Update on congenital glaucoma

Background: primary infantile glaucoma, commonly termed congenital glaucoma or trabeculodysegenesis, is an unusual, inherited congenital anomaly of the trabecular meshwork and anterior chamer angle which leads to obstruction of aqueous outflow, increased intraocular pressure, and optic nerve damage. Primarycongenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment

A Novel Sclerectomy Technique for Glaucoma and Ocular Hypertension Treatment.

Purpose: To introduce and evaluate the efficacy and safety of a new surgical scleral technique for treatment of glaucoma based on the concept of scleral biomechanics. Methods: Twelve 3-month-old New Zealand white rabbit eyes were operated under general anesthesia. Single large rectangular full thickness sclerectomy (3 mm limbal x 5 mm) exposing the choroid was performed in each eye. The intraocular pressure (IOP) was measured preoperatively, one day, one week and one month postoperatively. Results: Twelve eyes of 6 New Zealand white rabbits were operated with sector sclerectomy technique. The mean (±SD) intraocular pressure (IOP) was significantly reduced from a preoperative value of 6.0 (±0.0) mmHg to 2.0 (±0.0) mmHg (p = 0.003) in the post-operative assessment. The IOP was quite stable in the following one week and one month follow up assessments at 2.0 (±0.0) mmHg (p = 0.998). Eight out of 12 (66.7%) operated eyes had no postoperative complications. Four (33.3%) eyes faced different complications where: one (8.3%) had corneal perforation by traction suture, 3 (25%) had vitreous loss (one mild and two severe), while one of them (8.3%) had bleeding. Conclusion: Full thickness sector sclerectomy can change the scleral biomechanical behavior leading to highly significant intraocular pressure reduction.

interpreting physician is essential to avoid inaccurate diagnosis of PET-CT: a case report

The presence of a pulmonogist in the process of interpreting chest PET-CT is quite crucial, as the clinical findings will prevent any miss leading interpretations that result an inaccurate diagnosis

Endothelial nitric oxide synthase gene polymorphisms [G894T] in diabetes mellitus in Egypt

Diabetic nephropathy [DN] is one of the major microvascular complications of diabetes. Genetic predisposition has been implicated in DN. The eNOS protein synthesizes nitric oxide constitutively via a reaction including the conversion of L-arginine to L-citrulline, which involves the transfer of five electrons provided by nicotinamide adenine dinucleotide phosphate The aim of this study is to evaluate the association of G894T polymorphisms of endothelial nitric oxide synthase [eNOS] gene with the development of diabetic nephropathy [DN] among Egyptian patients with type 1,2 diabetes mellitus in Egypt. Study subjects comprised 86 patients of type 2 diabetes with nephropathy,23 patients of type 1 diabetes with nephropathy and 46 patients of type 2 diabetes without nephropathy. G894T genotypes was determined by SSP- PCR analysis. Mutant T allele, GT and TT genotypes of G894TSNP had no significant frequencies in type 1.2 diabetic patients with nephropathy compared to those without nephropathy. These findings indicate that G894T polymorphism of eNOS gene may be not considered as genetic risk factors for DN among Egyptian type 1, 2 diabetic patients. T2DM: type 2 diabetes mellitus-DN: diabetic nephropathy eNOS: Endothelial nitric oxide synthase:- SNP: single nucleotide polymorphism- SSP-PCR: sequence specific primer- polymerase chain reaction

Hypothalamic hamartoma presenting with gelastic seizures, generalized convulsions, and ictal psychosis

We report a case of hypothalamic hamartoma in an adult female who presented with gelastic seizures, generalized convulsions, and ictal aggressive psychotic behavior. Anticonvulsant treatment was ineffective in controlling the epileptic seizures. Surgical excision after accurate imaging diagnosis 3 decades after the onset of symptoms markedly ameliorated her condition. Delayed and erroneous diagnosis had unnecessarily prolonged the suffering of our patient

Complications of acute myocardial infarction in relation to the site of infarction

