Predictive value of hepcidin in patients with chronic hepatitis C infection among egyptians

Background Iron is essential for oxygen transport and energy production, but it is potentially toxic through generation of oxidative stress. Patients with chronic hepatitis C [CHC] infection frequently have serum and hepatic iron overload, which is a cofactor for disease progression. Human hepcidin, a 25-amino acid peptide produced by hepatocytes, is considered a new mediator of innate immunity and master iron-regulatory hormone.Aim To determine clinical relevance of hepcidin in patients with CHC infection and whether it correlates with markers of hepatic inflammation and iron status in those patients

Patients and methods This study included 80 [54 patients and 26 controls] individual who were matched in age and sex. Serum hepcidin levels and serum iron status were determined. Their levels were correlated with each other and with other laboratory parameters

Results Mean serum hepcidin levels were significantly lower in patients with CHC than in controls [P=0.001]. Patients with CHC had significantly higher mean values of serum iron and ferritin than controls [P=0.001 and 0.017, respectively]. There was a significant negative correlation between hepcidin levels and alanine aminotransferase, [r=-0.454, P<0.001], aspartate aminotransferase [r=-0.440; P=0.001], and serum iron [r=-0.453, P=0.001], whereas hepcidin levels correlated positively with ferritin [r=0.105, P=0.017], platelets count [r=0.245, P=0.028], and hepatitis C virus RNA level [r=0.308, P=0.023]

Conclusion Adequate levels of hepcidin may improve severity of liver disease and may contribute to management of patients with CHC

Ocular manifestations in patients with senile sensorineural deafness: experience at Prince Rashid Bin Al-Hussien hospital

Objectives: To screen patients having senile sensorineural hearing loss [presbycusis] for the presence of age- related changes in their eyes particularly age- related macular degeneration

Method: A prospective study conducted at prince Rashid Bin Al Hassan Military hospital, Irbid Jordan between March 2016 and May 2016. Three- hundred and forty-five patients diagnosed with senile sensorineural hearing loss [Presbycusis] at the ENT clinic were referred to the ophthalmology clinic to perform comprehensive eye examination including visual acuity [VA], anterior segment examination using slit lamp biomicroscope, applanation tonometry using Goldmann applanation tonometer and dilated fundus examination using non-contact 78 diopter lens

Results: Three- hundred and forty-five patients aged between 45 and 87 years [mean 64.4 +/- 12.5 years] were included in the study. One-hundred and fifty-seven [45.8%] were females with a mean age of 62 years. The mean visual acuity was [0.6]. Arcus senilis was present in [53.6%] of patients with slight male predominance. Cataract was found in [55.9%] of patients. Pseudoexfoliative material on the anterior capsule of the lens and/or pupillary margin was found in [8.3%] of patients. Glaucoma was found in [3.2%] of patient's eyes. Age-related macular degeneration was found in [20.1%] of patients

Conclusion: Age related macular degeneration and pseudo exfoliation syndrome were present at higher frequency among patients with presbycusis. There was no increase in the frequency of arcus senilis, cataract and glaucoma among those patients

retrospective analysis of the first Yemeni experience on Artisan phakic intraocular lens for the treatment of moderate and high myopia

To evaluate the outcome and safety of the iris-fixated Artisan phakic intraocular lens [PIOL] for the correction of moderate and high myopia. A retrospective non-controlled clinical study of the data of patients who underwent Artisan PIOLs between March 2006 and July 2008 was evaluated. Pre-operative examination included age, gender, refraction, uncorrected [UCVA] and best spectacle corrected [BSCVA] visual acuity, predictability and safety were analyzed. Post-operative time course ranged from 12 to 36 months. An Artisan myopia lens was implanted in 62 eyes of 39 patients. The mean pre-operative spherical equivalent [SE] was -13.17 +/- 5.62 D. The pre-operative myopia ranged from -4.5 to -24 D. Mean patient age was 25.44 +/- 5.22 years. At last follow-up visit, residual SE was within +/- 1.00 D in 36 eyes [58.1%] and +/- 2.00 D in 56 eyes [90.3%]. In the last visit UCVA was equal to or better than pre-operative BSCVA in 57 [91.9%] of the eyes. One eye [1.6%] lost one Snellen line, three eyes [4.8%] lost two or more Snellen lines and one eye lost vision [1.6%]. Post-operative complications included anterior chamber reaction in one eye, rise in intraocular pressure in two eyes and retinal detachment in one eye. When laser keratorefractive surgery is not an option, implantation of Artisan PIOL to correct moderate to high myopia results in a stable and good refractive result with few complications that must be kept in mind

Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

Assessment Of Students’ Perceptions Towards E-Learning Management System (E-LMS) In A Malaysian Pharmacy School: A Descriptive Study

The study aims to evaluate students’ perceptions towards e-Learning Management System (e-LMS) in pharmacy education. A cross-sectional survey was conducted among all undergraduates enrolled at School of Pharmaceutical Sciences, Universiti Sains Malaysia. A pre-validated questionnaire consisting of two domains (demographic characteristics and students’ perception regarding the use of e-LMS) was used for data collection. Descriptive statistics were used to describe the demographic characteristics of the study respondents. Chi Square test was used to measure association between the study variables. All analysis was performed by using Predictive Analytical Software (PASW) v. 18. A total of 315 students completed the survey questionnaire with a response rate of 57.6%. Majority of the students (61.0%) accessed e-LMS to acquire lecture notes for their studies, followed by 53.3% have used e-LMS for the preparation of the assignments. Seventy eight percent of the respondents agreed that e-LMS is very useful and felt that e-LMS is making their studies easier. However, 50% of students claimed that poor network connection at the campus is a major barrier in accessing e-LMS. Moreover, 48% of the respondents disagreed that e-LMS should be taken into account as an assessment criterion for students’ grading. Students are found to be frequently engaged in using e-LMS and believed that online based learning is enhancing their academic performances. Nevertheless, students still prefer hybrid teaching methodologies than choosing traditional system or e-learning as an alone entity.

Polymorophisms in MTHF and ACE genes and the association with hypertension among Saudi population from Qassim region

Three clinically important mutations; Two of the methyl-tetrahydrofolate reductase [MTHFR] gene namely C677T, A1298C, and insertion/deletion [I/D] polymorphism of the angiotensin converting enzyme [ACE] gene are reported to be associated with various pathological conditions. This study is planned in order to evaluate the association of genetic polymorphisms related to these genes with hypertension. These polymorphisms can be utilized as biomarkers for susceptibility and severity of the disorder with a potential impact on diagnosis and management. Participants included 117 cases [78 males and 39 females] with an age mean +/- SD of 50.93 +/- 15.43 years. They were hospitalized for hypertensive complications including cardiac affection [64.9%] and renal dysfunction [17.9%] or strokes [20%]. For comparison, 169, age and sex matched; with an age mean +/- SD of 47.65 +/- 11.15 normal healthy unrelated subjects [78 males and 91 females] were taken from the same locality as controls. For all participants, DNA was extracted followed by real-time PCR amplifications for characterization of genotypes and alleles related to MTHFR C677T, A1298C and ACE I/D gene polymorphisms. Compared to controls, cases showed significantly higher frequency of the heterozygous genotypes of MTHFR AC [52.1% vs. 36.5%, p<0.05] and ACE ID [96.5% vs. 43.5%, p<0.0001]. Cases showed also significantly higher MTHFR 1298 mutant C allele carriage rate with nonsignificant higher carriage rate for the MTHFR 677 mutant T allele and ACE mutant D allele. It was also noted that 74% of cases carried at least one of the 3 studied mutant forms. Comparing case-subgroups in terms of being either positive or negative for diabetes, cardiac, renal or cerebral complications and obesity showed non-significant difference related to the studied genotypes and alleles. This work shows that genetic polymorphisms related to the methyltetrahydrofolate reductase [MTHFR] and angiotensin converting enzyme [ACE] genes are associated probably with other environmental factors as that imposed by smoking and obesity. With the risk of hypertension among Saudi subjects from Qassim region

Elevated Expression of CD151 Gene in Estrogen Receptor and Progesterone Receptor Positive Breast Carcinoma

