Indeterminate cell tumor [histiocytosis]

Indeterminate cell tumor [ICT; histiocytosis] is a rare disorder characterized by accumulation of histiocytes that do not fulfill the phenotypic criteria designated for Langerhans cells [LC]. The cells classified as "indeterminate" exhibit overlapping features between dendritic cells and histiocytic cells by showing variable reactivity for CD1a and positivity for S-100 protein and CD68. Ultrastructurally, absence of Birbeck granules, a feature consistent with LC, epitomizes the lesional cells. Herein, we report a case of ICT in a new born emphasizing its histogenesis and clinical, morphologic, immunohistochemical, and ultrastructural features

Antioxidants and tumor necrosis factor-alpha in patients with pulmonary tuberculosis

Tuberculosis [TB], is one of the major common air born infectious bacteria! diseases whichremains a major worldwide health problem with global mortality. To evaluate the efficiency of serurr samples compared to sputum for the early diagnosis of TB, and to evaluate the levels of superoxide dismutase [SOD], catalase [CAT], total antioxidant status [TAS] and tumor necrosis factor-a [TNF-alpha] in patients witt pulmonary tuberculosis [PTB]. One hundred patients with clinically suspected PTB and 25 healthy individuals were enrolled in the study. According to the bacteriological results, 78 patients were diagnosed as having PTB infection. These cases were categorized into 69 culture positive cases [sputum anc serum PCR positive patients [n=42], sputum PCR positive and serum PCR negative patients [n=16] and sputurr and serurr. PCR negative patients [n=11]] and 9 culture negative and sputum PCR positive cases witi radiological lung abnormalities suggestive for PTB. For these 78 cases, erythrocyte SOD, CAT, serum TAS an? TNF-alpha were determined. Twenty two patients were culture negative and negative for both sputum and serun PCR. They had no PTB and were not involved in biochemical studies. In all 78 PTB patients erythrocyte SOD, CAT and serum TAS levels were statistically lower than controls [p<0.05], while TNF-alpha was highly significantly .increased [p=0.001]. There was a significant direct linear correlation between SOD and CA" and TAS [p<0.0001, r= 0.78; p<0.0001, r= 0.88; p<0.0001, r=0.80 respectively] and a significant reverse linea correlation between TNF-alpha and SOD, CAT and TAS level [p<0.0001 r=-0.55; p<0.0001, r=-0.51; p<0.0001, r= 0.65 respectively]. Although the sputum culture is still the gold standard for the diagnosis of patientt with PTB, sputum PCR is an efficient method that could be used as an alternative to the culture for the rapk identification of PTB cases. The lower levels of SOD, CAT and TAS may be improved by the antioxidant therap which may help in better prognosis. Also anti TNF-alpha therapy may help in decreasing the elevated level of TNF-alpha shown in all PTB patients

Transgenic canola plants over-expressing bacterial catalase exhibit enhanced resistance to Peronospora parasitica and Erysiphe polygoni

Transgenic canola [Brassica napus.L] plants expressing the bacterial catalase katE in the chloroplasts were obtained by the Agrobacterium-mediated transformation method. Resistance and susceptibility of the transgenic canola plants were evaluated against the airborne pathogenic fungi, Peronospora parasitica causing downy mildew and Erysiphe polygon causing powdery mildew under artificial infection in the greenhouse. The bioassays of the transgenic plants demonstrated that the growth of both fungi and the development of disease incidence were significantly inhibited in the leaves of the transgenic canola plants compared to controls. Chemical analyses of the transgenic plants revealed constitutive expression of the enzymes catalase, peroxidase and polyphenoloxidase as well as higher levels of free polyamines i. e. putrescine, spermidine and spermine compared with the control plants. Together, these data indicate an enhanced resistance of the transgenic canola plants expressing the bacterial catalase to the downy mildew and powdery mildew pathogens

Genetic markers associated with salt tolerance in canola [Brassica napus L.]