It has been suggested that infarction site may be significant determinant of clinical course and outcome after acute myocardial infarction [AMI].We aimed To assess the incidence of different sites of myocardial infarction [MI] and the different complications recorded according to the site of infarction, also to assess in-hospital mortality and its relation to age, sex, site of MI and other complications in patients with AMI. This study included all patients admitted to coronary care units of internal medicine and cardiology departments of Assiut university hospitals, Assiut government, Egypt, in the period from May 2007 to May 2008 with first AMI throughout one year [No=485 patients]. All patients were subjected to: careful history and clinical examination, electrocardiography [ECG], laboratory investigations, echocardiography and hemodynamic monitoring. In addition, 50 age and sex matched controls were included in this study. The incidence of AMI was higher in the old age group >/= 60 years [59.38%] with a higher percentage in men than women [71.75% vs 28.25%] in all age groups. Extensive anterior location of MI had the highest incidence among our patients [44.7%] while the inferopostenior location had the lowest incidence [4.1%] in both genders. Then the overall, inferior [26.2%], antroseptal [10.1%], extensive [9.3%] and lateral location [5.6%] came in between the two sites. Patients with extensive MI experienced the highest incidence of serious complications as cardiogenic shock [13.3%], left ventricular [LV] aneurysm [35.5%], LV thrombus [35.5%], stroke [2.2%], atrial fibrillation [AF] [13.3%], premature ventricular ectopics [PVCs] [100%] and they also had the highest incidence of in-hospital mortality [17.7%].The incidence of the various sites of MI as well as the complications recorded in these patients are near to that recorded in other studies all over the world. Patients with anterior and extensive infarction experienced the highest incidence of complications and mortality than those with inferior and inferoposterior locations

Cerebral malaria in adult patients in the Sudan: clinical presentation and outcome

In endemic areas adults are less vulnerable to cerebral malaria [CM] than children because of acquisition of partial immunity. This prevalence difference is one of the reasons why we see fewer epidemiological and case studies in adult CM. The objective of this study was to determine the clinical presentation and outcome of CM in adult Sudanese patients. A prospective hospital-based study was conducted in Khartoum Teaching Hospital. Thirty adult Sudanese patients presenting with CM conforming to the World Health Organization [WHO] definition of the disease were recruited. Their presenting features, laboratory investigations and clinical outcome were documented and studied. The mean age at presentation was 32.2 years +/- 15.4 SD. Nineteen patients [63.3%] were males and 11 [36.7%] were females. The predominant initial symptoms of CM were fever, excessive sweating, headache, nausea and vomiting. Before lapsing into coma, 15 patients [50%] manifested psychotic symptoms and 14 [46.7%] developed generalized convulsions. The neurological manifestations appeared after an average of six days from the onset of the febrile illness and reached its nadir within 24 hours. The level of coma was often deep, and 56.6% of patients had scored

Patterns of pituitary adenoma among adult Sudanese patients

The objective of this study is to determine the clinical presentation and hormonal secretions of patients with pituitary adenomas. This is a descriptive, prospective study on 53 adult Sudanese patients with pituitary adenoma. Only adults [16 years or more] were included. The study was conducted in Al-Shaab Teaching Hospital in the period from January 2001 to February 2007. Twenty eight [52.8%] patients were females and 25 [47.2%] were males. Their ages ranged between 16 -80 years [mean 40.8 +/- 15.6 years]. Twenty seven [50.9%] patients had functioning pituitary adenomas [FPA] and 26 [49.1%] patients had nonfunctioning pituitary adenomas [NFPA]. Hormonal secretion of the adenomas was found to be prolactin in 16 patients [14 females and 2 males], growth hormone in 8 patients [3 females and 5 males], ACTH in 2 patients [one female and one male] and TSH in one female. Macroadenoma was found in 44 patients [83%], while microadenoma was found in 9 patients. All non functioning adenomas were found to be macroadenomas, while functioning adenomas were found in 18 patients with macroadenoma and in 9 patients with microadenoma. In our series all NFPAS were macroadenomas. They were usually discovered late after assuming mass effect or incidentally on imaging for other reasons. Patients with functioning adenomas tend to present earlier with hormonal dysfunction and hence are diagnosed earlier before the tumors assume big sizes. Prolactin secreting tumors are the commonest among functioning pituitary adenomas and tend to predominate in females

Ataxia telangiectasia: findings from two families in the Sudan

We report herein two families with ataxia telangiectasia. Patients in both families fulfilled the diagnostic criteria and showed unusual presentations that are rarely reported in literature. No patient developed malignancy yet. To the best of our knowledge this is the first report on Ataxia telangiectasia from Sudan

Humoral immune IgG response to Plasmodium falciparum in adults: the role of subclass-IgG in clinical immunity to cerebral Malaria

Although antibodies are essential mediators of immunity, high levels of IgG antibodies against a wide range of blood-stage antigens of P. falciparum are poor predictors of clinical protection. It is the qualitative and the functional specificity of the antibodies to malaria antigens that predict the development of a clinically potent protective immunity. The objective of this work is to study the pattern of IgG sub-class in healthy and malaria-infected adults resident in a malaria-endemic area in Sudan. Total plasma IgG and IgG subclasses [IgG1, 2, 3 and 4] against the C-terminal region of the MSA-1[19] antigen of Plasmodium falciparum were measured by a quantitative enzyme-linked immunosorbent assay [ELISA] in 30 adult patients presenting to the emergency department with cerebral malaria [CM]. The levels of IgG antibody profile in CM patients were compared with those in patients with uncomplicated acute malaria [n=20] and in clinically healthy asymptomatic volunteers [n=20]. Total plasma IgG level was significantly higher in CM patients. The level of the sub-class IgG1 antibody against MSA-119 was significantly lower in patients infected with P. falciparum; the lowest values being observed in CM patients and the highest values in the clinically healthy volunteers. Our data suggest that acquisition of IgG1 antibody to MS A-1[19] is associated with a clinically protective immunity and that low production or defective IgG1 response may be associated with severe form of malaria in adults

