Prevalence of methylenetetrahydrofolate reductase C677T and A1298C polymorphisms in Egyptian patients with type 2 diabetes mellitus

Type 2 diabetes mellitus [T2DM] is a major public health problem around the world. The C677T and A1298C polymorphisms of the methylenetetrahydrofolate reductase [MTHFR] gene have been reported to be associated with T2DM and its complications. This study is a case-control study which was performed to clarify the association between polymorphisms in these two genes and T2DM among Egyptians. Study population [n = 120] consists of 60 Egyptian diabetic patients and 60 healthy controls. The MTHFR C677T and A1298C polymorphisms were gen-otyped by polymerase chain reaction, followed by enzymatic digestion with Hinfl and MboII enzymes, respectively. C677T and A1298C genetic polymorphisms conveyed an increase in T2DM risk [OR = 3.5, 95% CI = 1.1-11.6, p = 0.032 and OR = 2.2, 95% CI = 0.7-6.9, p = 0.004 respectively] Additionally, no significant associations between lipid/glucose metabolic indexes with MTHFR genotypes among diabetic patients were observed. Combined MTHFR gene polymorphisms revealed higher T2DM risk in homozygous and heterozygous forms compared to single gene polymorphism with pronounced risk in C677T/CT-A1298C/CC combined form [OR = 6.56, 95% CI = 0.76-56.2, p 0.041]. In conclusion, our data suggest that MTHFR C677T and A1298C polymorphisms are risk factor for T2DM in Egyptian patients. Also, the two gene polymorphisms may act synergistically to increase the risk of diabetes. Furthermore, it should be noted that the size of the studied population was relatively small and therefore, large-scale prospective studies are needed to confirm these findings

study of serum levels of B cell-attracting chemokine-13 [CXCL 13] and rheumatologic manifestations of chronic hepatitis C virus infection in a cohort of Egyptian patients

Many rheumatologic manifestations have been associated with Hepatitis C virus [HCV] infection including; arthralgia, myalgia, fatigue, fibromyalgia, vasculitis, and sicca syndrome. The relationship between emergence and persistence of intrahepatic or circulating B cell clonotypes and HCV infection is still unknown. However accumulating evidences indicate that certain chemokines play a critical role in providing the appropriate environment for activation and expansion of naive lymphocytes, one of these chemokines is B cell-attracting chemokine-13 [CXCL13]. CXCL13 is a major regulator of B-cell trafficking. This study evaluates circulating levels of CXCL13 protein in chronically HCV-infected Egyptian patients compared with healthy controls and its association with articular synovial hypertrophy. Rheumatic manifestations were present in 85% of patients; included fatigue [20%], arthralgia [the commonest manifestation] [65%], fibromyalgia [22%], myalgia [37%], Rayunad's phenomenon [10%], peripheral neuropathy and arthritis [2.5%], and tendenitis [7.5]. Cryoglobulins recorded in this study were of type II and III mixed cryoglobulins [MC] positive in 25% all of which showed positive rheumatoid factor [RF]. Significant low levels of C3 and C4 were reported in the patient group. CXCL13 serum levels were significantly high in the patient group especially in the MC positive group compared to controls. The highest levels of CXCL13 were significantly associated with rheumatologic manifestations with or without mixed cryoglobulinemia and significantly associated with articular synovial hypertrophy

Compliance with recommended life style behaviors in kidney transplant recipients. Does it matter in living donor kidney transplant?

Lifestyle after transplantation is the key link between transplantation and its outcome, and it is crucial to comply with the recommended life style behaviors. Our aim was to assess the compliance of kidney transplant recipients to the recommended life style behaviors in Mansoura, Egypt. One hundred kidney transplant patients were surveyed on their compliance with the recommended lifestyle behaviors including transplant medications, preventing from infections, diet, exercise, regular medical visits, personal hygiene, sexual activity, and cancer prevention. Most of the kidney recipients were compliant with the immunosuppressants. One-third of the participants were compliant with low-salt diet. Noncompliance with annual dental and eye checkup was reported in the majority of the subjects 94.0%. Compliance with infection prevention was partial. Half of the patient had a poor compliance with exercise or were not complying the recommendations at all. Only 9.0% of the patients were avoiding sun exposure. The majority of women were not compliant with breast self-examination. One-third of the patients consulted with their nephrologists about their sexual problems, and only half of the women were compliant with family planning program. The women were less compliant than men with medications [P = .02], and poor compliance with medications was more frequent among those with living unrelated donors [P = .04]. Our kidney transplant patients had good compliance with immunosuppressive medications, but not with most of the recommended behaviors. Intensive assessment of patients before and after transplantation should be done to identify their needs which help planning to improve their compliance

