Association of serum level of vitamin D and VDR polymorphism Fok1 with the risk or survival of pancreatic cancer in Egyptian population

BACKGROUND AND AIMS: Pancreatic cancer (PC) is the fourth most common cause of death from cancer in Egypt. Few studies have been conducted to assess the relationship between vitamin D serum level and vitamin D receptor (VDR) polymorphisms with the survival of PC patients. This is the first study in Egypt to investigate the association of the status of vitamin D serum level and genotypic distribution of single nucleotide polymorphisms (SNP) Fok1 with the risk of developing PC and whether they could detect survival or not. PATIENTS AND METHODS: The study included a total of 47 PC cases that were histopathologically proven to have PC, and 37 controls that were attending at the same time for investigation but proved that they were all PC free. Pre-diagnostic concentrations of vitamin D and VDR polymorphism Fok1 were assessed from all participants in the study. RESULTS: There was a 1.5-fold increase in the serum level of vitamin D in PC patients when compared to non-PC subjects. Regarding VDR Fok1, polymorphism distribution in PC was CC (Wild Type) 26 (55.3%), CT 16 (34%), and TT 5 patients (10.7%). For the control group, CC was found in 24 (64.8%), CT in 12 (32.4%), and TT genotype was found only in one individual 1 (2.8%) with no statistically significant difference between the two studied groups (P 0.72). CONCLUSION: Low serum vitamin D or VDR-SNP is not a risk factor for PC in Egyptian patients. Recommendations to increase vitamin D concentrations in healthy persons for the prevention of cancer and improving overall survival should be carefully considered.

The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial

BACKGROUND: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. METHODS: Sixty ASA-I pediatric patients aged 3–10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales. RESULTS: Postoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B. CONCLUSIONS: Adding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

Insulin Resistance in Egyptian Nonalcoholic Fatty Liver Disease patients.

Background: The liver has been recognized as a major target of injury in patients with insulin resistance or the metabolic syndrome. Insulin resistance is associated with fat accumulation in the liver, a condition called nonalcoholic fatty liver disease (NAFLD). NAFLD is a clinicopathologic entity that includes a spectrum of liver damage ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), advanced fibrosis, and rarely, progression to cirrhosis. Recent studies emphasize the role of insulin resistance, oxidative stress and subsequent lipid peroxidation, proinflammatory cytokines, adipokines and mitochondrial dysfunction in the development and progression of NAFLD. About 20% all adults have NAFLD and 2% to 3% of adults have NASH. A strong correlation exists between overweight, in particular visceral fat accumulation, and prevalence of NASH. Aim: "This study aimed at assessing the effect of insulin resistance in a sample of Egyptian patients with non-Alcoholic fatty liver". Methods: This study was conducted on 2 groups 104 NAFLD as diagnosed by ultrasound examination and 21 healthy participants as control group. All the participants were subjected to an abdominal ultrasonography, liver enzymes, lipid profile (triglycerides, HDL, LDL cholesterol), glucose and fasting insulin. Results: The blood sugar and fasting insulin levels were significantly higher in NAFLD patients than control group (172.81±35.47 mg/ml vs 101.33±11.95 mg/ml and11.72±4.7 U/ml vs 5.93±4.68) respectively. 88.5% of NAFLD patients were obese (BMI ≥ 30) and 11.5% were over weight (BMI < 30) while 23.8% were obese and 76.2% were overweight for control group. HOMA-IR was significantly higher in NAFLD patients than in healthy controls (5.02±2.39 vs. 1.41±1.20; P<0.001). We found 81.7% of the studied patients fulfilled the metabolic syndrome criteria while 9.5% for controls. HOMA-IR ROC curve showed 94.23% sensitivity and 85.71 specificity in NAFLD group. Fasting Insulin ROC curve showed 91.35% sensitivity and 80.95% specificity in NAFLD group. Conclusion: Patients with NAFLD have higher insulin resistance and have higher lipid profile, ALT & AST levels compared with their control group. Also the Ratio of the metabolic syndrome was higher in the NAFLD patients (81.7%).

Reduction of Plasma Adiponectin in Egyptian Obese Children with Nonalcoholic Fatty Liver Disease.