The tetraspanin gene, CD151 is involved in various tumour cell progression and metastasis. Its expression is increased in high grade, estrogen receptor negative and c-erbB-2 positive breast cancer. However, the biological function and expression phenotype among different tumour status, estrogen receptor (ER) status, progesterone receptor (PR) status and c-erbB-2 expression in multi-ethnic Malaysian breast cancer patients has not been well investigated. We used quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) to measure the CD151 gene expression in 45 breast cancers. Our preliminary results revealed that CD151 expression is significantly higher in ER positive and PR positive breast cancers at 95% and 99% confidence intervals, respectively. In contrast, there is no significant correlation between CD151 expression and tumour grades or c-erbB-2 status at 95% confidence interval level. Our preliminary findings suggested that CD151 may be involved in the estrogen responsive pathways. CD151 could be a potential prognostic marker and therapeutic target in the treatment of estrogen dependent breast cancer patients.

Assessment of fatigue in chronic hepatitis C Egyptian patients: relation to TNF-alpha, Leptin, IL-i and IL-6

Fatigue is a common symptom in chronic hepatitis C [CHC]; but it is not well understood and remains poorly investigated. One of the major obstacles to research is the highly non specific nature of fatigue. In 1994; the fatigue impact scale [FIS] was developed to improve our understanding of the effect of fatigue on quality of life. Recent attention has focused on the role of leptin and energy expenditure in chronic hepatitis C [CHC]. The importance of leptin in the regulation of energy balance, body composition and food intake has been demonstrated in both animal and human studies. 4herations in immune activation and cytokine release have been implicated in the occurrence of fatigue in CHC patients. The purpose of this study is to analyze fatigue in chronic hepatitis C Egyptian patients and to determine its relationship with the degree of underlying hepatitis, resting energy expenditure [PEE], circulating leptin and tumor necrosis factor-a [TNF-alpha], IL-1, and IL-6. Ninety patients were included in the study [61 males, 29 females], who were referred to the department of Tropical Medicine Al Hussein and Bab-Al-Sharyia University Hospitals during the period from March 2004 to March 2006. They were divided into two groups. Group I: 65 patients with chronic hepatitis C. Group II: 25 healthy persons, tested negative for hepatitis C [Control group]. All were submitted to history and clinical examination, liver function tests, HCV [Ab and PCR], the modified fatigue impact scale, resting energy expenditure, tumour necrosis factor [TNF-alpha], serum leptin. IL-alpha, and IL-6. FIS and REE, serum leptin, TNF-, IL-alpha and IL-6 were significantly elevated among HCV patients in comparison to controls. Fatigue didn't correlate with the degree of underlying hepatitis. Fatigue impact scale is a beneficial tool for subjective valuation of fatigue. Fatigue is present in CHC patients but it is not related to the degree of hepatitis. TNF-alpha, IL-1 and IL-6 may contribute partially to the occurrence of fatigue in these patients

Prostate inflammation. Association with benign prostatic hyperplasia and prostate cancer

To study the association and possible relationship of prostate inflammation with benign prostatic hyperplasia [BPH], and prostate cancer. The medical records and pathological findings of all Saudi patients who underwent transrectal ultrasound guided prostatic needle biopsies in King Abdulaziz University Medical City, Jeddah,Kingdom of Saudi Arabia from June 2003 to June 2008 were reviewed retrospectively. The indications for biopsy were elevated levels of serum prostate specific antigen, abnormal findings on digital rectal examination, or both. The specimens harboring inflammation, adenocarcinoma, BPH, or their combinations, were selected and included in the study. A total of 214 patients were selected with an age ranging from 37-100 years [median=68]. Inflammation was histologically evident in 88 patients. Of them, only one demonstrated acute inflammation, while 87/88 demonstrated chronic inflammation with, or without acute inflammation. Histopathologic features were categorized into 3 main categories: inflammation alone [12/214, 5.6%], BPH category [126/214, 58.9%], and cancer category [76/214, 35.5%] patients. The last 2 categories also included cases associated with inflammation. In the overall analysis of 214 specimens, BPH with inflammation was more prevalent than cancer with inflammation [43/214 [20.1%] versus 33/214 [15.4%]]. In a subgroup analysis within each category, inflammation was less prevalent in the BPH category compared to the cancer category [43/126 [34.1%] versus 33/76 [43.4%]]. The association between chronic inflammation and both BPH and cancer is obvious in our study. Further studies are needed to substantiate this observation, and to clarify the magnitude of association of inflammation with BPH compared to cancer

clinicopathologic patterns of prostatic diseases and prostate cancer in Saudi patients