Evaluation of parenteral nutrition on the immune system of patients with polytrauma

Nutritional support for trauma and critically ill patients has been advocated to promote immune system recovery and to prevent as much tissue break down and nutritional deficit. The present study aiming to assessment of the parenteral nutrition on the immune system of patient with multiple trauma. Compare the effect of early parenteral nutritional and conventional hospital diet on the nutrition and immunology markers in trauma patients. A convenient sample of 40 severely traumatized patients within 8 hours after trauma they were enrolled sequentially into conventional [n = 20] and total parenteral nutrition [n = 20] groups [TPN]. Criteria for subject inclusion were, age 18-<45 years, Injury severity score [ISS] 20-40 score. Tools of data collection, four tools were utilized to collect data pertinent to the study. These tools were, nutritional assessment sheet, trauma scales and [APACHE] score [checklist], parenteral nutrition plans, evaluation tool which includes [Anthropometric measurement, Laboratory studies Immunological parameters]. Total parenteral nutritional has positive impact for trauma patients on anthropometric measurement, [weight loss, TSF and MAC] which was observed at the end of therapy [7th day.] for the conventional group while there were no changes for the same parameters in TPN group. As regard, laboratory tests, there were significantly increase in the values of total serum protein and albumin among patients of the TPN group after the end of therapy at [7th day] .As regard immune function, it was found that the mean values of [IL-10, IL-6, CD8] were significantly dropped in the TPN group after the end of therapy as compared to the admission. Also there were significantly increase in the values of complement C3, IGA, CD4, and CD4/CD8 ratio among patient of the TPN group at [7th day]. Establishment and implement of standardized protocol of parenteral nutrition support using nutritional screening and physical assessment forms, for the critically ill patients

Análise das alterações na curvatura corneana com implante intra-estromal: estudo experimental em coelhos / Analysis of corneal curvature alteration following intrastromal corneal ring implantation: experimental study in rabbits

OBJETIVO: Avaliar os efeitos do implante de anel corneano intra-estromal sobre a curvatura da córnea em coelhos. MÉTODOS: Trinta olhos de 15 coelhos foram divididos em 2 grupos: o primeiro com 7 e o segundo com 8 animais. O olho esquerdo foi operado e o direito serviu de controle nos 2 grupos. Paquimetria ultra-sônica e ceratoscopia computadorizada foram realizadas no pré-operatório; biomicroscopia de segmento anterior e ceratoscopia computadorizada, no pós-operatório. No grupo 1, foi realizado implante de dois segmentos de anel. No grupo 2, os segmentos foram implantados separadamente. Compararam-se os achados topográficos do pré e do pós-operatório por meio de alterações quantitativas e qualitativas em 4 quadrantes. RESULTADOS: A análise quantitativa no pré-operatório não demonstrou diferença significativa entre os grupos. No grupo experimento 1, houve abaulamento corneano nos setores nasal (p=0,02) e temporal (p=0,04), na comparação com o grupo controle 1. No grupo experimento 2, observou-se o mesmo fato (p=0,02 nasal e temporal) quando comparado ao grupo controle 2. Após implante do segundo segmento, observou-se aplanamento significativo nos setores superior e inferior e abaulamento nos setores nasal e temporal (p=0,02 para todos os quadrantes). Pela análise qualitativa, observou-se astigmatismo uniforme nos grupos controle 1 e 2. No grupo experimento 1, observou-se astigmatismo simétrico contra a regra. No grupo experimento 2, observou-se astigmatismo contra a regra assimétrico, após implante do primeiro segmento, e simétrico, após o segundo implante. CONCLUSÃO: Observou-se aplanamento corneano significativo no eixo onde se localizam as extremidades do segmento de anel e abaulamento nos setores onde se localiza seu corpo. O implante de apenas um segmento induz astigmatismo assimétrico.

