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Background: Diabetes mellitus [DM] is a systemic disease having serious microvascular and macrovascular complications. DN in T2DM has an inflammatory pathology. Many inflammatory markers have been found to be related to DN, such as interleukin1 [IL1], IL6, IL8, transforming growth factor beta 1[TGF-Beta1] and tumor necrosis factor alpha [TNF Alpha]. However, their measurement is not used routinely as it is not easy to do it, in this respect. Search for inflammatory markers for the disease is a continuous process to enhance the diagnostic and treatment process
Aim of the Work: To assess neutrophil lymphocyte ratio [NLR] and platelet lymphocyte ratio [PLR] as a predictor inflammatory markers for diabetic nephropathy in type 2 diabetic patients
Patients and Methods: This study is a prospective one that was carried out on one hundred [100] type 2 Diabetes mellitus [T2DM] patients attending to internal medicine outpatient clinic and inpatient department of internal medicine at Al-Azhar university hospital, Damietta and twenty five [25] apparently healthy volunteers as a control. The populations of the study were classified into three groups according to their level of albuminuria. All were subjected tofull history and Clinical examination, Laboratory tests include Fasting mid-stream urine samples were obtained and examined for complete urine analysis and albumin/creatinine ratio [UACR],Complete blood count [CBC], HbA1c,Fasting blood sugar, Renal Function Tests,eGFR and Abdominal ultrasonography, Fundus examination and ECG and Assessment of NLR and PLR
Results: Our study showed that there was high statistically significant increased NLR, PLR and UACR in group IB when compared to group IA, II and III. Also there was statistically significant increased NLR,PLR and UACR in group IA in comparison to group II and also there was statistically significant increased NLR,PLR and UACR in group II in comparison to group III
Conclusion: Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] was significantly associated with diabetic nephropathy [DN] and high Neutrophil lymphocyte ratio [NLR] and Platelet lymphocyte ratio [PLR] values may be considered as a predictor and a prognostic risk markers of diabetic nephropathy [DN]
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Background: numerous studies have shown that severity of respiratory distress syndrome may affect th endogenous cortisol secretion in preterm infants
Aim of the Work: assess the relationship between Cortisol level in umbilical cord in first and third day after delivery and Respiratory distress syndrome in preterm
Patients and Methods: a case control study that includes 90 preterm infant. Each included infant was submitted to history taking, complete clinical examination and laboratory investigations including complete blood count, arterial blood gases, level of cortisol in day one and day three
Results: in the present work, there was no significant difference between cases and controls as regard age, gender, weight, gestational age, as regards the serum cortisol levels in the studied groups,this study revealed that mean level of serum cortisol in 1stday of life among the three groups showed elevation and showed no significant statistical difference between the three groups [P-value = 0.107] Regarding mean level of serum cortisol in 3rd day of life showed high significant difference between the three groups [P-value = 0.001]. group I [without RDS] marked lower than both groups II and III [with RDS], and comparison between group II and III regarding the same value, showed that group III had significant higher level than group II [P-value = 0.001]
Conclusion: preterm infants respond to the stress at delivery and cortisol production continues in infants with RDS than those without RDS
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Background: Polycystic ovary syndrome [PCOS] is a common complex genetic condition of women in the reproductive age. PCOS is a heterogeneous syndrome characterized by clinical/biochemical androgen excess, ovulatory dysfunction and polycystic ovaries. Metformin therapy has been proved to improve fertility in patients with PCOS, inducing not only high ovulation and pregnancy rates, but also reducing the incidence of miscarriages
Aim of the Work: This study was aimed to evaluate the effects of metformin therapy on hormonal profile and endometrial tissue, including pattern of immunohistochemical expression of androgen receptors [AR], in patients with PCOS
Patients and Methods: 100 patients with PCOS were included in this study. Each investigated case was submitted to detailed medical history, clinical examination that included body hair distribution, body weight, height and body mass index [BMI], transvaginal ultrasound, laboratory investigations [included fasting insulin, free testosterone, LH and FSH levels]. Endometrial pipelle samples were taken for histopathological evaluation and assessment of androgen receptor expression. These investigations were done before and after three months of metformin treatment