This study aimed at elucidating the genetic variation between five selected canola cultivars grown under Egyptian environment for salt tolerance. Seedlings from three local and two German cultivars were subjected to salt stress for two weeks. Plant growth, leaf osmotic adjustment, peroxidase isozyme, protein banding patterns and RAPD analyses were performed. Salt stress decreased leaf osmotic potential in all cultivars. The results showed that the cultivar Masrri-L16 can maintain higher osmotic potential of the cells than the other cultivars, leading to enhancement of the ability to tolerate salt stress. Salt stress induces a new peroxidase bands and increases the band intensity, indicating the protective role of peroxidase enzyme. The genetic polymorphism between the cultivars was detected by protein and RAPD analyses. In total three [21.4%] and 78 [52%] polymorphic bands were detected for protein and RAPD, respectively. The comparison between the two protocols revealed that the latter gave more markers and more conclusive results. These molecular markers were sufficient to distinguish among five canola genotypes. The genotype-specific markers represent 12.3% of the total markers detected by both analyses, 94.7% of them were RAPD markers. Thirteen RAPD markers may be considered as markers for salt tolerance in the cultivar Masrri-L11 and five markers for the cultivar Masrri-L16. These markers can be verified as being RAPD markers associated with salt tolerance in the two canola genotypes that help in marker-assisted selection breeding programs

Right ventricular function in patients with inferior myocardial infarction undergoing rescue percutanous coronary intervention: impact of right ventricular artery patency

Patients with inferior acute myocardial infarction [MI] and right ventricular [RV] MI represent a high-risk. Moreover, RV function is difficult to evaluate, given its geometry, inter relation with left ventricle, and sensitivity to load. Data concerning percutanous coronary intervention [PCI], RV dysfunction and prognosis are scared. To test the value of pulsed Doppler tissue imaging [DTI] to delineate RV dysfunction in acute inferior Ml and to determine the value of RV artery [RVA] patency following rescue PCI on RV functional recovery and short tern: clinical outcome. 40 patients with acute inferior MI who underwent rescue PCI to the right coronary artery. Tricuspid annulus [TA] and RV free wall DTI used to measure systolic [Sm] and diastolic [Em and Am] myocardial velocities plus myocardial power index [MPI=isovolu, nic relaxation+isovolumic contraction/ejection times]. According to RVA patency pts were divided into two groups [group I occluded RVA=21 pts, group 11 patent RVA=19 pts]. Data were compared to 12 control subjects. Electrocardiographic RV MI was confirmed in 14 pts [35%]. DTI revealed RV dysfunction in all pts vs. control [TA [9.31 +/- 0.36, 9.80 +/- 0.39, 12.1 +/- 0.05 cm/sec and 0.71+0.12 vs. 15.6 +/- 2.3 16.21 +/- 1.85 15.9 +/- 1.25 cm/sec and 0.55+0.14 for Sm, Em, Am, and MPI p<0.01] and RV free wall [10.9 +/- 3.1, 8.6 +/- 1.8, 13.8 +/- 3.1 cm/sec and 0.74 +/- 0.13 vs. 14.3 +/- 3.2, 10.1 +/- 3.4, 14.8 +/- 4.4 cm/sec and 0.54 +/- 0.15 for Sm, Em, Am, and MPI p<0.02]] Pts with RVMI had more severe RV dysfunction [TA [6.37 +/- 0.28, 6.11 +/- 0.48, 8.36 cm/sec and 0.86 +/- 0.23 for Sm, Em, Am, and MPI p<0.001] and RV free wall [6.81 +/- 4.21, 4.95 +/- 2.62, 10.64 +/- 2.93 un/sec and 0.91 +/- 0.21 for Sm, Em, Am, and MPI P<0.001]]. Similarly pts with occluded RVA had significantly lower RV free wall and TA velocities and higher MPI I [10.9 +/- 1.3, 8.9 +/- 0.39, 9.6 +/- 0.83 cm/sec and 0.83 +/- 0.llfor RVfree wall Sm, Em, An, and MPI p<0.05] and [8.20 +/- 0.47, 8.90 +/- 0.28, 11.2 +/- 0.09 cm/sec and 0.78+0.22 for TA Sm, Em, Am, and MPI p<0.0l]]. After PCI, pts with patent RVA showed significant improved RV function [high RV and TA velocities with low [MPI] with less in hospital [9/21 vs. 2/19 p=0.034], and 3 months events [7/21 vs. 1/19 p=0.046]. Doppler tissue imaging is highly sensitive to detect subclinical R V dysfunction in patients with acute inferior myocardial infarction. Successful reperfusion of R V artery was associated with better recovery of RV function and less short term clinical adverse cardiac events