PURPOSE: To evaluate the effect of intrastromal corneal ring implantation on corneal curvature in rabbits. METHODS: Thirty eyes of 15 rabbits were divided into two groups: group 1 with 7 animals and group 2 with 8 animals. The left eye underwent surgery and the right eye was used as control. Ultrasound pachymetry and corneal topography were performed prior to surgery. Anterior segment biomicroscopy and corneal topography were performed after surgery. In group 1, implantation of two ring segments was performed. In group 2, ring segments were implanted separately. Topographical findings, before and after surgery, were compared through quantitative and qualitative alterations and divided into four quadrants. RESULTS: Quantitative analysis showed no significant difference between the groups in the preoperative period. Experiment group 1 showed nasal (p=0.02) and temporal (p=0.04) corneal steepening, compared to control group 1. Experiment group 2 showed nasal and temporal corneal steepening and superior and inferior corneal flattening (p=0.02 for all quadrants) compared to the control group 2. Qualitative analysis showed uniform astigmatism in both control groups. In experiment group 1, against-the-rule regular symmetrical astigmatism was observed after surgery. In experiment group 2, against-the-rule regular asymmetrical astigmatism was found after implantation of the first ring segment, and against the rule regular symmetrical astigmatism was observed after implantation of the second segment. CONCLUSION: In this study, significant corneal flattening occurred in quadrants where ring segments extremities were located and corneal steepening was observed in quadrants where its body was located. Implantation of one ring segment induces asymmetrical astigmatism.

Investigação experimental da utilidade da medicação no pós-operatório em cirurgia refrativa / Experimental investigation of postoperative use of medication in refractive surgery

OBJETIVO: Isolar microrganismo em microceratótomo, induzir ceratite infecciosa avaliando a resposta terapêutica. MÉTODOS: Foram realizadas coletas consecutivas de material a partir do microceratótomo usado rotineiramente para cirurgia refrativa em olhos humanos durante um período de 8 dias. Preparou-se uma diluição segundo a escala de MacFarland para inocular na córnea de cobaias. Utilizaram-se oito animais, injetou-se 10 µl no estroma corneano de ambos os olhos. No olho direito não se instilou medicamento (grupo 1) e no olho esquerdo instilou-se ciprofloxacina 0,3 por cento associado a dexametasona a 0,1 por cento e trometamina de cetorolac de 4 em 4 horas por 24 horas (grupo 2). Após este período as cobaias foram sacrificadas e as córneas divididas, sendo uma metade enviada para análise microbiológica e outra para histopatologia. RESULTADOS: No grupo sem tratamento, todas as 8 amostras foram positivas, ao passo que no grupo tratado, 3 desenvolveram cultura positiva para Staphylococcus aureus (p=0,0128). A avaliação histopatológica de polimorfonucleares e monomorfonucleares no estroma mostrou que eram menos numerosos no grupo tratado (grupo 2), com p=0,0203 e p=0,0051, respectivamente. CONCLUSAO: Este estudo portanto sugere que o uso de antibiótico de amplo espectro associado a antiinflamatório tem efeito significativo na diminuição do processo inflamatório e infeccioso em possível contaminação intra-estromal após cirurgia refrativa.

Postprandial platelet depleted plasma 5-hydroxytrypamine concentration in symptomatic female with diarrhea predominant irritable bowel syndrome