Results: A significant decrease of BMI of the investigated cases after metformin therapy was observed [P value <0.003]. There was a significant decrease of LH level after metformin therapy from 9.17 +/- 2.84 Miu/ml to 6.18 +/- 3.6 Miu/ml and of fasting insulin level from 14.3 +/- 4.3 to 8.2 +/- 5.9. Insignificant increase of FSH level from 3.87 +/- 1.8 to 4.85 +/- 2.6 and also insignificant decrease of free testosterone level from 1.58 +/- o.83 to 1.38 +/- 1.4 were also observed. Histopathological results of the endometrial specimens before metformin therapy revealed histologic features of early proliferative endometrium in 64 cases, 20 cases with a late proliferative endometrium and examination of the remaining 16 cases revealed features of simple endometrial hyperplasia. Among the 64 cases diagnosed as early proliferative endometrium before the therapy, 60 cases showed features of a late proliferative endometrium after treatment and the remaining 4 cases showed no histomorphologic changes. Among the 20 cases diagnosed as a late proliferative endometrium before therapy, 6 cases showed features of early secretory phase after therapy, 6 cases showed features of mid-secretory endometrium while the remaining 8 cases showed a late secretory endometrium that indicate successful ovulation after therapy. Regression of hyperplasia after therapy was noted in 6 of the 16 cases diagnosed as simple endometrial hyperplasia. Immunohistochemical [IHC] results revealed marked increase in endometrial AR expression in patients with PCOS compared to the normal fertile controls [p<0.004]. Also, a significant decrease of AR expression in endometrial epithelial and stromal cells after metformin administration in patients with PCOS was noted [p<0.003]
Conclusion: Metformin therapy restores normal menstrual cyclicity in patients with PCOS, induces ovulation and showing significant decrease in endometrial AR expression
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Background: Lateral epicondylitis, also known as 'tennis elbow', is a very common condition affecting mainly middle-aged patients that is associated with local tendon pathology, alteration in pain perception and motor impairment. Several approaches to treatment have been proposed, the most frequently used is PRP. Platelet-rich plasma [PRP] is a growing modality for tissue healing, regeneration and has more pain relief lasting effect
Aim of the work: was to estimate the clinical efficacy of local injection of Platelet Rich Plasma compared to local injection of corticosteroids in cases of lateral epicondylitis
Patients and Methods: This study was a prospective clinical trial study in which 80 patients with lateral epicondylitis of both sexes between 2l - 60 years of age were recruited for the study. The included patients were divided into two groups: 1- Platelet Rich Plasma group [40 patients] were received a two injections of 1 ml of PRP with one month interval between the two injections, with absolute platelet count of 1 million platelets/ mm3 as confirmed by automated cell counter. . PRP were prepared under complete aseptic conditions. 2- Corticosteroids group [40 patients] were received a two injections of corticosteroid [methyl-prednisolone, 40mg in l ml] with one month interval between the two injections. The site of injection and the technique used was same in both the groups
Results: Affected side was higher in right hand than left hand in both studied groups. In PRP group, there were 92.5 % right hand and 7.5 % left handed patients. Whereas, in corticosteroid group, there were 95.0 % right handed and 5.0 % left handed patients; and there was no significant difference between the studied groups. Visual Analog Scale [VAS] was significantly improved at 1 and 3 months in PRP patients compared to only significant improvement at 3 months in corticosteroid group. Both studied groups showed significant improvement of grip strength at 1 and 3 months. qDASH at 1 and 3 months was significantly better in the PRP group, but it statically not reached. On the other hand, significant improvement of US edema was estimated in the corticosteroid group at 3 months when compared with PRP group. In addition, slight improvement of US tears was appeared in both groups after 3 months
Conclusion: It could be concluded that both PRP and corticosteroids showed better improvement of pain, grip strength and qDASH at 3 months. However, PRP is suggested to be an effective treatment for lateral epicondylitis. PRP provides better improvement in all parameters with nearly durable effect when compared to corticosteroids. On the other hand, corticosteroids treatment resulted in better improvement of US detected edema
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Background: Hepatitis C virus [HCV] infection is a challenging health problem in Egypt. Esophageal varices are a major complication of it which may bleed and endanger patient's life
Aim of the work: to assess the relationship between type-2 DM and the development of gastroesophageal varices and explore the role of insulin resistance as a predictor of gastroesophageal varices
Patients and methods: This study included 100 patients with Child A, HCV-induced cirrhosis. They were divided into two main groups: Group A included 50 patients with type-2 DM, while Group B: included 50 non-diabetic which were subdivided into: Group B1: patients without DM but, with insulin resistance [IR] [32], and Group B2: patients without DM or IR [18]. All patients were subjected to full history taking, clinical examination, laboratory and imaging studies [abdominal ultrasound] and upper GI endoscopy
Results: The prevalence of esophageal varices in patients with Child A HCV-induced cirrhosis was 80%, elevated to 88% in patients with type-2 DM. Insulin resistance played the major role in development of esophageal varices. There are statistically significant elevated HOMA-IR score, lower platelet count/spleen diameter ratio and higher right liver lobe diameter/albumin ratio in patients with varices