Cerebral venous thrombosis. Clinical presentation and outcome in a prospective series from Sudan

To describe the presentation and outcome of treatment of cerebral venous thrombosis [CVT] in patients from Sudan, an example of a developing country. In a prospective study, we described the clinical features, risk factors, and outcome of CVT in patients admitted to the National Center for Neurological Diseases, Khartoum, Sudan, the only specialized neurological hospital in the country, during the period from February 2001-October 2006. Patients were referred from other hospitals in the town or from nearby hospitals in Khartoum state. We recruited only adult and adolescent patients aging >/= 15 years. We reviewed 15 patients [12 females and 3 males] with a mean [ +/- SD] age of 33.9 +/- 11.8 years. Headache [n=15], papilledema [n=13], paresis [n=3], and generalized seizures [n=3] were the most common symptoms, and signs encountered. A prothrombotic risk factor was often identified [n=12]. At the time of the first visit namely, 12 weeks after discharge, 7 patients [46.7%] attained complete neurological recovery, 4 [26.7%] developed optic atrophy, and 2 [13.3%] died of pulmonary embolism. The clinical features and risk factors of CVT in Sudan are not different from elsewhere, but the outcome is less favorable. Places with less privileged health service resources, late presentation or delayed accessibility to appropriate diagnostic tools may negatively influence the final outcome

Thyroid and pancreatic islet cell antibodies in chronic hepatitis c [HCV] infection with and without diabetes

The prevalence and the clinical relevance of thyroid and pancreatic beta cell immunity in HCV +ve patients with and without diabetes before interferon [IFN-alpha] therapy remain controversial. So, the aim of the present study was : 1-To determine the prevalence of organ specific Pancreatic beta cell and thyroid autoantibodies and organ non-specific antibodies [Anti Neutrophil Cytoplasmic Antibodies [ANCA], Anti Smooth Muscle Antibodies [ASMA] and Liver Kidney Microsomal Antibodies [LKMA] in HCV+ve patients with and without diabetes. 2- To evaluate whether autoimmune beta cell damage could be involved in the development of diabetes in HCV +ve patients. 3- To assess the clinical value and the relationship between such autoantibodies. Research design and Methods: The evidence of clinical autoimmune diseases and the presence of autoantibodies were assessed in 56 HCV+ve patients before INF-alpha therapy. Autoantibodies to Islet Cells [ICA], Thyroglobulin [TGAs]. Thyroid Peroxidase [TPAs] were tested by ELISA and immunometric assay, in addition to ANCA, ASMA and LKMA were tested by ELISA and immunoflorescence assay in 30 patients with diabetes [Group I], 26 patients without diabetes [Group II], in addition to 14 sex and age matched controls. Correlating these antibodies with age, sex, body mass index [BMI], presence of liver cirrhosis and its staging. It was found that age, BMI, family history of diabetes, and insulin levels were significantly higher in the diabetic group than in non diabetic HCV+ve patients. None of the 56 patients studied showed evidence of clinical autoimmune diseases. However, 5.4% of patients were positive for ICA[3/56], 10.7% [6/56] were positive for TGAs, 8.9% [5/56] were positive for TPAs. The coexistence of ICA and thyroid antibodies were found in only 3.6% of patients [2/56]. Furthermore, 71.4% of patients [40/56] were positive for ANCA, 35. 7% [20 /56] were positive for ASMA, 12.5% [7/56] were positive for LKMA. The frequencies of these autoantibodies were not significantly different in the presence- or absence of diabetes or when compared with controls except in ANCA +ve group in which antibodies were significantly higher [p<0.05] in the diabetic group. Moreover, ICA +ve patients were all diabetics. The ICA, TGAs and TPAs were more frequent among HCV+ ve female patients although most of our patients [75%,] were men. The presence of liver cirrhosis or / is staging according to Child Pugh score had no relation to the presence of such antibodies. Our study indicated a low prevalence of beta cell immunity and thyroid autoantibodies in HCV +ve patients. The level of such autoantibodies whether organ specific or non organ specific had no relation to the presence of diabetes or liver cirrhosis complicating or associated with HCV infection. Old age, high BMI, and family history of diabetes are risk factors for diabetes in HCV patients. Furthermore, the role of NCV in the development of diabetes was unlikely to be mediated by autoimmune mechanism. However, hyperinsulinemia and insulin resistance may play a role