RESUMO
Background: Portal hypertension, which occurs as a consequence of liver cirrhosis, leads to splenic vasodilatation and alterations in the systemic circulation. Arterial vasodilatation in the splanchnic circulation appears to play a central role in hemodynamic changes and in the decline in renalfunction in cirrhosis. Peripheral vasodilatation, which occurs as a part of alterations in the systemic circulation, may decrease the renal blood flow and subsequently raise plasma renin activity. Midodrine is a agonist and acts as a peripheral vasoconstrictor; therefore, it may reduce plasma renin activity and improve renal function
Aim of the work: The aim of the study was to evaluate the relationship between renal resistive indices [RIs]in cirrhotic patients before and after oral administration of 7.5 mg midodrine three times dailyfor 3 days
Patients and methods:The study was conducted on 40 patients with liver cirrhosis and ascites and on 40 healthy controls from October 2014 to March 2015 at Al Azhar University Hospital, Assiut, where allpatients were subjected to history and clinical examination as well as to routine investigations such as total bilirubin, albumin, international normalized ratio, and serum creatinine. Patients underwent an abdominal ultrasound with duplex Doppler examination of the kidneys, and RIwas calculated before and 3 days after oral intake of midodrine
Results: Patients with liver cirrhosis and ascites had significantly higher RI in the right kidney[0.69 +/- 0.101 vs. 0.57 +/- 0.055, P < 0.001] and in the left kidney [0.69 +/- 0.097 vs. 0.59 +/- 0.047,P < 0.001] compared with healthy controls. After oral administration of midodrine for 3 days,RI showed significant improvement [RI = 0.928, P < 0.001] in the right kidney and in theleft kidney [R = 0.993, P < 0.001]. RI had significant positive correlation with Child-Pughscore [R = 0.75, P < 0.001, in the right kidney and R = 0.75, P < 0.001, in the left kidney] and significant positive correlation with Model for End Stage Liver Disease score [R = 0.536,P < 0.008, in the right kidney and R = 0.487, P < 0.005, in the left kidney]
Conclusion: Oral midodrine improved renal hemodynamics as assessed by RI in cirrhotic patients. RI is correlated with severity of liver disease as assessed by Child-Pugh and Model for End StageLiver Disease scores
RESUMO
The present study was conducted on 280 Egyptian buffaloes [Bithalis bubalus] during the period from June 2008 to July 2009. These animals belong to different villages in Assiut Governorate, Upper Egypt. The age of these animals ranged from less than one year to above eight years old. Examination of diseased animals revealed that they suffered from itching, loss of patches of hair in different regions of the body with appearance of scales on the skin. The more common sites of infestation were the head, neck and the base of the tall. In this study skin scrapings were examined microscopically revealed that Sarcoptic spp. and psoroptic spp. were identified from Egyptian buffaloes in Upper Egypt in percentage of 11.78%and 8.57%, respectively, with overall percentage of 20.35%. infestation by Sarcoptic mange mites [57.89%] was recorded to be the most frequent in the examined cases, followed by Psoroptes spp. mites [42.10%]. Statistical analysis of some ecological parameters reveled that there is a significant relationship between prevalence of mange mite Infesting buffaloes and season, age, housing management as well as regular or irregular using acaricides. Moreover, this study included using different methods of clinical therapeutic trails. The infested buffaloes with mange mites were classified into four groups. The first one received two doses of Ivermectin [Ivomec, Merial], 10 days apart at dose rate of 200 micro g/kg subcutaneously. The second group received two doses of doramectin [Dectomax, Pfizer, Egypt] a, 10 days apart at dose rate of 200 micro/kg subcutaneously. The third group received two doses of Ivermectin [Ivomec, Merial], 10 days apart at dose rate of 200 micro g/kg subcutaneously, Adjunct to this drug, Deltamethrin [Butox-50, Intervet] was applied to the surrounding environment [bedding material, wall, fomites, etc....] twice at a 10 days interval, All cases were isolated in a separate place during treatment period. The fourth group received two doses of doramectin [Dectomax, Pfizer, Egypt] a, 10 days apart at dose rate of 200 micro g/kg subcutaneously, Adjunct to this drug, Deltamethrin [Butox-50, Intervet] was applied to the surrounding environment twice at a 10 days interval. We found that administration of Ivermectin or doramectin adjunct with treatment of animal environment Is the best protocol for eradication and prevention of mange mite from Infested buffaloes with mange mite and Its environment