To determine the clinicopathologic patterns of prostatic diseases in Saudi patients, with special emphasis on prostate cancer [PCa]. The records of patients who underwent histopathological examinations of their prostatic specimens in King Abdulaziz University Medical City and King Faisal Specialist Hospital, Jeddah, Kingdom of Saudi Arabia, between June 2003 and June 2008 were reviewed retrospectively. The age, indications for biopsy, histological diagnosis, and Gleason grading of cancer patients, were studied. The study included 330 patients aged 37-100 years [median=68]. Specimens included 233 transrectal ultrasound [TRUS] biopsies, 85 transurethral resection of the prostate [TURP], 8 simple prostatectomies, 3 radical prostatectomies, and one radical cystoprostatectomy. Indications for TRUS guided biopsy in PCa patients were elevated prostate specific antigen [PSA] [85.2%], abnormal digital rectal examination [5.5%] or both [9.3%]. Prostate specific antigen values <4 ng/ml were found in 13.6% of PCa patients. Among others, adenocarcinoma was found in 28.5%, benign prostatic hyperplasia [BPH] alone in 43.3%, BPH with inflammation in 20.3% and inflammation alone in 4.2%. In specimens of TURP or simple prostatectomy for apparently benign disease, incidental PCa was detected in 14/93 [15%]. The Gleason sum of >/= 6 was found in 92.8% of patients. The incidence of prostate cancer in Saudi Arabia is low compared to the western countries. However, incidental PCa detected in presumed benign disease appears to be rising. Further future studies addressing this issue are needed to confirm the potential rising trend, and its possible etiology. Our findings support the recommendations to lower the PSA cutoff value for prostatic biopsy to 2.5 rather than 4ng/ml

Lack of detection of human papillomavirus infection by hybridization test in prostatic biopsies

To explore the possibility of finding human papillomavirus [HPV] infection in the prostate tissue of a cohort of Saudi men presenting with benign prostatic hyperplasia [BPH] or prostate cancer. A cohort study on prospectively collected tissue samples was conducted at King Abdulaziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia from March 2007 to December 2008 on a total of 56 male patients, age range 50-93 years [average 68], diagnosed as having BPH or prostate cancer. The HPV DNA hybridization by hybrid capture 2 technology was performed on prostate biopsies of these patients to detect 18 types of HPV infection, and differentiate between 2 HPV DNA groups, the low-risk types, and the high/intermediate risk types. The tissues of all the prostatic biopsies were negative for HPV DNA. Our results, using the hybridization test, indicate that it is unlikely that HPV-16 or HPV-18, or the other tested subtypes, enhance the risk of prostate cancer

Intraocular lesions simulating choroidal melanoma

During the last 3 years intraocular lesions simulating choroidal melanoma were reported. 6 eyes were reported with choroidal melanoma. A single patient was reported to have secondaries in both eyes. Intraocular haemangioma were found in 2 cases. Choroidal nevi were found in 2 cases. Pigmented epithelial hypertrophy is a single case and two eyes with absolute secondary glaucoma proved to be retinal haematoma

Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Shock wave lithotripsy in patients with renal calculi

To demonstrate the efficacy of shock wave lithotripsy [SWL] in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter. One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation [Pethidine 1mg/kg and Midazolam 5-10mg] for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months. Complete clearance of the stones occurred in 2154 kidneys [89.5%]. At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 [23.5%] for Group I, 254 [36.1%] for Gourp II, 473 [85.5%] for Group III, 278 [100%] for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction. Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys

Short-term efficacy and safety of valproate sustained-release formulation in newly diagnosed partial epilepsy [VIPe-study]. a multicenter observational open-label study