Background: Obesity, insulin resistance and dyslipidemia are the most significant risk factors of non-alcoholic fatty liver disease (NAFLD) in children, and a major cause of liver-related morbidity. The aim of this study was to evaluate the serum levels of adiponectin, leptin and fasting insulin in obese children with NAFLD to explore the role of adiponectin in the pathogenesis of this disease. Materials and Methods: The fasting serum levels of adiponectin, leptin, glucose, insulin, ALT, AST, total bilirubin, direct bilirubin, albumin, alkaline phosphatase, creatinine, cholesterol, triglycerides, HDL, LDL, GGT and CRP were measured in a group of 50 NAFLD children after making ultrasonography and 40 other participants were considered as a control group with comparable age, sex and body-mass index. Results: Plasma adiponectin was found significantly low in NAFLD children than its level in control group (3.23± 2.5 vs 11.0 ± 2.95 ng/dl). Moreover, NAFLD group had significantly higher insulin resistance, fasting insulin 11.4± 4.9 vs 4.7±3.1 mu/l levels in comparison with control group. Regarding serum leptin, there was no significant difference. An inverse correlation was observed between adiponectin and homeostatic model assessment (HOMA-IR), fasting insulin, leptin, triglycerides, ALT, AST, GGT and BMI. Conclusion: This data supports a role for low circulating adiponectin value in the pathogenesis of NAFLD and its association with insulin resistance.

[ effect of using self management skills in improving Childhood Bronchial asthma outcome]

Bronchial asthma is a chronic inflammatory disease of the airways affecting more than 300 million people worldwide. It is the most common chronic lung disease in childhood

Aim: The study aimed to improve pediatric asthma outcome by using self management skills. Design: Quasi experimental was used in this study.

Setting: study was conducted in the pediatric chest out-patient clinic, medical and emergency pediatric unit, at Assuit University Children Hospital and health insurance in Assuit city

Sample: A convenient sample of 60 mothers of asthmatic children aged from 6 to 14 years from both sexs. Two tools were developed by the researcher

Tool one: Interview sheet: used in the study. Tool two: Observation check list for mothers and children

Result: showed that more than two thirds of mothers [66.7%] were housewives and came from rural areas. Males constituted [66.7].while [33.3%] were females. There were significant improvement in knowledge and practice of the mother and their children and improvement in children outcome by using self management skills after the program. Recommendation. Future studies are recommended that would focus on the prevalence of bronchial asthma, methods of prevention and risk factors in some other nearby communities in Assiut Governorate and periodical seminars in the village for the public about bronchial asthma by the directors of rural and urban health units shared with professors in medicine and nursing in the University

IFN-stimulated genes upregulation pattern in Chronic Hepatitis C

Background: The development of effective tools for the large-scale analysis of gene expression has provided new insights into the involvement of gene networks and regular pathways in various disease processes. The chemokine receptor CXCR3 is a G protein-coupled receptor found predominantly on T cells that is activated by three ligands as follow: CXCL9 [Mig], CXCL10 [IP-10] and CXCL11 [I- TAC], and play a key role in immune and inflammatory responses by promoting recruitment and activation of different subpopulations of leukocytes. Aim of the work: The study is a logical functional approach for the development of serum markers chemokines that bind to CXC chemokine receptor 3 to determine whether they play a role in the future of immune system to clear HCV, these chemokines: CXCL9, CXCL10 and CXCL11

Patients and methods: 131 male and female patients with chronic hepatitis C virus [CHCV] infection, their age ranges between 22 and 55 years,selected from the National Hepatology and Tropical Medicine Research Institute. The included patients were divided to two groups, the first group: 80 patients were investigated for the predictive values of CXCL9,10,11 and CXCR3 chemokines in peripheral blood mononuclear cells [PBMCs], the second group were fifty one patients analyzed for the expression of surface markers on CD8+T cells. Twenty healthy individuals were included to serve as controls for each group. All the patients and controls were subjected to the following: history, clinical examination, abdominal ultrasonography and collection of blood samples for routine laboratory investigation and serological assay

Results: Chemokine CXCL9, CXCL10, CXCL11 and their receptor CXCR3 expression levels are induced in PBMCs during CHCV infection, associated with increased the expression levels of CD8+T cells in CHCV patients

Conclusion: The interaction between chemokines and their receptors is essential in recruiting HCV-specific T cells to control the infection

Recommendations: The regulation of chemokines and their receptors could be a future potential therapeutic target to decrease liver inflammation and to increase specific T cell migration to the infected liver, the blocking of chemokines and chemokine receptor engagement is a therapeutic strategy that should be explored in the near future for non-responders to current anti-HCV therapy

Tumor necrosis factor-alpha [TNF - alpha] gene expression in chronic hepatitis B virus infection