Serum levels of platelet-activating factor, platelet-activating factor acetylhydrolase, and tumor necrosis factor-alpha in neonates with necrotizing enterocolitis before and after treatment

Because previous investigations have suggested that platelet activating factor, and tumor necrosis factor,-alpha [TNF-alpha] are thought to be important mediators of experimental necrotizing enterocolitis in animals, we measured platelet activating factor [PAF], PAF-acetylhydrolase [PAF-AHs], and TNF-alpha in the serum of 23 human neonates with necrotizing enterocolitis before and 2 weeks after treatment and 14 age-matched control subjects with similar gestational ages, postnatal ages, and weights. Patients included in this study were studied from June 2002 to May 2004 at Neonatal Intensive Care Unit of Tanta University Hospital, Egypt Almost all patients with necrotizing enterocolitis had elevated serum platelet activating factor values [17.9 +/- 4.1 ng/ml vs. 3.7 +/- 0.8 ng/ml in control subjects, p < 0.01]. Serum acetylhydrolase activity was lower in patients than in control subjects [11.2 +/- 0.6 nmol/ml/min vs. 24.9 +/- 2.1 nmol/ml/min, p < 0.01]. Serum TNF-alpha concentration was significantly elevated in patients with necrotizing enterocolitis [119.2 +/- 63.1 U/ml vs. 5.7 +/- 1.7 U/ml, p < 0.01]. There were no significant differences between serum levels of PAF, TNF-alpha, and PAF-AHs between controls and survived patients 2 weeks after treatment, p>0.05. Also there were no significant differences between serum levels of PAF, TNF-alpha and PAF-AHs on admission between dead and survived patients, p>0.05. There was no correlation between individual platelet activating factor levels and both TNF-alpha and PAF-AHs levels in patients. We concluded that platelet activating factor and TNF-alpha are elevated in patients with necrotizing enterocolitis and that reduced platelet activating factor degradation contributes to the increased platelet activating factor levels, which together with TNF-alpha may con tribute to the pathophysiology of necrotizing enterocolitis in human neonates. The use of agents that antagonize or contain degrading factors of PAF might provide therapeutic and/or prophylactic options in the management of NEC