Serotonin [5-HT] may play an important role in the regulation of colonic motility in humans. However, Meal ingestion is often associated with exacerbation of gastrointestinal symptoms in subjects with irritable bowel syndrome [IBS]. Abnormalities of 5-HT release after a meal might explain some of the postprandial symptoms associated with the irritable bowel syndrome [IBS]. To assess plasma serotonin [5-HT], 5-hydroxyindole acetic acid [5-HIAA] concentrations, 5-HT turnover, platelet 5-HT stores, and any relationship to symptomatology. In addition, to determine whether patients with different clinical manifestations of IBS have different mucosal disposition of 5-HT. After an overnight fast, 20 healthy female volunteers [aged 21- 46 years] [mean 29.3], and 39 female subjects with diarrhea predominant irritable bowel syndrome [d-IBS] [aged 20-48 years] [mean 31.4], were given a standard carbohydrate meal [457 Kcal]. Platelet depleted plasma 5-HT, and 5-HIAA concentrations for two hours [60 minute intervals] under fasting conditions, and then for a further four hours [30 minute intervals] after standard carbohydrate meal were assessed, together with fasting platelet 5- HT concentrations. IBS symptomatology, in particular abdominal pain and bloating, and urgency to defecate were assessed throughout the study. Colonic mucosal specimens ranging from the ascending colon to the rectum were obtained from patients with diarrhea-predominant and from subjects with normal bowel habit by endoscopic biopsy, the tissue concentrations of 5-HT and its major metabolite, 5-hydroxyindoleacetic acid, were determined by reversed-phase high-performance liquid chromatography with fluorescence detection. When related to fasting level, there was no statistically significant difference in postprandial plasma 5-HT concentrations between d-IBS and healthy subjects. However, when fasting levels were not taken into consideration, d-IBS subjects exhibited higher postprandial plasma 5-HT concentrations compared with healthy subjects [p = 0.040]. Furthermore, d-IBS subjects who exhibited postprandial symptomatology had higher levels of postprandial plasma 5-HT, whether assessed with respect to fasting baseline levels [p = 0.065] or not [p = 0.046], compared with dIBS subjects who did not report postprandial symptomatology. This appeared to be associated with a concomitant increase in plasma 5-HIAA [p = 0.162] but reduction in turnover [0.057]. Also, d-IBS subjects had higher platelet concentrations of 5-HT than healthy subjects [p = 0.009]. The mean mucosal 5-HT concentrations obtained from the rectum regions of the colon. In addition, the overall mean mucosal 5-HT concentrations obtained from patients with d-IBS were significantly [p = <0.05] lower than those obtained from the control subjects. No significant difference were observed in 5-HIAA concentrations among the two groups. These data suggest that postprandial symptomatology may be associated with increased platelet plasma 5-HT concentrations in female subjects with d-IBS. The increased release of 5-HT into plasma leads to depletion of mucosal 5-HT in subjects with d-IBS. The presence of increased platelet stores of 5-HT may act as a useful marker for the diagnosis and management of d-IBS

Análise de nova técnica para o implante do anel de Ferrara no ceratocone / Analysis of new technique for Ferrara ring implantation in keratoconus

OBJETIVO: Descrever nova técnica para o implante do anel de Ferrara por meio de incisão única e avaliar segurança e eficácia em pacientes com ceratocone. MÉTODOS: Estudo prospectivo em vinte pacientes com ceratocone, submetidos ao implante por meio desta nova técnica. Critérios de exclusão: boa adaptação a lentes de contato, presença de cicatrizes corneanas significativas, ápice do cone com mais de 65 dioptrias, paquimetria inferior a 400 micra no local da incisão e presença de doenças oculares ou sistêmicas que contra-indicassem a cirurgia. Acuidade visual (LogMAR) e medida do ápice corneano pela topografia foram as variáveis analisadas no pré e pós-operatório. Foram registradas possíveis complicações ou queixas relacionadas às cirurgias. Período mínimo de um ano de acompanhamento. RESULTADOS: A acuidade visual média não corrigida melhorou de 1,045 ± 0,478 (mediana de 1,150) no pré-operatório, para 0,586 ± 0,373 (mediana de 0,500) unidades LogMAR, após doze meses de pós-operatório (p<0,0001). A acuidade visual com correção melhorou de 0,714 ± 0,542 (mediana de 0,500) para 0,264 ± 0,162 (mediana de 0,200) unidades LogMAR (p=0,001). A média do ápice corneano pela topografia variou de 55,9 ± 4,4D no pré-operatório, para 51,5 ± 4,8D após doze meses de pós-operatório (p<0,0001). Após o terceiro mês de cirurgia, todos os pacientes evoluíram com estabilização da acuidade visual. Não houve complicações ou queixas durante o período estudado. CONCLUSAO: O implante do anel de Ferrara, por meio de incisão única, determinou melhora da acuidade visual, sem correção e com correção, e aplanamento corneano significativos no grupo estudado, após doze meses de cirurgia.

