Impact of obesity and body fat distribution on pulmonary function of Egyptian children

Childhood obesity is an emerging global public health challenge. That is because the prevalence of obesity among children and adolescents has increased greatly in all parts of the world.[1] Overweight and obese children are at increased risk of a wide range of health conditions including respiratory diseases. A number of studies have reported an inverse relation between respiratory function and various indices of obesity or fat distribution.[2] The aim of this work: was to study the impact of obesity on pulmonary function and to assess the correlation between lung function impairment, degree of obesity and fat distribution in Egyptian children with simple obesity. Patients and method: This study was conducted on thirty children. They were divided into two groups. Group I included 20 children with simple obesity. Group II included 10 healthy normal children as a control group. All children were subjected to full history taking, thorough clinical examination, anthropometric assessment, plane x-ray left hand for bone age assessment, plane x-ray chest and pulmonary function testing including: FVC, FEV1, FEV1 / FVC or FEV1%, PEF maximum, PEF25%, 50% and 75%,: FEF25-75%, MVV. Obese children had statistically significant higher rate of chest symptoms suggestive of bronchial asthma than the control group. They had also statistically significant reductions in FVC, FEV1, PEF, and MVV. They showed also lower values of FEV1/FVC ratio FEF 25%, 50%, 75% and FEF 25-75% when compared with control group but the difference did not reach significant level. BMI had significant negative correlation with FVC, FEV1, PEF max, flow rates [FEF25%, FEF50%, and FEF25-75%] and MVV. Triceps skin fold thickness had significant negative correlation with, FEV1, FEF25%, FEF50%, PEF max, and MVV. MAC was inversely correlated with FEV1, FEF25%, FEF50%, FEF75%, PEF max, and MVV. There was no statistically significant correlation between waist circumference or WHR and all the parameters of pulmonary functions. Obese children have more respiratory symptoms than their normal weight peers. They have significant restrictive pulmonary defect, evident small airways obstruction and a defect in respiratory musculature, week effort and coordination, with increased airway resistance. BMI was inversely correlated with most of pulmonary function abnormalities. So, BMI is recommended to be used as a predictor of pulmonary function in assessment of obese children in epidemiological studies

Use of hypoosmotic swelling test for evaluating camel spermatozoal membrane integrity in relation to different solutions

Five male camels at 5 to 10 years of age and 400 - 600 kg body weight, were used in the present study. Semen was collected, evaluated, pooled and extended with seven different hypoosmotic solutions [glucose - yolk-citrate: GYC, fructose-yolk-citrate: FYC, lactose-yolk-citrate: LYC, sucrose-yolk-citrate: SYC, tris-yolk-fructose: TYF, skim-cow-milk: SCM and skim camel-milk: SLM] at a level of 100 mOsmol/L and then incubated at 37 'C for up to 60 minutes. After each incubation time [0, 5, 15, 30 and 60 minutes], the percentages of sperm motility, spermatozoa with intact acrosome, spermatozoa with coiled tails and swollen spermatozoa, were estimated. The results showed that, the extended camel semen with FYC, SYC, TYF and SCM solutions at a level of 100 mOsmol/L, during an incubation of 37 'C for up to 60 minutes increased significantly [P < 0.0l] the percentage of sperm motility, spermatozoa with intact acrosome and swollen spermatozoa as compared to GYC, LYC and SLM solutions, however, the percentage of spermatozoa with coiled tails decreased significantly [P < 0.0 1] in the extended camel semen with SYC and TYF solutions as compared to GYC, FYC, LYC, SCM and SLM solutions. The advancement of incubation time at 37 'C for up to 60 minutes with the all different solutions [GYC, FYC, SYC, LYC, TYF, SCM and SLM] at 100 mOsmol/L decreased significantly [P < 0.01] the percentages of sperm motility and percentage of spermatozoa with intact acrosome, while was increased significantly [P < 0.01] the percentage of swollen spermatozoa and spermatozoa with coiled tails. The maximum reactivity of the extended camel spermatozoa with the all different solutions to hypoosmotic swelling-test [HOS-test] was reached significantly [P < 0.01] at 30 minutes of incubation at 37°C

Can prostate cancer be predicted in BPH patients with elevated serum PSA and negative initial sextant biopsy? a multivariate analysis study

Objective: To define a predictor of prostate cancer in BPH patients with an intermediate PSA [4.1-10 ng/ml] and a negative initial sextant biopsy

Patients and Methods: During 1999, 193 BPH patients with an intermediate PSA [4.1-10 ng/ml] underwent TRUS and sextant biopsy. The patients whose initial biopsies were negative for prostate cancer were re-evaluated by serum PSA every 6 months. A total of 76 patients were subjected to an extended 11-core biopsy in view of: [1] PSA velocity >/= 1 ng/ml/year, [2] a PSA rise to > 10 ng/ml and [3] suspicious biopsy findings [atypical adenomatous hyperplasia or high-grade prostatic intraepithelial neoplasia]. Overall, 160 patients were subjected either to TURP [n=127] or open prostatectomy [n=33]