Risk of epilepsy after electrographically proven neonatal seizures

Neonatal seizures often are manifestations of significant neurological disease and major predictors of adverse neurological outcome in the newborn. The present work aimed at estimation of outcomes of neonatal seizures especially the development of epilepsy. The present study was conducted on 30 patients [15 males and 15 females] with neonatal seizures, their ages ranged from one to 30 days. All patients were subjected to full history taking and through clinical examination. Laboratory investigations included: complete blood picture, metabolic screening tests [blood glucose, serum Ca, Mg and Na, blood urea, serum creatinine, serum bilirubin and ferric chloride test], sepsis screen [blood, CSF and urine culture, and TORCH titers], brain C. T. scan and EEG [interictal and follow up]. The etiologic diagnosis of neonatal seizures was based on positive clinical data, laboratory data and/or imaging data. Follow up for at least 6 months was performed with serial neurological evaluation and EEG. From this study, it was found that the seizures etiologies were diverse, hypoxic ischemic encephalopathy [HIE] was the most common cause 46.7%, meningitis 16.7%, cerebral dysgenesis 10%. Metabolic causes 13.3% and intracranial hemorrhage 13.3%. Etiology of seizures was significantly correlated with total outcome, subsequent development of epilepsy and developmental delay. There was significant correlation between findings of neurological examination and total outcome, epilepsy and developmental delay. Neonates with mildly abnormal neurological findings had favorable outcome in 100% of cases. Patients with severely abnormal neurological findings were associated with unfavorable outcome [mortality, epilepsy or developmental delay] in 81.8% of cases. Type of seizures was significantly correlated with the total outcome and mortality. Generalized tonic seizures had the worst prognosis. There was significant correlation between brain CT findings and total outcome, subsequent development of epilepsy and developmental delay. EEG findings were significantly correlated with the outcomes findings of neurological examination and frequency of seizures but insignificantly correlated with type of seizures, onset of seizures and brain CT findings. The 3-months follow up EEG was significantly correlated with the development of epilepsy. Seizure etiology, neurological evaluation of the newborn at birth [mildly, moderately and severely abnormal], clinical characteristics of seizures [onset, frequency and types], brain CT. and EEG findings [interdicted EEG background activity], 3-months follow-up EEG and meticulous follow-up clinical examination were the most important determinants for prediction of the neurological outcome of neonatal seizures. Epilepsy and developmental delay after neonatal seizures were more frequent in presence of one or more of the following: severely abnormal neurological examination at birth, cerebral dyesgenesis as an etiology of seizures, generalized tonic seizures, seizure frequency >/= 2 seizures/h, abnormal brain CT scan findings and abnormal inter-ictal EEG background. EEG is recommended to be performed for all cases with neonatal convulsions as a diagnostic and prognostic tool. Meticulous follow up [clinical examination, EEG] of cases with neonatal seizures is essential to predict the subsequent development of epilepsy and developmental delay

Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in cholangiopancreatic disease

Endoscopic retrograde cholangiopancreatography [ERCP] has been widely used in clinical work for decades in evaluation of the pancreatobiliary tree, whereas magnetic resonance cholangiopancreatography [MRCP] has only been used in recent years. This study was conducted in gastrointestinal endoscopy center and Radiology department, Assuit university hospital from March 2003 till April 2005 using ERCP and MRCP to diagnose cholangiopancreatic lesions and compare their accuracy. 126 patients were included in the study, 78 males and 48 females referred and scheduled for ERCP. MRCP was performed 24 hours before ERCP, Either endoscopist or radiologist performed ERCP or MRCP respectively, reported separately on their findings. ERCP was performed successfully in 117 cases [92.8%], while MRCP was carried successfully in all cases. Choledocholithiasis was present in 63 cases diagnosed by ERCP, 60 cases were diagnosed by MRCP. Ampullary carcinoma was present in 14 cases diagnosed by ERCP. Only 10 cases were diagnosed by MRCP. Cholangiocarcinoma was present in 20 cases, 16 cases were diagnosed by ERCP and MRCP with equal sensitivity and specificity. Benign inflammatory strictures of the common bile duct were present in 9 cases, was illustrated in 7 cases by ERCP, only 5 cases were diagnosed by MRCP. Pancreatic cancer was present in 20 cases, 17 cases were diagnosed by ERCP, 16 cases were diagnosed by MRCP. MRCP has an equal efficacy to ERCP in diagnosis of biliary stones, Cholangiocarcinoma, pancreatic cancer, but less efficient to diagnose ampullary carcinoma

Neonatal cerebrospinal fluid plasminogen and plasminogen activator inhibitor-1 assay as predictors of post hemorrhagic hydrocephalus

