinations with the O01/O02 and A102/O02 genotypes being the most frequent with frequencies of 33.6% and 14.95%, respectively. Common genotypes such as A101/A101, A101/A102, A101/B101, B101/B101, and O01/O01 were not detected. Similarly, the rare genotypes, cis-AB01/O02, cis-AB01/O01, and cis-AB01/A102 were not found in our cohort. The most frequently observed allele was O02 (35.98%) followed by the A102 allele (17.76%). Furthermore, our findings are discussed in reference to ABO allele and genotype frequencies found in other ethnic groups. CONCLUSION: The study has a significant implication on the management of blood bank and transfusion services in Saudi Arabian patients.

Diagnostic biomarkers for neonatal sepsis [meta-analysis study]

Background: Neonatal sepsis is the single most important cause of neonatal deaths in the community. It remains a major cause of mortality in newborn and life- threatening disorder in infants

Aim: To assess the validity of using diagnostic markers in predicting neonatal sepsis

Methodology: This was a systematic review and meta- analysis. More than 200 potentially relevant studies were collected in 2 years standing from 2012 to 2014 but only 42 of them met the inclusion criteria. A standard method for meta- analysis of diagnostic markers evaluation was performed using Biostat, Comprehensive Meta- analysis version 3.0.

Results: Meta- analysis was performed on 2722 neonates divided into 2 groups according to their clinical manifestations of neonatal sepsis and laboratory findings. PROM was the commonest risk factor predisposing to sepsis. Klebsiella and staphylococcus aureus were the most common isolated organism. Based on the results from included studies in this review, 6 predominant markers were used to evaluate early diagnosis of neonatal sepsis, PCT, IL- 6, TNF- alpha, CD64, slCAM and Eselectm. Procalcitonin was highly significantly elevated with sensitivity [0.93] whereas specificity was [0.87] and it had the most diagnostic accuracy [0.95]. SICAM was the most sensitive marker [0.95] its diagnostic accuracy and specificity were [0.93] and [0.90], TNF- alpha had diagnostic accuracy [0.92] sensitivity and specificity were [0.86], the sensitivity of Eselectin was [0.92], its diagnostic accuracy and specificity were [0.91] and [0.82]. IL6 had diagnostic accuracy [0.93]; the specificity and sensitivity were [0.90] and [0.88]. CD64 was the most specific biomarker for predicting neonatal sepsis [0.91]. sensitivity [0.87] accuracy [0.92]

Conclusion: Based on results from the studies included in this review, it was dear that serum slCAM had a high sensitivity for diagnosis of neonatal sepsis; CD64 had a high specificity and serum procalcitonin had the most diagnostic accuracy

Evaluation of inflammatory markers in full term neonates with unconjugated hyperbilirubinemia

Objective: To evaluate inflammatory markers in full term neonates with unconjugated hyper-bilinibinemia. Design: Prospective case control study. This study was done in the department of pediatrics screening clinic, Al-Galaa Teaching Hospital, in Cairo, Egypt from October 2012 to June 2014

Subjects and Methods: The study was done on seventy five full term neonates their age ranged from 3 to 6 days after birth, fifty with unconjugated hyperbilirubinemia compaired to twintyfive normal neonates as control group with matched age and sex. All neonates were subjected to history taking [including gestational age, postnatal age] and clinical examination, anthropometric data, and laboratory investigations including complete blood count, CRP and inflammatory markers TNF-a and ILIp concentration by ELISA

Results: Regarding total bilirubin level in unconjugated hyperbilirubinemia neonates, there was statistically significant to inflammatory markers TNF-a and IL-Ip[p-value was <0.001]. The same finding were also it was found that both inflammatory markers IL-lp and TNF-a showed statistically significant positive correlation with breast feeding p-value was 0.021 for IL-lp and 0.003 for TNF-a respectively. Inflammatory markers IL-lp and TNF-a increasing levels showed positive correlation with neurological examination [Lethargy or irritability, p-value were 0.01 1 for IL-p and 0.046 for TNF-a respectively

Conclusion: Inflammatory markers IL-lp and TNF-a levels increased in neonatal unconjugated hyperbilirubinemia. Inflammatory markers IL-lp and TNF-a was found correlation between neurological examination. Recommendations: Further studies on larger sample size [are advised to verify the diagnostic and prognostic value of inflammatory markers in neonatal unconjugated hyperbilirubinemia which may help also in treatment. Key words: Inflammatory markers, IL-lp and TNF-a, neonatal unconjugated hyperbilirubinemia, Bilirubin and neurological dysfunction

Reasons for complications of type 2 diabetes mellitus observed in United Arab Emirates: An opinion survey among practicing physicians

Objective: The present study explored factors responsible for complications of diabetes mellitus as observed in the clinical practice of doctors

