Differential expression of alpha-smooth muscle actin and vascular endothelial growth factor in skin biopsy of patients with systemic sclerosis: a histological and immunohistochemical study

Vasculopathy is a hallmark of systemic sclerosis [SSc]. It contributes to many of its clinical manifestations and precedes fibrosis. The aim of this study was to investigate the expression of alpha-smooth muscle actin [alpha-SMA] in skin biopsy of patients with SSc and correlate it with other manifestations of vasculopathy, including those seen on fundus fluorescein angiography and tissue vascular endothelial growth factor [VEGF] expression. This study included 25 patients with SSc and 10 healthy individuals. Patients underwent full history taking and a clinical examination. All participants underwent fundus fluorescein angiography. Skin biopsy was examined by H and E staining, Mallory triple staining, and immunohistochemical staining for alpha-SMA and VEGF. Histological examination showed loss of dermal papillae, hypovascularity of the dermis, and subepidermal fibrosis. Immunohistochemical staining of the vessel wall in skin biopsy samples showed a statistically highly significant increase in VEGF and a highly significant decrease in alpha-SMA in patients as compared with controls. There was a highly significant positive correlation between VEGF and duration of illness, Raynaud's phenomenon, digital ulcers, disease activity score, and modified Rodnan Skin Score. As regards alpha-SMA, there was a highly significant negative correlation with Raynaud's phenomenon, disease activity score, modified Rodnan Skin Score, and VEGF, whereas there was a significant negative correlation with digital ulcers. The strongest correlation [r] for the duration of illness was found with alpha-SMA, followed by VEGF. alpha-SMA was found to be correlated to different manifestations of vasculopathy in SSc. It was found to be one of the early markers of vasculopathy among the other studied variables. Besides its diagnostic role in SSc vasculopathy, it could play a role in impaired vasculogenesis, making it a potential therapeutic target in the management of SSc

effect of a teaching program on nutritional practices for hemodialysis patients

Diet is an important factor for patients on hemodialysis [HD] to maintain good nutritional status and to enable the patient to eat palatable and enjoyable diet. Restricting protein, sodium, potassium, and fluid intake help to minimize uremic symptoms, fluid / electrolyte imbalances, accumulation of nitrogenous wastes, and may even postpone the initiation of dialysis for a few months. For patients with chronic renal failure, or ESRD, hemodialysis prevents death. However, it does not cure or reverse. These patients need to use a proper nutritional practice, which is a crucial intervention. The purpose of this study was to evaluate the effect of a teaching program on nutritional practices for patients undergoing hemodialysis. Thirty-five subjects: male [n=16] and female [n=19] patients were selected over a year. The study was conducted at dialysis units both in El-Manial University Hospital and King Fahd Units. A quasi-experimental research design was utilized in this study. One group, pre-post test design was implemented. Three tools were used to collect data; [1] demographic and medical data sheets, [2] assessment sheet, and [3] pre-post test sheet. Results indicated that there was a significant differences between nutritional knowledge scores before and after [34.73+3.46] [3mths, 75.36+3.51; 6mths, 88.31+6.24; F=86.18 at p=0.000] respectively conducting the program. Also, there was an improvement in practicing nutritional dietary habit, which was indicated by increased number of meals from 2-3 meals per day [X[2]=27.5 at p=0.001] and the amount of daily fluid intake decreased to one liter or less [X[2]=19.1 at p=0.001]. Physical examination assessment revealed that hair, nails, tongue and gums status were improved after changing nutritional habits and practice [X[2]=12.9, X2=16.7, X[2]=21.3, X[2]=40.1 at P<0.001, respectively]. A moderate improvement appeared in renal function tests [urea; F=3.388 at P=0.038, Creatinine; F=3.964 at P=0.022]. While serum electrolyte levels were about normal range before and after conducting the program. The study concluded that there was positive impact of the teaching program on the improvement of patient nutritional practices. The findings of this study showed that the education session can have an effect on patients' knowledge and compliance. The study findings implied the necessity of physician, nurse and dietician to devote some of their time to provide HD patients and their family with simple explanation about permitted and omitted food and fluid, and planning for a convenient amount and quality. In addition, distributing a dietary guide would prepare the patient for developing new skills in eating habits to gain satisfaction and increase the pleasures of life