Massive intraventricular hemorrhage [IVH] in neonates is followed by progressive ventricular dilatation in 55-80% of cases if the infant survives. The initial mechanism of post hemorrhagic hydrocephalus [PHH] is thought to be obstruction by multiple small blood clots of the channels of the cerebrospinal fluid [CSF] to areas of absorption. Plasminogen activator inhibitor-1 [PAI-1] is the principal regulator of fibrinolysis in blood and one of the most highly controlled of the fibrinolytic components. The aim of this study is to measure plasminogen and plasminogen activator inhibitor-1 levels in the CSF of the neonates after IVH to assess endogenous fibrinolytic activity and to predict the development of post hemorrhagic hydrocephalus. Fifteen full term and preterm neonates with IVH were enrolled in the study. Ten neonates without IVH were used as a control group. Cranial ultrasound was performed at age of 2 weeks and 2 months. Plasma and CSF plasminogen and PAI-1 levels were assessed for these neonates. The results revealed that CSF PAI-1 was significantly higher in infants with IVH than in the controls [P<0.001]. There was no significant difference in the CSF and plasma plasminogen between infants with IVH and controls [p>0.05]. CSF PAI-1 was significantly higher in infants with PHH than in infants with post hemorrhagic ventricular dilatation [p<0.05], with a sensitivity [100%] and specificity [100%]. CSF PAI-1 is a very sensitive and specific parameter than CSF plasminogen for prediction of PHH in neonates with IVH, and this might be useful to evaluate the specific therapeutic programs of these neonates

Plasma natriuretic peptides as predictors of hemodynamically significant patent ductus arteriosus in preterm neonates

The objective of this study was to determine whether the plasma levels of natriuretic peptides in preterm infants with patent ductus arteriosus [PDA] are predictors of the hemodynamic significance of the PDA shunt, and correlate them with clinical and echocardiographic assessment. Fifty preterm neonates, with a mean gestational age of 29.4 wk and weighing less than 1500 g, were enrolled in the study. Based on the clinical and echocardiographic findings, the hemodynamic influence of PDA shunt was classified as: large [8 infants], moderate [10 infants], small [12 infants] or no PDA [20 infants]. Plasma N-terminal atrial natriuretic peptide prohormone [Nt-pro ANP] and brain natrituretic peptide [BNP] were assessed using ELISA kits. The results showed that plasma levels of Nt-pro ANP and BNP significantly increased with the size of PDA shunt, and when compared to infants without PDA [P<0.05]. A value of Nt-pro ANP > 5000 pmol/l predicted a hemodynamically significant PDA with a sensitivity of 97% and a specificity of 90%, whereas a value of BNP > 25 pmol/l had a sensitivity of 87% and a specificity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 75%. Using echocardiographic left atrial/aortic root ratio [LA: Ao ratio] of 1.5 as a cut off gave a sensitivity of 80% and a specificity of 95%. There were significant positive correlations between these studied parameters [P<0.01]. Plasma naturiuretic peptides [Nt-pro ANP and BNP] can be used as predictors of the hemodynamic significance of PDA in preterm neonates, and their measurement may be regarded as complementary to echocardiography in the assessment of PDA shunt and institution of appropriate treatment. Nt-pro ANP is more sensitive and specific predictor than BNP

Relationship of Monocyte chemoattractant protein-1 with diabetic nephropathy in children with type-1 diabetes: effect of high dose vitamin E therapy

Monocyte chemoattractant protein-1 [MCP-1] is a specific chemokine that activates monocytes from the circulation to the inflammatory sites. In diabetic nephropathy, similar to other glomerulonephropathies, infiltration and activation of monocytes / macrophages in the glomeruli have been implicated in the development of glomerular injury. The aim of this study was to examine a possible relationship of the MCP-1 with the development of diabetic nephropathy in children with type-1 diabetes before and after treatment with high dose of vitamin E for eight weeks. This study was carried out on thirty diabetic children, group 1; fifteen children with type 1 diabetes mellitus with persistent microalbuminuria, and group 2; fifteen children without microalbuminuria. Fifteen healthy children served as control group. Albumin excretion rate [AER] and glycosylated hemoglobin [HbA[1C]] were measured, also plasma MCP-1 levels were measured by ELISA before and after treatment with vitamin E for eight weeks. The results proved that plasma levels of MCP-1 were significantly higher in children with diabetic nephropathy than diabetic children without nephropathy and the control group [P<0.05]. There was strong positive correlation between HbA[1C] level and AER and MCP-1 [P<0.0001]. After treatment with vitamin E, there was a significant decrease in the MCP-1 plasma levels in diabetic children with nephropathy. This study suggests that facilitated MCP-1 production by the mesangial cells in diabetic children contributes to the initiation and progression of diabetic nephropathy. High-dose vitamin E supplementation may provide an additional benefit, as adjuvant therapy to insulin treatment, in reducing the risks for the development of diabetic nephropathy

