Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE) / 대한뇌졸중학회지

Background@#and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. @*Methods@#Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). @*Results@#Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). @*Conclusions@#The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Influence de la vitamine D3 livrée localement sur la conservation des crêtes alvéolaires après extraction, des dents (évaluation clinique radiographique et histologique)

BUT DE L'ÉTUDE: Le but de cette étude d'essais cliniques contrôlés randomisés était d'évaluer et de comparer la conservation des dimensions de la crête alvéolaire après une extraction dentaire atraumatique à l'aide d'une membrane de collagène et d'une xénogreffe mélangée avec du gel vit D3 actif par rapport à une membrane de collagène et à une xénogreffe uniquement. MATÉRIEL ET MÉTHODES: Dix patients ont été sélectionnés. Tous les patients ont dû extraire deux prémolaires non restaurables (ou dents antérieures) situées dans des quadrants symétriques d'arcs maxillaires ou mandibulaires et ont demandé une restauration d'implant. Deux chirurgies ont été réalisées pour chaque patient; le premier était destiné à l'extraction de la préservation de la crête alvéolaire, tandis que le second était destiné à la biopsie osseuse centrale et à la pose d'implants de façon routinière. Chez le même patient, une prise d'extraction (site de test) a été traitée avec une membrane de collagène et une xénogreffe mélangée avec de la vit active D3 tandis que la deuxième prise d'extraction (site de contrôle) a été traitée avec une membrane de collagène et une xénogreffe uniquement. Des évaluations cliniques, radiographiques et histologiques / histomorphométriques ont été réalisées. RÉSULTATS: Cliniquement et par radiographie tout au long de la période d'étude, il n'y avait pas de différence statistiquement significative entre les variations moyennes en% de la largeur des crêtes BL et de la hauteur des crêtes dans les deux groupes. L'analyse histomorphométrique a montré une différence statistiquement significative entre la fraction de surface moyenne de la nouvelle formation osseuse dans les deux groupes. CONCLUSION: L'application locale de vitamine d3 avec la xénogreffe dans la préservation de la crête alvéolaire accélère la formation de nouveaux os et favorise la maturation osseuse lors de la comparaison avec la xénogreffe uniquement

Comparison between the use of a genexpert device and conventional diagnostic methods in the detection of mycobacterial tuberculosis and its resistance to drugs

Background: Mycobacterium tuberculosis [MTB] is the causative agent of tuberculosis [TB], which remains the leading cause of morbidity and mortality worldwide. The emergence of drug-resistant strains of MTB has put status of TB to threatening levels

Aim of the Work: was to detect MTB along with rifampicin [RIF] resistance using Genexpert [MTB/RIF]. Its diagnostic, sensitivity and specificity were evaluated by comparing with conventional technique

Patients, Materials and Methods: This prospective study was conducted on two hundred and seven Egyptian patients at Abbasia Chest Diseases Hospital, from November 2016 to December 2017, and comprised clinically and radiologically diagnosed TB suspected cases. This study was approved by the Ethical Committee of faculty of medicine, Alazhar University and the Ethical Committee of Ministry of Health and after Verbal consents from the patients or their parents were taken. Pulmonary specimens [sputum and bronchial lavage] and pleural effusion as an extra-pulmonary specimen were included. All samples collected were sent to TB laboratory of Abbasia Chest Diseases Hospital for further analysis

Result: Out of the 26 Genexpert [MTB/RIF] positive samples for MTBC, 3 [11.54%] showed RIF resistance and diagnosed as MDR-TB. Using LJ and MGIT cultures for drug sensitivity test [DST] on 31 and 34 positive TB samples; respectively, the same three specimens showed resistance to rifampicin [RIF]. Four positive specimens were also resistant to streptomycin [STR] using the previously mentioned cultures. Moreover, resistant to INH was reported in five positive TB samples using the same cultures. Finally, it was found that all positive specimens were sensitive to Ethambutol [ETH]

Conclusion: Although the conventional methods remain the gold standard for diagnosing pulmonary TB, delayed diagnostic times demand for more rapid and sensitive nucleic acid amplification techniques. Genexpert [MTB/RIF] assay is simple, rapid and accurate method for detecting mycobacterial tuberculosis

Sudan Rheumatic Heart Disease Control Initiative: achievements and challenges: 2012-2017. Sudan RHD Control Committee

NA

Infantile Dural Arteriovenous Fistula of the Transverse Sinus Presenting with Ocular Symptoms, Case Reports and Review of Literature

Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure.This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula.

Influence of Feeding Pattern on Head circumference as a Marker for Nutritional Status during the First Year in Healthy Infants and Malnourished Infants

Frequent and accurate assessment of growth is of primary importance in the care of children. Growth curves or charts are a standard part of any checkup, and they show health care providers how children are growing compared with other children of the same age and gender. Observation and recording of a growth parameter over a period of time permit early detection of any deviation from normal growth pattern. Weight is early affected by malnutrition. Length, on the other hand, is affected by malnutrition and also head circumference is affected if this is for at least 6 months. Human breast milk is the unique and superior form of infant nutrition against which all substitute feeding methods must be measured with regards to growth, health, development, and other effects. Our aim of this work is to evaluate height, weight and head circumference in healthy infants and infants with malnutrition, in the first year with different types of feeding. In our study, we evaluated the measurements of one hundred and forty infant; 20 normal nevvborns, 60 babies at 6 months and 60 at 12 months of age also we recalled the pattern of their feeding. History about the type of feeding, breast, formula and mixed feeding were taken, complete clinical examination including anthropometric measurements were performed including weight, height and head circumference . Cases of malnutrition were diagnosed according to water low classification. Our results found that a statistically significant difference between head circumference and length between breast, mixed fed infants compared to formula fed infants, being higher in infants exclusively breast fed and mixed fed infants and this nutritional superiority continued - to a slightly less significant degree throughout the end of year. In our study we found that malnutrition not only affects weight and height but also affects head circumference. Our study showed this strong linkage between malnutrition and failure to establish breast feeding as we found that all malnourished cases included in our study were formula fed exclusively. Encourage of breast feeding is a protective against malnutrition

validity of exhaled nitric oxide [NO] in breath condensate in the evaluation of controlled asthma