Background: Tumor necrosis-alpha [TNF-alpha] is produced by macrophages, neutrophils, T-cells and NK-cells after stimulation. In turn, TNF-alpha can stimulate secretion, increase the expression of adhesion molecules as well as active neutrophils. Hence, it fulfills the role as a principal mediator of cellular immune response and inflammation, and may play an important role in non-cytopathic and cytolytic clearance of hepatitis B virus [HBV]. The clearance of HBV is a complex process which may be influenced by many factors including polymorphisms in the tumor necrosis [TNF-] gene promoter

Aim of the work: The study aimed to determine the TNF-alpha as a gene expressed in chronic hepatitis B virus infection and its role in outcome of the virus

Patients and methods: Ninety four patients with chronic HBV infection, their age between 19 and 59 years, selected from the National Hepatology and Tropical Medicine Research Institute were included in this study, during treatment and twenty healthy individuals were included to serve as controls. All the patients and controls were subjected to the following; history, clinical examination, abdominal ultrasonography and collection of blood samples for routine laboratory investigation, and serological assay for HBsAg, HBsAb, HBeAg, HBeAb, HBV DNA [quantitative], and TNF-alpha promoter polymorphisms in two sites 238 and 308

Results: The prevalence of the variant at position -308 GA was similar in all investigated groups [patients and controls]. An association was found between the TNF-alpha promoter polymorphism at position -238 and the development of chronic HBV infection with sensitivity of 93% and specificity of 75%

Conclusion: TNF-alpha-308 GA was significantly associated with clearance, showing protective antibody and persistent HBV infection. The promoter variant of TNF-alpha at position 238 GA, GG appears to be linked to defective viral clearance, controls had higher TNF-alpha-238 GG,GA, AA as compared to cases with significant difference

Recommendations: The variation in the genes governing the levels of constitutive and inducible TNF-alpha might be an important factor, which might explain the variable outcome of HBV infection

Role of Serum Adiponectin, IL-6 and Hs CRP in Nonalcoholic Fatty Liver Egyptian Patients.

Non alcoholic fatty liver (NAFLD) is accumulation of fat in the liver cells of peoples who drink little or no alcohol causing mild steatosis with mostly no signs, symptoms or complication but this may progress to steatohepatitis (NASH) and may liver cirrhosis then failure. NAFLD is recognized as the most common type of chronic liver disease in Western countries and the leading cause of cryptogenic cirrhosis. Insulin resistance (IR) is a key factor in the pathogenesis of NAFLD, the latter being considered as the hepatic component of IR or metabolic syndrome (MetS). Although the pathogenesis of NAFLD is not fully elucidated, a complex interaction between adipokines and cytokines produced by adipocytes and/or inflammatory cells infiltrating adipose tissue appears to play a crucial role in MetS and NAFLD and its progress. A number of factors are linked with NAFLD such as obesity, type 2 diabetis mellitus (T2DM), hyperlipidemia, gastric bypass, and its progress to NASH correlate with certain cytokines secreted like adiponectin, interlukin-6 (IL-6), and C- reactive protein CRP. Adiponectin is a novel adipocyte-specific protein, which, it has been suggested, plays a role in the development of insulin resistance and atherosclerosis. The role of (IL-6) in liver pathology is very complex, and its participation in the development of NAFLD remains unclear. IL-6 is a key element in the acute phase response, mediating the synthesis of several acute phase proteins (such as CRP and serum amyloid A). Thus, we cannot exclude the possibility that IL-6 might also play an indirect deleterious role in NAFLD pathogenesis. In diet-induced obese mice, treatment with IL-6 antibodies improved sensitivity to insulin. Objective: This study aim is to evaluate the level of adiponectin, IL-6 and CRP in Egyptian patients with NAFLD. Methods: This study was conducted on 2 groups 104 NAFLD as diagnosed by ultrasound examination and 21 healthy participants as control group. All the subjects were subjected to an abdominal ultrasonography, liver enzymes ALT & AST, lipid profile (triglycerides, HDL, LDL, cholesterol, CRP, IL-6 & Adiponectin). Results: Plasma adiponectin levels were significantly lower in NAFLD patients than control gp (3.05±2.65μg/ml vs 10.52±3.35 (μg/ml). IL-6 level was higher in NAFLD than control gp but not significant (114.24±22.32pg/ml vs 104.9±19.98pg/ml). CRP was significantly higher in NAFLD than control gp (17.86±11.59mg/L vs 5.4±3.81mg/L). Adiponectin ROC curve showed an AUROC curve in NAFLD gp (0.918 p=0.0001). IL-6 ROC curve showed an AUROC curve in NAFLD gp (0.703 p=0.0003). CRP ROC curve showed an AUROC curve in NAFLD gp (0.853 p=0.0001). Conclusion: Patients with NAFLD have lower adiponectin levels and higher IL-6 and CRP levels compared with their control group.