Assessment of the waste stabilization pond performance, New Borg EL-Arab City

New Borg Al-Arab city includes 9 residential areas and 4 industrial Zones. The four industrial zones are Occupied by 266 running factories belonging to different industrial sectors. All the domestic sewage as well as the industrial wastewater is treated at an oxidation pond treatment plant and the plant effluent is used in irrigation of silviculture areas. The plant consists of 2 pond complexes Each complex comprises 9 facultative ponds, arranged in 3 parallel series. Raw wastewater is pre-treated through screens and grit removal before entering the primary ponds. The study aims at assessment of the performance of the waste Stabilization ponds. The results revealed that pre-treatment units were not functioning properly. The retention time was calculated to be 6 days in each pond of the first complex and 3 days in each pond of the second complex. The mean BOD surface loading rate was calculated to be 676 kg/ha/d for the first complex and 1584 kg/ha/d for the second. The plant was hydraulically and organically Overloaded The percentage removal of BOD, COD, SS, and NH3-N had an annual mean of 57%, 56%, 44%, and 39%, respectively for the first complex and 21%, 42%, 39%, and 25%, respectively for the second. Faecal coliforms were reduced by about 1 log10 unit in both complexes. The final pond effluent was not complying with the Egyptian law for reuse in irrigation The study proposed some recommendations which can improve the efficiency of the plant as well as the effluent quality

Pain as a fifth vital sign in a standardized pain flow sheet: impact on patient-reported pain experience after cardiovascular surgery

Random pain assessments and the subsequent administration of analgesics may provide inadequate pain management, which is a major health care problem. To improve the quality of pain management, pain should be assessed as the fifth vital signs in a standardized pain flow sheet, because pain assessment is rarely complete, and because health care professionals are poor predictors of patient's pain. Thus the present study was conducted to examine the impact of nurses' use of a standardized pain flowsheet to document pain assessment and pharmacologic management on patient reported pain intensity after cardiac surgery. A pre and post implementation design was used to compare 51 patients from Cardiac Surgical Units in Shark El Madina Hospital /Ministry of Health/ Alexandria and Mansoura University Hospital. For the first [28 patients] in the pre-implementation group, traditional charting of presence or absence of pain was documented in the narrative notes and the pharmacologic management was documented in the medication profile. In the post-implementation group [23 patients], the intensity of pain and pharmacological management were documented on a pain flowsheet. Within 24 hour patients were interviewed regarding pain intensity experienced in the surgical heart unit and at the time of questioning. The distribution of these pain intensity scores was compared. Results revealed that the use of a standardized pain flowsheet to assess pain intensity and document pharmacological intervention improved pain management in post operative cardiovascular patients. Use of this scale helps patients quantify pain intensity and relief and requires the health care member to be accountable for providing effective management of pain