Materials and Methods: One hundred and seven practicing physicians and general practitioners from clinics and hospitals, identified using a snowballing technique starting with one physician in each emirate, participated in the cross sectional survey

Results: The majority [81%] was males, and 62% were from clinics and 48% from hospitals; more than 50% had over 5 years of clinical experience in the UAE. Fifty eight percent of those practicing in clinics and 80.6% in hospitals felt they had the facilities required for monitoring DM and complications. While 22.4% felt that the complications were due to poor glycemic control, 11.2% attributed it to sedentary life-style, 10% to smoking, 9.3% each to diet and co-morbidity, and 4.7% to obesity. Poor glycemic control was considered to be mainly due to low compliance [25.2%], life-style [18.7%], lack of awareness [14%] about the silent disease and its complications, finance [5.6%] and depression [0.9%] Of the 46 who responded, 57% felt the complications were more common among Asians compared to other nationals. No age, gender or occupational difference was reported

Conclusion: One third of the respondents attributed the complications to poor glycemic control mainly due to low compliance and lack of awareness and hence mostly preventable. Health service needs to organize nationwide campaigns emphasizing diabetic care. Financial and social support are likely to enhance compliance among the victims of this fast increasing slow epidemic

Quality of care assessment and adherence to the international guidelines considering dialysis, water treatment and protection against transmission of infections in university hospital based dialysis unit in Cairo, Egypt

End stage Renal Disease [ESRD] has emerged as a major public health problem around the world. In recent decades, several important advances have been made in the therapy of hemodialysis [HD] with introduction of international guidelines to ensure the delivery of optimum care to HD patients. Increased mortality risk in HD patients unable to meet six targets in different areas of HD practice has been reported by the DOPPS investigators. In this retrospective study, we assessed the current practice patterns of care for HD patients in the Kaser El-Aini Nephrology and Dialysis Center in comparison with Dialysis Outcomes Quality Initiative [DOQI] Guidelines, European Best Practice Guidelines [EBPG], CDC guidelines for prevention of transmission of infections among HD patients, and American Association for Medical Instrumentation [AAMI] standards for dialysis water quality. Mean URR% was 63 +/- 8.8% in prevalent HD patients. A-V Fistula was the vascular access in 91% of prevalent HD patients, whereas temporary catheter was used in 9% of cases mostly as a bridge till A-V fistula creation/ maturation. Bicarbonate was the base used in 80% of cases. 97% patients had thrice weekly sessions and 3% had twice dialysis sessions/week. Mean serum albumin was 4.19 +/- 0.39g/dl, 66.66% of prevalent patients had serum albumin level > 4g/dl. Mean serum calcium was 8.66 +/- 1.4mg/dl, phosphorus was 6.26 +/- 2.54mg/dl with approximately 60% of patients had serum phosphorus level > 5.5mg/dl. CaxPi product was higher than 55 in around 40% of cases and PTH level was in the range of 150-300 pg/ml in around 10% of prevalent patients. Mean hemoglobin [HB] was 10.03 +/- 4.18g/dl in prevalent cases; however, around 70% of cases had hemoglobin level less than 11 g/dl. Iron deficiency was prevalent as 18% of patients had serum ferritin < 200ng/l and 34% had TST < 20%. 70% of patients were HCV positive and 4% were HBsAg positive and all were negative for HIV serological test. Dialysis water was monitored regularly for chemical and bacterial contamination as recommended by the AAMI, but endotoxin assay is currently not included in the monitoring checklist. Annual mortality rate was 8% in 2007. The current Audit revealed a reasonable quality of care for HD patients in the fields of vascular access care, dialysis adequacy and nutrition areas. It also reveals the need for improving anemia management and control of hyperphosphatemia with dietary counseling and more frequent dialysis. To fully meet guidelines targets, each patient should., be treated in an individualized way with more counseling, nutritional education and individualized dialysis prescription. Besides, the unit needs to adopt primary and secondary intervention strategies to prevent and promptly correct any deviation from desired targets

effect of training on head nurses time management skills at Benha University and Benha Teaching Hospitals

Time management can be viewed as a systematic approach to taking control of the issues that confront people on a day to day basis. This study was carried out to determine the effect of time management training program on head nurses work skills. One group Pretest-Posttest design was used with pre-post-follow up program assessment was used in carrying out the study. The present study was conducted at Benha University and Benha Teaching hospitals, over the period from September 2007 to June 2008. The sample consisted of 55 head nurses. The first tool of data collection was time management knowledge questionnaire used to assess the knowledge level that head nurses have regarding to time management, and also to assess their knowledge gain after implementation of the designed program. The second tool, time management assessment questionnaire was used to measure attitude of head nurses toward managing their time. The third tool of data collection is delegation scale that was used to assess the head nurses attitude toward delegation skills. The fourth tool of data collection is time waster questionnaire developed for the purpose of measuring factors affecting time management. The results of the present study revealed that, head nurses knowledge and attitude related to time management were deficient in the pre-test and statistically significant improvement in head nurses knowledge and attitude related to time management were noticed through out the post and follow-up phases. According to these results the researcher recommended that In-service training programs about time management must be developed on regular basis and the hospital policies, rules, and regulations should be clear for head nurses to save time and prevent different methods of time wasters