Nitric oxide was recognized as a key signaling molecule in a wide variety of biological functions, and NO research affects all branches of medicine. In the lung, NO acts as a vasodilator, bronchodilator and non-adrenergic non-cholinergic [NANC] neurotransmitter and is an important mediator of the inflammatory response. Nitric oxide is formed in the lungs and the presence of NO has been detected in the exhaled air of several species, including humans. The aim of the present work to evaluate the validity of exhaled nitrite and nitrate level in exhaled breath condensate in evaluating cases of controlled asthma. The study included 61 subjects: 49 controlled asthmatic patients and 12 control subjects All subjects in the present study were subjected to spirometric study, collection of exhaled breath condensate, breath condensate analysis using nitrite assays, pH measurement. The asthmatic group was further subdivided into two groups: [group I a] including 34 patients receiving anti inflammatory treatment [inhaled corticosteroid] and [group I b] including 15 patients receiving bronchodilators [Beta 2 agonist or theophylline]. Exhaled nitric oxide end product level was significantly higher in asthmatic patients than in control subjects. Asthmatic patients receiving inhaled corticosteroid therapy had a significantly lower exhaled nitric oxide end product level than the others .Breath condensate pH was significantly lower in asthmatic patients than in control subjects. Asthmatic patients receiving inhaled corticosteroid therapy had a significantly higher breath condensate pH than the other patients. Exhaled nitric oxide end product and breath condensate pH reflect the degree of airway inflammation and airway obstruction in stable asthmatic patients. Hence, they could both provide a valuable tool for early disease management and prevention

Effect of educational support for children with thalassemia on enhancement of their quality of life

Thalassemia is a genetic blood disorder which can be fatal if proper treatment is not received. It is characterized by partial or no production of alpha or beta globin chains which form part of the structure of the hemoglobin in the red blood cells. this study aims at assessing knowledge of children with major thalassemia about their illness and evaluate the effect of educational support on their quality of life, the study sample consisted of 50 thalassemic children. An experimental design was utilized in this study. the study was conducted at out patient clinics, Abo EL-Reech, pediatric Hospital, and Cairo University. Tools of data collection include, Interviewing questionnaire: It was designed by the researchers after reviewing of related literature. It was constructed to elicit personal data about the afflicted child with thalassemia and Quality Of life Instrument [Ferrell 1995]. Results, the study results revealed that, age of 64% of studied children under 12 year, while 24% more than 15 year. Majority of studied children 80%had relative within their families affected with thalassemia. Meanwhile 68% of children had kinship relation between their parents. there is no statistical significant differences regarding the children physical well being as a domain within quality of life as ascribed to test [pre and post tests], Meanwhile there are statistical significant differences in their psychological well being, social concerns and spiritual well being and the entire domains of quality of life for these children as ascribed to test pre and post tests Recommendation, Thalassemia-prevention program must be developed, with the use of better education programs that provide acceptable care, including transfusion of safe blood and supportive therapy including chelating, Premarital counseling to reduce the frequency of births with major thalassemia should be encouraged

Insulin therapy induced adiposity evaluted by computed tomography is not visceral

In individuals with type 2 diabetes, weight gain during treatment with insulin and other agents prevents the attainment of glycemic targets and probably limits the success of treatment. Studies have attempted to elucidate the mechanisms behind the apparent paradox of insulin improving glycemic control and cardiovascular risks, while causing weight gain. The aim of this study is to clarify the influence of insulin therapy on body weight and differential fat distribution [visceral or peripheral] in newly insulin treated type 2 diabetic male patients. The study was conducted on 26 type 2 diabetic male patients evaluated at baseline and 12 months after instituting insulin therapy. Body mass index [BMI], absolute waist circumference [AWC], systolic and diastolic blood pressure, HbA1c% were estimated. Abdominal Computed tomography was applied to evaluate areas of subcutaneous fat [SF] and visceral fat [VF] before and after insulin therapy. There is significant reduction in HbA1c [9.03 +/- 0.72 vs. 7.50 +/- 0.58, p<0.001] and significant increase body mass index [BMI =28.92 +/- 1.39 vs. 29.81 +/- 1.27, p=0.02] .However there was non significant changes in the AWC 103.27 +/- 3.87 Vs 105.14 +/- 3.25, P=0.065, VF 121.01 +/- 5.84 Vs 123.01 +/- 5.55, p=0.213, SF 206.54 +/- 9.93 Vs 212.12 +/- 11.62, P = 0.069and V/S ratio 0.59 +/- 0.03 vs. 0.58 +/- 0.03, P=0.365. Weight gain in the newly insulin treated type 2 diabetic patients during 12 months duration is equally distributed in both peripheral and visceral fat. So, insulin therapy does not appear to increase the visceral fat in type 2 diabetic patients which is strongly liked to atherosclerosis. Longer-term follow up and bigger sample size are necessary to address the issue of the kinetics of weight gain and to establish the possible correlation with other cardiovascular risk markers