Results: On initial sextant biopsy, prostate cancer was diagnosed in 22 out of 193 patients [11.4%]. The specificity of the sextant biopsy was 91.8% and its positive predictive value [PPV] was 61.1%. A repeat 11-core biopsy revealed prostate cancer in 11 out of 76 patients [14.5%]. The specificity of the 11-core biopsy was 95.4% and its PPV was 78.6%. Three cancers out of 160 [2%] were discovered on definitive pathology. The PSA velocity cut-off point at 1.4 ng/ml/year and the PSA density cut-off point at 0.12 were optimal for the prediction of cancer using receiver operating characteristic curves. The multivariate analysis [stepwise logistic regression] revealed that PSA density [p=0.011], PSA velocity [p=0.002] and age [p=0.021] were the most significant predictors of cancer when the data were inserted as a continuous format. The sensitivity, specificity and overall accuracy of the model were 80%, 98.7% and 95.9%, respectively. When the data were re-inserted as a coded format, PSA velocity and PSA density were the only predictors. All the analyzed risk factors [age, PSA, DRE, prostate echogenicity and PSA/TZ index] were excluded from the model

Conclusion: PSA velocity and PSA density were the most significant predictors of prostate cancer in BPH patients with an intermediate PSA [4.1-10 ng/ml] and a negative initial sextant biopsy

rationale for prostate cancer detection in a developing country: comparison of screening and case finding

Objective: This study was conducted to compare the results of community based screening program for prostate cancer with case finding among urologic patients. Patients and Methods: Two programs for prostate cancer detection were conducted based on PSA assay [cutoff value 4ng/ml] and DRE for men aged 50 to 75 years. The first one included 833 urologic patients [group 1] and the second included 882 men who responded to a campaign for early detection of prostatic diseases [group 2]. Diagnosis of prostatic adenocarcinoma depends on ultrasound guided six-core prostatic biopsies. Results: In group 1, 154 patients were biopsied [147 due to high PSA +/- suspicious DRE and 7 due to suspicious DRE alone]. Prostate cancer was diagnosed in 36 patients [4.3%]. Organ confined cancer was detected in 41.7% of them [15 patients]. In group 2, 75 men were biopsied [69 for high PSA +/- suspicious DRE and 6 for suspicious DRE alone].The cancer detection rate was 2.2% [19 patients] and the rate of organ confined disease was 37.87 [7 patients]. There was no significant statistical difference between both groups regarding cancer detection rates and the percent of organ confined tumors. Conclusion: The results of this study may present a rationale for application of prostate cancer detection program in developing countries to urologic patients

Immunohistochemical assessment of bladder carcinoma using two monoclonal antikeratin antibodies [UNME/K1 and CAM 52]

Cytokeratins which constitute a complex family of proteins are considered reliable markers of epithelial differentiation. We have generated a monoclonal antibody directed against keratin extracted from human bladder squamous cell carcinoma [UNME/K[1]]- The specificity analysis was performed by indirect immunoperoxidase on paraffin sections of 100 cases of bilharzial bladder carcinoma. The immunoreactivity of UNME/K[1] demonstrated that it does not react with normal urothelium. It intensely reacts with squamous metaplasia and keratinizing squamous metaplasia where it stains the suprabasal layers. Also strong reactivity is observed in Gl SCC. The intensity of staining appears to be related to the grading, maximal in grade 1, moderate in grade 2 and disappear in grade 3. Low grade TCC exhibits moderate reactivity. Also low grade adenocarcinoma demonstrates focal areas of reaction while grade 2 and 3 are negative. UNME/K[1] could be a useful reagent in the diagnosis and prognosis in patients with bilharzial bladder cancer

Doppler-echocardiographic assessment of left ventricular systolic function among insulin dependent diabetic patients, relation to other diabetic angiopathies

Doppler Echocardiography was used to determine left ventricular systolic function indices in 52 insulin dependent diabetic patients selected from the out-patient clinic of diabetes. They were classified according to the duration of diabetes into insulin dependent diabetics less than 5 years duration, group A [No 27, mean age 25.9 +/- 8.7] and insulin dependent diabetics more than 5 years, group B [No. 25, mean age 43.3 +/- 9.5]. The data were compared to 12 healthy control subjects of comparable age and sex [group c]. The most frequent indices abnormalities were diminution of ejection time, acceleration and deceleration time, peak aortic flow and aortic flow integral in diabetics. These changes were correlated more to the duration but not to the severity of the disease. These changes did not correlate with diabetic neuropathy, retinopathy nor nephropathy. Doppler-echocardiography may offer a reliable non-invasive means to assess systolic function and to detect early abnormalities before the appearance of clinical symptoms

Uroenteric fistulae

Seven cases in which a fistulous tract communicating the urinary system with the intestinal tract are presented. One case was a vesico colonic fistula following a full thickness resection of a bilharzial bladder ulcer in association with diverticulitis of the pelvic colon. A second case was a uaretero colonic fistula in association with colonic diverticulitis following ureterolithotomy The other five cases were urethro-rectal fistulae four following direct penetrating trauma and one after prostatectomy. The clinical course, etiology, pathogenesis and operative modalities of correction are discussed

management of Pyonephrosis

Sixty cases of pyonephrosis were treated in an 8-year period between 1977 and 1987. All patients were treated surgically. The operation consisted of primary nephrectomy. In contrast, nephrostomy as initial treatment was performed in some cases, There were many major complications [i.e. leading to death or substantial prolongation of hospitalization]. This experience suggests that nephrostomy is indicated when the patient is severely ill or the kidney is expected to recover function. Where dialysis is available, it may be applied to improve the patient's condition for a definitive radical operation instead of nephrostomy. It was prefered by us to apply percutaneous drainage where function appeared to be limited and there is still some function of the kidney by isotopic screening