Depression, quality of life and malnutrition-inflammation scores in haemodialysis patients

Depression is the most common psychiatric illness in patients with end stage renal disease [ESRD], and has been associated with increased risk of death, cardiovascular events and hospitalization in a substantial proportion of patients. Impaired quality of life [QoL] has been reported in dialysis patients and is a marker of poor outcome. We aimed to assess the prevalence of depression and quality of life status among chronic hemodialysis patients. We explored the relationship between depressive symptoms and poor QoL on the one hand and sociodemographic profile, dialysis adequacy, serum chemistry, malnutrition-inflammation score [MIS] and symptom burden on the other hand. 60 chronic hemodialysis patients participated in the study between June and August 2007. They were on thrice weekly dialysis at the Kasr El-Aini Nephrology and Dialysis centre, Cairo University Hospital. Clinical and socio-demographic data were obtained and their case records were reviewed to obtain laboratory results including haemoglobin, urea reduction ratio, serum albumin, calcium, phosphorus, creatinine and total iron binding capacity. We used the Beck Depression Inventory [BDI] to assess the severity of depression, and SF-36 questionnaire to assess quality of life in the study group. MIS was used to assess the extent of malnutrition and inflammation complex and total symptom burden was evaluated using dialysis symptom Index [DSI]. Mean age was 46.13 +/- 16.55 years, with a range of 22-77 years. 20 patients [33.33%] had BDI score >/= 15. Two patients [3.33%] had QoL total score less than 50, 8 patients [13.33%] had scores in the range of 50-60, 30 patients [50%] had a score range of 60-70, 12 patients [20%] had scores of 70-80, 8 patients [13.3%] had a score range 80-90. Employment was found to significantly affect BDI scores; all patients with BDI scores >/= 15 were unemployed. The mean BDI score of unemployed patients was significantly higher than employed patients [13.03 +/- 6.27 Vs. 8.50 +/- 3.51, p=0.03]. Widowed had significantly higher BDI and lower F-36 scores compared to single, married and divorced patients [p<0.05]. DSI and MIS showed significant positive correlations with BDI scores [p<0.05] and significant negative correlations with F-36 scores [p<0.05]. Neither age, BMI, DIS, MIS, dialysis adequacy, haemoglobin, blood urea and serum creatinine, calcium, phosphate and albumin were predictable of BDI scores on regression analysis [p>0.05]. Our results showed high prevalence of depressive symptoms among the study group that was linked to poor quality of life, total symptom burden and malnutrition inflammation complex. We propose the routine use of simple screening tools such as BDI, F-36 form, and MIS to identify vulnerable patients at higher risk for poor outcome, increased hospitalization and death

Urinary monocyte chemoattractant protein-1 [MCP-1] correlates with prameters of renal injury in type II diabetes mellitus

Diabetic nephropathy [DN] is the leading cause of end stage renal disease in western world. Increased number of interstitial macrophages has been observed in biopsies from patients with DN. Monocyte chemoattractant protein-1 [MCP-1] is the strongest known chemotactic factor for monocytes and is upregulated in DN. We examined urinary level of MCP-1 in type 2 DM patients to assess the possible correlation between its level and the parameters of renal injury. Urinary MCP-1 level was assessed in 75 patients with type 2 DM [25 with and 25 without microabluminuria and 25 with macroalbuminuria and renal impairment] and compared with matched healthy control subjects. HBA1c and estimated glomerular filtration rate [eGFR] derived from the abbreviated Modification of Diet in Renal Disease [MDRD] equation were examined in the study groups in relation to the urinary MCP-1. urinary MCP-1 level was significantly higher in patients with micro and macroalbuminuria [167.4 +/- 50.23 and 630.87 +/- 318.10 ng/g creatinine respectively] as compared with normoalbuminuric patients and healthy controls [63.85 +/- 21.15 and 61.50 +/- 24.81 ng/g creatinine, p<0.0001]. MCP-1 correlated positively with urine albumin/creatinine ratio [ACR] [r=0.75, p<0.001], HBA1c [r=0.55, p<0.001] and inversely with eGFR [r=-0.60, p<0.001]. The study findings suggest that hyperglycemia is associated with increased urinary levels of MCP-1 that is closely linked to renal damage as reflected by proteinuria and eGFR levels. Collectively, these findings suggest that MCP-1 is involved in the pathogensis of diabetic nephropathy throughout its variable stages

modification of diet in renal disease [MDRD] equation underestimates glomerular filtration rate [GFR] in egyptian kidney donors