Conclusion: Insulin resistance is a major contributor for development of esophageal varices in HCV induced cirrhosis. Platelet count/spleen diameter ratio, right liver lobe diameter/albumin ratio and insulin resistance measured by HOMA-IR are good predictors for the presence of esophageal varices
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This is a randomized double-blind controlled clinical trial aimed to assess the impact of using probiotics as adjuvant therapy to WHO guidelines for management of severe protein energy malnutrition associated with diarrhea. Fifty severely malnourished infants and children having diarrhea<14 days were-assigned either to probiotic group [n=25] which received yogurt containing combination of Lactobacillus acidophilus and Bifidobacterium bifidum plus starter or placebo group[n=25] which received yogurt containing only starter. During the study, the enrolled infants and children were assessed and treated according to WHO guidelines. At enrollment and discharge the following investigations were performed: hemoglobin, hematocrit, serum iron, blood glucose, total serum proteins and albumin. On the seventh day of admission, no failure cases were recorded in the probiotic .group while in the placebo group 2 cases [8%] suffered diarrhea, 2 cases [8%] had edema and 6 cases [24%] gained less than 5% of their admitted weight. At discharge the mean duration of admission or diarrhea was shorter in the probiotic group than placebo group [p=0.00 for each of them]. Furthermore the mean percentage of weight gain was higher in the probiotic group than placebo group [p=0.00]. It was concluded that the combination of Lactobacillus acidophilus and Bifidobacterium bifidum when used as adjunctive to WHO guidelines for management of severe protein energy malnutrition associated with diarrhea hastened the recovery from the disease and increased weight gain. Confirmation of this result with a large number of malnourished children is clearly warranted
Sujet(s)
Humains , Mâle , Femelle , Probiotiques , Yaourt , Poids , Études de suivi , EnfantRÉSUMÉ
The aim of this study was to assess the effect of uncontrolled long standing asthma without corticosteroid therapy on the growth of pre-pubertal Egyptian children. This was an analytical study conducted at Damietta university hospital Two groups of patients suffering from uncontrolled moderate [n=30] or severe [n=18] asthma were compared for their physical and skeletal growth with a control group [n=30]. All enrolled children were followed up for 1 year. At enrollment the following investigations were performed: CBC, serum IgE, tuberculin test, chest x-ray and x-ray of lift hand and wrist [also at end of the study]. At start and end of the study, no statistically significant differences were detected between the 3 study groups regarding growth indicators [weight for height [W/H] and height for age [H/A] percent of median reference]. The percent of change in growth parameters [weight, height, BMI, upper segment lower segment ratio] were comparable from beginning to end of the study and the differences between groups were not statistically significant. At start and end of the study, bone age was delayed among asthmatic children than controls [p=0.00 each of them]. Both severe and moderate asthma groups were associated with lower standard deviation scores of bone age than controls group and the differences between groups were statistically significant [p=0.00 at start and end of the study]. Comparing growth indicators before and after controlling asthma clarified that no statistical significant differences were detected between asthmatic children and controls [W/H p=0.2, H/A p=0.2]. It was concluded that asthma did not influence the growth, however bone age was delayed
Sujet(s)
Humains , Mâle , Femelle , Troubles de la croissance , Poids , Taille , Indice de masse corporelle , Hôpitaux universitaires , Études de suivi , EnfantRÉSUMÉ
This study aimed to asses the impact of zinc supplementation on the clinical severity and recovery from shigellosis among affected infants and children. A randomized, double-blind controlled clinical trial was conducted in shigellosis infected infants children aged<5 years. Sixty patients were randomly allocated to receive either zinc [n=30] or placebo [n=30]. Participants<6 and>=6 months were given 3.5 ml and 7 ml of zinc sulphate or placebo solution, respectively, once a day for 14 days. Standard rehydration and antimicrobial therapy were given to all patients according to WHO guidelines. At enrollment the following investigations were performed: serum zinc, serum electrolytes [Na, K], hemoglobin, hematocrit, and total and differential leukocyte count. A second blood sample was obtained at a follow-up visit after the completion of 14 days of treatment for estimation of serum zinc level. At discharge, duration of diarrhea [39.2[6.5] vs 57.7[7.2] h, p=0,00], and duration of presence of blood in stool [38.1[5,4] vs 561[6.11 h], p=0.00] were significantly shorter in zinc group in comparison to placebo group. The children in zinc group consumed significantly lesser amount of ORS than placebo group [138.3[9.1] vs182 [11.5] ml/kg, p=0.00]. Zinc supplemented children experienced significantly fewer stool motions than those in placebo [11.2[0.6] vs 18.4 [0.4], p=0.00]. After 14 days of intervention serum zinc was higher among zinc group than placebo group [78.4 [16.2]vs 65. [15.8] micro g/dl] and the difference between two groups was statistically significant [p=0.002]. It was concluded that zinc supplementation for infants and children suffering acute shigellosis hasten the recovery from the illness