Incidence and clinical predictors of left atrial appendage thrombosis risk markers in end stage renal disease patients on maintenance haemodialysis

The incidence of intracardiac thrombosis and its risk markers in haemodialysis patients has not been sludied in the Egyptian population. This study was designed to determine the incidence of left atrial appendage [LAA] thrombosis and its risk markers as well as its clinical predictors in patients on maintenance haemodialysis in Suez Canal area in the period from 2003-2004. Transoesphageal echocardiography [TEE] was performed in 55 haemodialysis patients, 34 [62%] were males, the mean age was 46 +/- 10 years with mean dialysis duration b8 +/- b months. Any potential candidate with current or past chronic or intermittent atria] fibrillation or with cardiovascular diseases was excluded from the study. LAA abnormalities were defined as the presence of LAA thrombus, spontaneous echo contrast [SEC], LAA emplying or filling Doppler velocities <25cm/s, or LAA area 5 cm[2] Nothrombi were found in the LAA, but SEC detected in 4 [7%] patients, LAA velocities <25cm/s in 12 [22%] palients, and LAA area >5cm2 in 15 [27%] patients. On multe-variate analysis; older age, hypertension, diabetes mellitus, cigarette smoking, low haematocrit <30%, and left venlridilar mass index [LVM1] >116gm/m2 were the only ilinical variables independently associated with LAA abnormalities predisposing to thrombosis. Patients on maintenance haemodialysis in Suez Canal area are at low risk for LAA thrombosis. However, I.AA abnormalities predisposing to thrombosis can still be detected and correlated with older age, hypertension, diabetes incllilus, cigarette smoking, low haematocrit, and increased LVMI>116gin/m2.

Evaluation of serum alpha-L-fucosidase and alpha-fetoprotein levels in patients with liver cirrhosis and hepatocellular carcinoma

Hepatocellular carcinoma [HCC] develops during the natural history of cirrhosis. HCC lesion of one cm in diameter with high or low echogenicity can be detected by ultrasonography and confirmed by needle biopsy. However, it is still very difficult to detect small isoechogenic HCC lesions, especially when AFP is normal. The serum level of alpha -L-fucosidase has been proposed as a marker of HCC. The aim of our study was to evaluate the serum alpha-L-fucosidase and alpha-fetoprotein levels in patients with liver cirrhosis and HCC. All patients were subjected to full history taking, clinical examination, laboratory investigations, abdominal ultrasonagraphy and ultrasongraphy guided percutaneous fine needle aspiration biopsy. To evaluate the role of serum alpha-L-fucosidase [AFU] in the diagnosis of hepatocellular carcinoma [HCC], we simultaneously studied both AFU activity and alpha-fetoprotein [AFP] levels in 40 patients with cirrhosis, 40 patients with HCC and 40 healthy subjects. Serum AFU activity in patients with HCC [573 +/- 210 nmol/ml/hr] and cirrhosis [285 +/- 143 nmol/ml/hr] was significantly higher than controls [216 +/- I l7nmol/ml/hr, p < 0.001]. With 450 nmol/ml/hr [mean value of controls plus 2 standard deviations] considered as the cut-off point, AFU was more sensitive [76 vs 65.4%] but less specific [90.9 vs 95.5%] than AFP at a level of> 400 ng/ml as a tumor marker of HCC. We conclude that AFU is a useful marker, in conjunction with AFP and ultrasonography, for detecting HCC

Assessment of CD5+B Cell Compartment in Chronic Hepatitis C virus patients

The present study was designed to assess the peripheral blood CD5+B lymphocytes in Egyptian patients with chronic HCV infection, which could help in predicting early autoreactivity and targeting appropriate therapeutic intervention. The present study is a cross-sectional analytical study carried out at the hepatology and gastroenterology unit of Suez-Canal University Hospital, Ismailia Egypt. Thirty individuals were enrolled in the study and classified into two subgroup; the study group 15 HCV-RNA positive associated chronic liver disease patients and the control group 15 adult apparently healthy volunteers blood donors. Individuals included in the study were subjected to medical history, clinical examination, complete liver function tests using the fully automated Hitachi-704 biochemical analyzer, serological tests for rheumatoid factor, HBV, HCV viral markers by Elisa technique, HCV-RT-PCR was used for detection of HCV RNA. ANA was tested by the indirect immunofluorescence technique, complete blood picture by the fully automated cell-day hematology counter and flowcytometric assessment of the peripheral blood CD19+/5+B lymphocytes by using B and D FACS caliber. The evident predominance of this B cell population in chronic liver disease patients with active HCV infection may give rise to immune-mediated squeal associated with HCV infection. This expanded population of CD5+B cells may modulate the course of the liver disease complicating HCV infection

relation between esophageal motility disorders glycemic control in type II diabetes mellitus