Inulin clearance and radioisotopic studies are the most accurate methods of GFR measurement, but are expensive. The K/DOQ1 guidelines recommended estimating GFR by using the Modification of Diet in Renal Disease [MDRD] or Cockcroft-Gault [CG] equations. So far, the MDRD equation has not been validated for GFR estimation in healthy donors. We examined the accuracy of the MDRD equation and creatinine clearance based on 24 hour urine collection in the prediction of GFR in a group of healthy donors in comparison with radionuclide measured GFR. We retrospectively examined the medical records of 100 of kidney donors who underwent [99M]Tc-diethylenetri amine-pentaacetic acid [DTPA] renal clearance and creatinine clearance at the transplant outpatient clinic, Cairo University Hospital between June 2002 and July 2006. GFR was predicted with the abbreviated MDRD formula without the variable for black. We examined the significant differences, potential correlations and agreements between the predicted and measured GFR. The mean eGFR [MDRD] was 8.16% lower than [99M]Tc-DTPA GFR [116.11 +/- 25.44 ml/ min/ 1.73 m[2] Vs. 126.32 +/- 24.21 ml/min/1.73 m[2], the difference range -84 to +61 ml/ min/ 1.73 m[2], p=0.002]. CrCl was 13.14% higher than [99M]Tc-DTPA GFR [142.90 +/- 27.51 ml/min 1.73 m[2], the difference range +65 to -60 ml/min/1.73 m[2], p<0.001]. A significant positive correlation was observed when CrCl and [99M]Tc-DTPA measured GFR were compared [r=0.451, r[2]=0.203, p=0.000]. No significant correlation was noted between eGFR MDRD and [99M] Tc-DTPA measured GFR [r=0.126, r[2]=0.016, p=0.211]. Linear regression analysis showed that at eGFR[MDRD] <99.37 ml/min/1.73 m[2], eGFR [MDRD] underestimated the DTPA GFR values. Bland Altman analysis showed poor agreement between GFR[MDRD] and CrCL on the one hand and measured GFR on the other hand [+54.2/-74.6 and +70/-36.8 respectively]. Our results indicate that neither MDRD equation nor CrCl are accurate in predicting GFR in healthy donors. Using MDRD in healthy individual might carry the risk of underestimating GFR in individuals with normal kidney function

Assessment of nitric oxide and prostaglandins levels in different pathological types of glomerular disease

The objective of this study was to evaluate plasma nitrite and nitrate as well as urinary nitrite levels in forty cases with different glomerular disorders. In addition, serum thromboxane A2 [TXA2] and prostacyclin 12 [PGI2] levels were evaluated in these cases in comparison to 20 healthy control subjects. The effect of steroid therapy on the above mentioned parameters was also evaluated. The results revealed that urinary nitrite level was significantly elevated among patients compared to control. The elevation was observed in diabetic nephropathy as well as proliferative forms of glomerular disease such as lupus nephritis and mesangioproliferative GN. However, plasma nitrite, nitrate and serum cGMP levels were similar in patients compared to the control levels. TXA2 level exhibited significant elevation in patients, whereas serum PGI2 showed significant decrease in its level among cases as compared to control subjects. Steroid therapy was demonstrated to have no effect on all of the studied parameters. The study concluded that the data indicated that NO might play a role in the pathogenesis of proliferative glomerular disease and diabetic nephropathy. The demonstration of normal level of urinary nitrite in non proliferative GN suggests that enhanced NO production is not the sole cause of proteinuria in these cases. Further studies are, therefore, needed to examine the exact role of NO in pathogenesis of glomerular injury. The significant elevation of TXA2 level together with the significant decrease in serum PGI2 should be thoroughly investigated regarding the renal hemodynamics, the extent of proteinuria and the thromboembolic tendency reported in these cases

Estimation of serum and urinary profibrotic cytokines in renal allograft recipients

In this study, serum and urinary transforming growth factor beta 1 [TGF- beta 1] and platelet derived growth factor [PDGF] levels were determined by enzyme-linked immunosorbent assay [ELISA] in ten renal allograft recipients for more than one year with normal renal function [group I], ten renal allograft recipients for more than one year with impaired renal function [group II] and ten patients with chronic renal failure [CRF] under conservative therapy [group III] and the measurements were compared with the levels of ten healthy controls [group IV]. The data confirmed the crucial contribution of the profibrotic cytokines TGF-beta 1 and PDGF in the development of chronic graft dysfunction that could be further augmented by cyclosporine A therapy. Further studies are needed to examine the effect of manipulation of immunosuppressive regimen on the extent of profibrotic gene expression as well as the long-term graft survival