To evaluate the efficacy and safety of valproate [VPA] sustained-released in monotherapy across all ages in newly-diagnosed epileptic patients with partial seizures [PS] with or without secondary generalization. This was a multicenter, prospective, observational, open-label, non-comparative study involving the Gulf Cooperation Council [GCC] countries except the Kingdom of Saudi Arabia, and was performed between November 2004 and May 2006. Adults and children [6 years or older with newly diagnosed partial epilepsy [PE]] with or without secondary generalization were enrolled. The primary efficacy parameter was 6 month-remission rate [proportion of seizure-free patients in relation to total number of retained patients]. Secondary efficacy parameters included: 6 month-retention rate, investigator's clinical global impression rating, maximal effective dose and safety profile. Seventy-seven patients were enrolled; 56% adults and 44% children, with average duration of epilepsy of 5 months in the pediatric and 17 months in the adult group. Seizures type distribution: PS with secondary generalization [62%], complex PS [53%] and simple PS [14%]. The majority had idiopathic seizures [48%]. Sixty-six patients completed the study [treatment retention rate 80.5%]. At 6 months, 87% of patients became seizure free with VPA sustained-release monotherapy [average dose 22 mg/kg/day]. Adverse drug reactions [hair loss and tremor] were recorded in <20% of patients, mostly affecting adults. In this population, short-term treatment with VPA sustained-release in monotherapy provides good seizure control and is well tolerated

Predictors of obstructive sleep apnea in snorers.

Snoring is a commong problem that poses a high risk for obstructive sleep apnea [OSA]. We studied the contribution of risk factors for OSA in snorers for full-night polysomnography [PSG]. A questionnaire was administered to subjects referred for PSG in the period from April 2002 to March 2005. There were 191 [84%] snorers identified by 227 PSG studies. They had a mean age of 48.1 +/- 9.8 years, [age range, 23-73 years] and 78.5% were males. OSA as indicated by a respiratory disturbance index [RDI] of>5 events/hour was seen in 126 [66%] subjects. In males, 72.7% had OSA, with a mean RDI of 43.0 +/- 26 events/hour, versus 41.5% [corrected] with OSA in females with a mean RDI of 27.8 +/- 26.5 events/hour [P<0.001]. The OSA group had a higher mean Epworth Sleepiness Scale [ESS] [P<0.001], a larger mean neck circumference [P<0.01], an increased mean age [P<0.050], and more witnessed apneas [P<0.001] but not choking [P=0.096]. The mean increase in body mass index was linked to OSA only in females [P<0.05] but not in the overall study [P=0.507]. Multivariate analysis showed that ESS, male gender, and a history of witnessed apneas were associated with OSA, while controlling for obesity, large neck circumference, age, and history of choking. In screening snorers for PSG, male gender, ESS and a history of witnessed apneas were the most important predictors of OSA, but other factors should be considered in referring snorers for PSG. In males, obesity did not contribute to the risk of OSA in our study population

Evaluation of procalcitonin, C-reactive protein and interleukin-6 level in neonatal sepsis

Bacterial sepsis is a major cause of morbidity and mortality in neonates. Diagnosis of neonatal sepsis may be difficult because clinical presentations are often nonspecific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. The aim of the present study was to evaluate the diagnostic use of procalcitonin, circulating cytokine [IL-6] and CRP in neonates with suspected sepsis. Blood was collected from 40 neonates admitted to neonatal intensive care units for suspicion of neonatal sepsis as well as 32 healthy controls. Sepsis group was subdivided into S1 [Proven sepsis n=16] and S2 [clinical sepsis n=24] according to the results of blood culture. Serum IL-6 was measured by Elisa, CRP was measured by nephlelometery and procalcitonin by Immunoluminometric assay. In sepsis group, level of CRP was significantly elevated compared to healthy controls P < 0.05. As regard to IL-6 level, it was significantly elevated in sepsis group compared to healthy control [P < 0.001], in addition it was increased in both patients subgroups S1, S2 with no statistically significant difference between both subgroups. Serum PCT concentration were significantly higher in sepsis group in comparison with the healthy control [P< 0.05]. PCT concentration were also significantly higher at initial suspicion and at 12-24 h and 36-48 h after the onset of symptoms in S1 than S2 subgroups. PCT seems to be a better marker of neonatal sepsis. Also, the combination of IL-6+CRP presented accuracy for differentiation between septic and non septic patients during the first 24 h of suspected sepsis