Risk factors associated with low bone mineral density in Ajman, UAE

To ascertain the determination associated with LBMD among patients above 30 years of age. The study was conducted over a period of two years. Age, gender, cigarette use, exposure to sunlight, physical activity, BMI, family history of osteoporosis and studyle of clothing were assessed using a structured, pre-tested questionnaire. Data were analyzed using SPSS 19 version. Chi-square test was used to find the association between bone mineral density and factors such as age, gender, physical activity, exposure to sunlight, and BMI. The study population consisted of 444 subjects, and among them 15.8% were males and 84.2% females. The results revealed that 60.8% had low bone mineral density, of whom 11 had severe osteoporosis, 99 osteoporosis, and 160 osteopenia. The risk was high in the age group 70+ [Adjusted OR=12.21], followed by 60-69 years [Adjusted OR=6.31], 50-59 years [Adjusted OR=4.70] and 40-49 years [Adjusted OR=2.15]. Participants who had occasional sunlight exposure had 3.28 times higher risk of developing osteoporosis. With regard to physical activity, a risk 1.5 times higher was noticed in those without any physical activity as compared to those with some physical activity. Obesity and overweight were associated with 0.38 and 0.37 times risk of developing osteoporosis respectively. A 2.57 times higher risk was observed among participants with a positive family history of osteoporosis. Aging, lack of physical activity, excess body weight, and inadequate exposure to sunlight were identified as the major risk factors associated with low bone mineral density

Needs of school aged children with speech impairment and their mother's adjustment pattern

Children with speech impairments have difficulties in transmitting the message from brain to mouth, which affect their ability to communicate. So, the mothers of these children need information and need to talk with professional counselors who understand the nature of their problems and can find solution for them. The study aimed to assess needs of school aged children with speech impairment and their mothers' adjustment pattern. A descriptive design was used in this study. The study sample consisted of 183 mothers accompanying children with speech impairment [117 boys and 66 girls], during their attendance of speaking sessions. These children have the following criteria [age ranged 6-10 years, both sexes and have follow up visits for at least six month]. Data were collected by using 3 tools; a structured interview questionnaire including sociodemographic characteristics of children and those of their mothers, and problems and needs of children with speech impairment as reported by mothers. The second todi, developed by Moss, is concerned with mothers adjustment pattern. The third tool deals with mothers' attitude and was developed by the researchers. Results of this study revealed that, the highest percentage of mothers/caregivers werc housewives and completed intermediate school. The most prevailing psychosocial problems among children were low self-esteem and limited response to verbal instructions and all mothers reported their need for periodical follow-up for their child. The mothers have positive adjustment and positive attitude toward children with speech impairment. The study recommended the implementation of counseling services in the phonetic out patient clinics for mothers caregivers about how to cope with their children impairment, emphasizing on psychological and social care for those children and their families by specialists help them to overcome their conflict

Von wilebrand factor in acute myocardial infarction

To determine the sensitivity of von Willebrand factor [vWF] and fibrinogen as diagnostic predictors of vascular injury in acute myocardial infarction [MI], the changes in plasma level of vWF and fibrinogen were assessed in 15 patients with acute MI, 15 patients with unstable angina and 10 control subjects with no subjective or objective evidence of ischemia. The samples were obtained immediately on admission from all groups. In patients with acute MI, the samples were drawn at 24 hours and 5 days later. The samples were analyzed for serum cardiac enzymes, vWF and fibrinogen. Plasma concentrations of vWF antigen were measured by enzyme linked immunosorbent assay [ELISA] method and by coagulation method for fibrinogen level. Compared with the control subjects, patients with acute MI and unstable angina had significantly higher levels of plasma vWF on admission. Twenty four hours and 5 days later, the plasma levels of vWF increased significantly from 203.6 +/- 17.7 and 252.6 +/- 2.6, respectively, compared with that on admission [104.1 +/- 23.8]. On the other hand, fibrinogen levels were significantly higher in patients with unstable angina compared with the control subjects, but insignificantly higher than that in patients with acute MI