Thirst distress scale for hemodialysis patients

Thirst is the most frequently occurring symptom in hemodialysis patients. An increase in thirst is usually associated with an increase in both fluid intake and an increase in weight gain. Intervention to reduce the symptom of thirst may provide a meaningful way to decrease intra-dialytic weight gain [IWG] and prevent associated complications. The purpose of the present study was to develop and test the psychometric properties of an instrument to measure thirst in hemodialysis patients. Hemodialysis Unit of the Main University Hospital / Alexandria University and Hemodialysis Unit of El Mouassat Hospital. Instrument development study. Two hundred and four adult patients receiving thrice-weekly outpatient hemodialysis therapy. Four dimensions of thirst were conceptualized in the instrument development in this study as follows: thirst intensity, distress, duration, and frequency. During a midweek scheduled hemodialysis session, participants were asked to verbally respond to the items based on experiences with thirst since their last dialysis treatment. The items were scored on 5-point rating scale from 1 [strongly disagree] to 5 [strongly agree]. Data were analyzed using the Statistical Package for Social Sciences [SPSS 10.0] and LISREL [LISREL 8.3]. Reliability was assessed using item analysis, and coefficient alpha. Validity was tested using confirmatory factor analysis, exploratory factor analysis, and relationship testing of constructs identified in the theoretical model. The sample age ranged from 18 to 74 years with a mean of 5 3 +/- 14.8 years. The individual's mean daily interdialytic weight gain [IWG] since the last hemodialysis treatment was 1.2 +/- 0.7 Kg. The mean thirst intensity was 54.23 +/- 27.31. The final thirst distress scale had 6 items whose correlations ranged from 0.43 to 0.68 and the Cronbach's alpha for the thirst distress scale was satisfactory [0.78]. The mean thirst distress score was 17.1 +/- 4.2. There was a positive relationship between thirst distress and IWG [r=0.17, P < 0.01], and also between thirst distress and thirst intensity [r=0.31, P<0.001]. The present study provided evidence for the reliability and validity of the thirst distress scale proposed herein. Although this scale was initially developed for use in a research study, it appears to have potential for use in a clinical setting, particularly in conjunction with measures that may be related to weight gain. The scale could also be tested on patients without end stage renal disease, such as persons with congestive heart failure

Diabetic nephropathy as a cause of end-stage renal disease in Egypt: a six-year study

The prevalence of diabetic nephropathy as a cause of end-stage renal disease [ESRD] in Egypt has been examined in small cross-sectional studies, with conflicting results. The need for a large-scale study prompted us to perform this 6-year multiple cross-sectional study. A sample of ESRD patients enrolled in the Egyptian renal data system was evaluated during the period 1996-2001 for the prevalence of diabetic nephropathy. Prevalence gradually increased from 8.9% in 1996, to 14.5% in 2001. The mean age of patients with diabetic nephropathy was significantly higher than that of patients with ESRD from other causes. Mortality was also significantly higher in diabetic patients with ESRD

Intralesional verapamil injection in treatment of Peyronie's disease: preliminary results

Objective: To evaluate the efficacy of intra-lesional verapamil injection in the treatment of Peyronie's disease

Patients and Methods: Twenty-six patients with Peyronie's disease were divided into two groups: the verapamil treatment group [study group] including 13 patients and the saline group [control group] including another 13 patients. The patients' age ranged from 35 to 58 years with a mean age of 43.75 years. The patients in the study group were subjected to a weekly injection of 10 mg verapamil hydrochloride [5 mg / 2 ml] into the plaque for the duration of six weeks. At the same time, the patients in the control group received a weekly injection of normal saline into the plaque, also for the duration of six weeks. The patients' response to the injections was evaluated subjectively with respect to pain and sexual dysfunction and objectively with respect to the plaque volume and the degree of curvature

Results: Following therapy, pain was improved in 8 of 9 patients [88.9] of the patients in the verapamil group, while in the control group it was stationary in 6 of 8 patients [75%] and had progressed in 2 of 8 patients [25%]. Curvature was improved in 5 of 10 patients [50%] and remained unchanged in 5 of 10 patients [50%] of the study group, while no improvement could be recorded in any of the patients of the control group. Three of five patients [60%] of the study group reported an improvement in sexual function, while no improvement was reported in the control group

Conclusion: Verapamil may be considered a safe, effective non-surgical remedy for the treatment of Peyronie's disease with an acceptable outcome in selected patients

Trichomonas vaginalis is not a rare sexually-transmitted disease among Egyptian men