Endoftalmite por Candida albicans após transplante penetrante de córnea: relato de caso / Candida albicans endophthalmitis following penetrating corneal graft: case report

Os autores relatam o caso de uma paciente submetida a transplante penetrante de córnea por ceratocone que evoluiu com resposta inflamatória exacerbada durante o período pós-operatório, suspeitando-se, inicialmente, de rejeição atípica e intensa ao botão doador. Houve períodos de melhora, seguidos por períodos de piora a cada tentativa de se reduzir o corticóide tópico. Iniciou-se terapia imunossupressora com ciclosporina via oral e altas doses de corticóide tópico, porém, a paciente desenvolveu endoftalmite por Candida albicans com acometimento do segmento anterior do olho e do corpo vítreo, mas sem surgimento de lesões coriorretinianas. Evoluiu de forma satisfatória após três injeções de anfotericina B 5µg intravítrea, cetoconazol 400 mg/dia via oral e clotrimazol tópico de 4/4 horas. Os autores discutem também as principais possibilidades de contaminação da paciente, sendo o quadro infeccioso provavelmente relacionado ao procedimento cirúrgico.

Anel intracorneano de Ferrara em ceratocone / Ferrara's intracorneal ring in keratoconus

Objetivo: Análise dos resultados dos dez primeiros pacientes com ceratocone submetidos a implante do anel de Ferrara no Hospital de Olhos do Paraná. Métodos: Foi realizado um estudo prospectivo em 10 pacientes com ceratocone. Os critérios de inclusão foram: intolerância a lentes de contato, acuidade visual sem correção inferior ou igual a 20/100, ausência de cicatrizes corneanas significativas e ausência de doenças oculares ou sistêmicas que contra-indicassem a cirurgia. Acuidade visual (LogMAR), refração e topografia pré e pós-operatórias foram as variáveis analisadas. Os pacientes foram seguidos pelo período mínimo de três meses. Resultados: Das complicações cirúrgicas encontradas, destacaram-se dois casos de microperfuração corneana durante a confecção das incisões para os túneis inferiores, um de extrusão e quatro de deslocamento pós-operatório do anel. A acuidade visual corrigida melhorou de 0,750 Ý0,374, para 0,438 Ý 0,342 (p=0,026). A média da acuidade visual não corrigida no primeiro dia pós-operatório foi de 0,667 Ý 0,447 (n=9), e a acuidade visual final não corrigida foi de 0,562 Ý 0,272. De acordo coma refração realizada após o terceiro mês pós-operatório, cinco pacientes evoluíram com acuidade visual com correção melhor do que ou igual a 0,5 unidades LogMAR. Um paciente não apresentou aplanamento significativo do cone segundo a topografia corneana. Conclusão: O presente estudo demonstrou melhora nos valores pós-operatórios de acuidade visual, refração e topografia na maioria dos pacientes avaliados, em relação aos valores pré-operatórios.

Ressecçäo cirúrgica em bloco de melanoma maligno de coróide / Surgical resection in block of choroidal malignant melanoma

O tratamento de melanoma maligno de coróide pode ser realizado através de enucleaçäo, radioterapia ou ressecçäo cirúrgica local do tumor, especialmente se o tumor localiza-se na íris, corpo ciliar ou coróide periférica. A ressecçäo local de tumores localizados mais posteriormente, somente se tornou possível com as técnicas mais avançadas de cirurgia vitreo-retiniana. Além disso, a técnica de ressecçäo local tem vantagens sobre a enucleaçäo e a radioterapia na preservaçäo da visäo. Os autores relatam um caso de paciente portadora de melanoma maligno de coróide que iniciava na periferia, atingindo o equador do olho, e que foi tratado com ressecçäo cirúrgica local. A remoçäo do tumor transcorreu sem anormalidades, e no 4§ mês de pós-operatório a paciente apresentava acuidade visual de 20/30, que diminuiu até 20/60 devido a adema macular cistóide. A paciente mantém-se estável desde entäo, e nenhum, sinal de crescimento tumoral foi observado até 18 meses após a cirurgia.

Genetic studies on retinitis pigmentosa

Our study included 50 cases with retinitis pigmentosa [RP] as an isolated anomaly. Patients with syndromes associated with RP were excluded. Twenty seven cases were familial and 23 cases were sporadic. Pedigree patterns were examined in familial cases. Consanguinity was search for in both familial and sporadic cases. Electo-retinogram [ERG] showed extinguished curves in two familial cases without fundus changes. Amino acids were estimated in blood and urine for 5 cases with different patterns of inheritance. Reduced threonine and histidine levels in blood was noticed in autosomal dominant and recessive cases and normal levels in the X-linked cases