Performance of New Biomarkers of Nephropathy in Patients with Type 1 Diabetes Mellitus.

Introduction: It is known that laboratorial tests (urinary albumin excretion and glomerular filtration rate), routinely used for nephropathy diagnosis in type 1 diabetes (T1DM), have limitations that justify the evaluation of new renal biomarkers. This study assessed the performance of cystatin C, alkaline phosphatase (AP) and gamma-glutamyl transferase (GGT) for nephropathy diagnosis in T1DM patients. The reduction of economic cost and increase in sensibility and specificity from correct biochemical diagnosis of diabetic nephropathy is an important objective of this work. Methods: Cystatin C, AP and GGT were determined in plasma and urine of healthy individuals (N=35) and T1DM patients with (N=45) and without nephropathy (N=80). Results: The plasma levels of cystatin C, AP and GGT, as well as urinary levels of cystatin C and AP were able to differentiate diabetic patients with and without nephropathy. Plasma cystatin C better followed the progression of albuminuria. Cystatin C and AP discriminated the onset of nephropathy in T1DM patients better than creatinine. AP plasma/urine ratio progressively increased from the controls to the diabetic patients without and with nephropathy. Conclusion: The plasma levels of cystatin C and AP may be useful, with the classical markers of renal function, for nephropathy diagnosis and monitoring in T1DM patients.

Saudi Guidelines for testing and treatment of latent tuberculosis infection. Joint statement of the Saudi thoracic society, the Saudi society of medical microbiology and infectious diseases, the Saudi association of public health, and the society of family and community medicine

Pulmonary tuberculosis is a common disease in Saudi Arabia. As most cases of tuberculosis are due to reactivation of latent infection, identification of individuals with latent tuberculosis infection [LTBI] who are at increased risk of progression to active disease, is a key element of tuberculosis control programs. Whereas general screening of individuals for LTBI is not cost-effective, targeted testing of individuals at high risk of disease progression is the right approach. Treatment of those patients with LTBI can diminish the risk of progression to active tuberculosis disease in the majority of treated patients. This statement is the first Saudi guideline for testing and treatment of LTBI and is a result of the cooperative efforts of four local Saudi scientific societies. This Guideline is intended to provide physicians and allied health workers in Saudi Arabia with the standard of care for testing and treatment of LTBI

[New criteria and quality of health care services in the governorate of Monastir, Tunisia]

In 2005 new quality criteria [7 items] were introduced for services provided to mother and child under the national perinatality programme. We evaluated this new version in a descriptive study conducted among a random sample of 400 parturient women from Monastir governorate. Mean age was 29.3 [SD 5] years and 42% were primipara. Although prenatal care was adequate in terms of number of antenatal visits for 82.5% of women, for only 21% were all 7 quality criteria fulfilled. The rates of caesarean section and premature birth were significantly higher in women who received quality care [P < 0.05]. In logistic regression analysis, age and parity were the only factors independently associated with the quality of care. Additional efforts are needed to ensure good maternal and infant quality of care

Characteristics of gastrointestinal stromal tumors in a Middle Eastern population

To demonstrate the immunohistochemical and epidemiological characteristics of gastrointestinal stromal tumors [GIST] in a Middle Eastern population. This is a retrospective analysis of all intra-abdominal mesenchymal tumors [excluding childhood embryonal rhabdomyosarcoma and small round blue cell tumors] collected from the archives of the Pathology Departments of King Hussein Cancer Center, Amman, and King Abdullah University Hospital, Irbid, Jordan between 2001 and 2008. The immunohistochemical profile of all cases was studied at King Hussein Cancer Center, Amman, Jordan, between January and August 2009. Gastrointestinal stromal tumors comprised 45% of the intra-abdominal mesenchymal tumors [42 out of 93 cases], with the most common site being the stomach [n=17, 40.5%]. Twenty-seven GIST cases [64.3%] were classified as high risk, 4 [9.5%] as intermediate risk, 6 [14.3%] as low risk, and 2 [4.8%] as very low risk. Immunohistochemistry showed diffuse and strong positivity [+3] for CD117 in 85.7% of GIST cases, and for CD34 in 65% of cases. The high-risk tumors were more common in male patients [M:F=1.7:1], while the non-high risk tumors were more common in female patients. The immunohistochemical profile of GIST in Jordanian patients is similar to previously published data from other populations, with a slight male preponderance for high-risk GISTs

Prognostic significance of EGFR, p53 and E-cadherin in mucoepidermoid cancer of the salivary glands: a retrospective case series

Evaluate the prognostic significance of EGFR, p53 and E-cadherin known, along with histopathologic criteria, in mucoepidermoid cancer [MEC] of the salivary glands. Retrospective case series review between January 1994 and December 2002 of all patients with salivary glands mucoepidermoid cancer treated at one university hospital. Histopathology review and immunohistochemistry study for EGFR, p53 and E-cadherin was undertaken on formalin-fixed, paraffin embedded surgical specimens. Clinicopathological parameters were reviewed and survival analysis was conducted to study the prognostic significance of these factors. All patients were treated by the same multidisciplinary team which included three head and neck surgeons, one plastic surgeon, two medical oncologists and one radiation oncologist at Hotel-Dieu de France, a tertiary care university hospital of Saint-Joseph University, Beirut-Lebanon. Thirteen patients were treated for MEC during this period. The parotid gland was the most common site. Mean survival in this series was 61 +/- 8 months [95% CI = 46-77 months]. Positive lymph nodes status was a significant predictor of poor survival. EGFR and p53 were correlated to histological grade. EGFR tended also to be more elevated in major salivary gland tumors. EGFR and p53 expressions were highly correlated to high histological grade, making them an interesting target for further investigation as prognostic factors in MEC

epidemic of the metabolic syndrome

The incidence of metabolic syndrome [MS] is rising worldwide. This is partly due to a significant increase in the prevalence of obesity. Observational cross-sectional studies as well as demographic health surveys from the Middle East, point out that the prevalence of obesity increases from an average of 6% in healthy children to 20% in adolescent males and to a further 32% in elderly patients. The impact of obesity on our population is expected to be considerable; especially, as it feeds into further rising in the prevalence of hypertension, diabetes, MS and cardiovascular disease. The prevalence of MS in nondiabetic adults in Europe was recently reported to be 15%. In the Middle East, as pointed out by pilot observational projects, is estimated to be anywhere between 15-25%. The medical system is unprepared to deal with this epidemic partly due to scanty knowledge on the clinical significance of the MS and importantly as there is a limited number of specific treatments that we can offer these patients

Comparison of piperacillin and amikacin with cefoperazone-sulbactam as empiric therapy in febrile neutropenic cancer patients

Sulbactam-cefoperazone monotherapy was compared with an aminoglycoside containing regimen of piperacillin and amikacin in a prospective randomized trial of empiric therapy for febrile neutropenic patients [neutrophils not more than 500/mm3]. Thirty febrile episodes were treated with cefoperazone-sulbactam and 16 febrile episodes were treated with piperacillin and amikacin. There was no significant difference between the two groups with respect to age, sex and mean duration of therapy. The cefoperazone-sulbactam regimen appeared to have a comparable overall response rate with piperacillin plus amikacin 29 of 30 patients versus 15 of 16. Modification of treatment was made in 20% of the patients treated with cefoperazone- sulbactam and 50% of the patients treated with piperacillin plus amikacin. Cefoperazone-sulbactam was found to be effective empiric therapy in febrile neutropenic patients