The objective of this work was to determine the etiological role of Trichomonas vaginalis in urethritis among Egyptian men. Urethral swabs were obtained from 90 male patients presenting with urethritis and from 60 patients presenting with sexual dysfunction or infertility as controls. The swabs were examined by wet mount examination, culture on CPLM medium and polymerase chain reaction [PCR] to detect the presence of Trichomonas vaginalis. The results revealed that Trichomonas vaginalis was found in 16.7% of patients with urethritis and in 8.3% among the controls. In conclusion, Trichomonas vaginalis is an important consideration in urethritis among Egyptian men

Impact of hepatitis viruses B and C on the management of anemia in CRF patients on regular haemodialysis

Anemia remains virtually the most common complication in chronic renal failure patients. Iron deficiency has emerged as the major factor that limite of response to recombinant human erythropoietin [rHuEPO], and treatment by intravenous iron has been advocated to treat iron deficiency. Hepatitis viruses [particularly HCV] is prevalent in dialysis patients and is common in Egyptian dialysis patients, and its effect on iron parameters and anemia is not well studied. Is to study the impact of hepatitis viruses B and C on management of anemia in HD patients and to study the iron status, target hemoglobin and the clinical improvement on two regimens of therapy, iron alone and iron and rHuEPO. Sixty patients with CRF on regular haemodialysis were studied. The patients were divided into three main groups: Group [A]; 18 patients with positive HbsAg, Group [B]; 22 patients with positive anti-HCV antibody and group [C]; 20 patients with negative HbsAg and negative anti HCV antibody. Half of the patients in each group [groups A [I], B [I], and C [I]] were given intravenous iron [regimen I] only and the second half [groups A [II], B [II], and C [II]] were given intravenous iron and rHuEPO [regimen II]. All patients had been subjected to; full medical history and clinical examination, Kamofsky's score [KS], hemoglobin, hematocrit, blood indices, iron status; Serum ferritin and transferrin saturation, hepatitis markers; HbsAg and anti-HCV antibody. For patients on regimen I [who were given intravenous iron only], we found a significant increase [p < 0.01] of the mean hemoglobin which represents 18.8% of the baseline value. Patients on regimen II [who were given intravenous iron and subcutaneous rHuEPO], showed highly significant increase [p < 0.0001] of hemoglobin [32.9% of the baseline value]. In groups A and B [HbsAg positive and anti-HCV positive patients], we found significant increase [p < 0.01] in mean hemoglobin reaching to 22.893% of the baseline value. However, this response is significantly lower [p < 0.03] than the hemoglobin response in anti-HCV negative patients, who showed increase of 31.045% of their basal HB in both regimens of treatment. Baseline serum aminotransferases [ALT, and AST] were significantly higher [p < 0.05] in hepatitis-positive than in negative patients, and positive correlation between baseline SF and aminotransferases was noted. However, there was no significant rise [p = 0.08] of aminotransferases after iron and erythropoietin therapy. The study revealed accepted efficiency of both SF and TSAT tests in all groups [83.3% for SF and 93.3% for TSAT] with high sensitivity [86.3 for SF and 96.1% for TSAT], average specificity [77.8% for SF and 66.7% for TSAT] and high predictive values for positive responses [93.6% for SF and 89.1% for TSAT] in all groups. There was positive correlation between final HB achieved and KS scores of the patients. Iron status is a mandatory investigation for all anemic CRF patients on regular HD. In HbsAg positive or anti-HCV positive dialysis patients: There were significant response to intravenous iron alone in iron deficient patients and the response is highly significant with intravenous iron and rHuEPO; however this response is significantly lower than that observed in virology negative patients. There were non significant rise of aminotransferases. Both serum ferritin and transferrin saturation are simple, safe, and have accepted sensitivity, specificity, and efficiency for diagnosis of iron deficiency in haemodialysis patients including hepatitis virus positive patients. Administration of intravenous iron did not result in increase in liver enzymes in either group. Quality of life is significantly improved in all groups due to improvement of anemia