Reduced values all of lower esophageal sphincter [LES] pressure, LES relaxation percentage, LES relaxation percentage, esophageal body contraction duration, velocity of waves in the esophageal body and pharyngeal pressure were noted in the diabetic patients when compared with the controls. Also, triple peaks as well as retrograde and spontaneous contractions were more frequently encountered in the diabetics. Uncontrolled diabetics showed reduced LES pressure, more prolonged esophageal contraction duration, more frequent triple peak and retrograde contraction than controlled ones. There were statistically significant negative correlations between fasting blood sugar and LES pressure and statistically significant direct correlations and retrograde contraction percentage, spontaneous contraction and pharyngeal pressure. There were statistically significant negative correlations between glycated hemoglobin and LES pressure and esophageal body contraction amplitude. It was concluded that poor glycemic control seems to adversely affect the esophageal motility parameters in patients with type II diabetes irrespective of autonomic abnormalities

Prediction of risk of hypertension in offspring of hypertensive subjects

The offspring of hypertensive patients has a tendency to develop hypertension, so the question of prediction of susceptible individuals is unclear. This Cross-sectional comparative study was designed to clarify some predictors of hypertension in offspring of hypertensive patients. The study included 100 subjects [12 to 18 year old, male and female]; 50 offspring of hypertensive parents [group I] and 50 offspring of normotensive parents [Group II]. They were subjected to full medical history and clinical examination including blood pressure record at rest and after exercise. Also anthropometric assessment was performed. Biochemical assessment for fasting C-peptide insulin level, and plasma level of norepinephrin [NE] were recorded. In group I. the mean resting systolic blood pressure [SBP] was 101.8 +/- 9mmHg, the mean peak SBP 197.2 +/- 27mmHg, the mean resting distolic blood pressure [DBP] was 76.5 +/- 7.5mmHg, the mean peak DBP 71 +/- 9.5mmHg. The mean resting heart rate [HR] was 83.6 +/- 8.7 Beat/min. the mean peak HR was 193.5 +/- 9.I Beat/min. The mean metabolic equivalent [METs] was 12.5 +/- 1.8 MEq. The mean body mass index [BMI] was 30 +/- 5.1 kg/m2. The mean serum insulin level was 23.5 +/- 15.7 micro U/dl and the mean serum NE level was 344.7 +/- 57.1 ng/dl. In group II, the mean resting SBP was 95.1 +/- 16.22mmHg, the mean peak SBP was 172.5 +/- 17.8mmHg; the mean resting DBP was 66.7 +/- 7.7mmHg, the mean peak DBP was 63.4 +/- 6.9mmHg. The mean resting HR was. 80.1 +/- 11.4 Beat/min, the mean peak HR was 188.7 = 6.2 Beat/min. The mean METs was 13.2 +/- 1.8 MEq. The mean BMI was 26.8 +/- 3.6 +/- 5.8 kg/m[2]. The mean serum insulin was 14.7 +/- 15.7 micro U/dl, and mean serum NE was 286.3 +/- 57.1 ng/dl. Both SBP and DBP were within normal limits but were significantly greater in group I than group II. Function capacity was significantly lesser in group I than group II. BMI was significantly greater in group 1 than group II. Serum insulin and NE were significantly increased in group I than group II. However the long-term effect of these risk factors on the cardiovascular system including the coronary arteries need more research

Effect of different treatment modalities on gingival crevicular protease a ctivity in refractory periodontitis

This study aimed to evaluate the effect of scaling and root planning [SRP] alone versus in conjunction with systemic doxycycline on gingival crevicular fluid [GCF] neutral protease activity in refractory periodontitis [RP]. Twenty patients with RP as well as eight healthy volunteers served as controls were enrolled into this study. The patients were randomized into two equal groups: The first group received SRP with adjunctive doxycycline [200 mg loading dose followed by 100 mg/day for fourteen days] and the second group received SRP only. At baseline and one, two, three and six months after treatment; gingival index [GI], pocket depth [DP] and attachment level [AL] were assessed for all patients. Neutral protease activities in GCF were measured by spectrofluorimetric method for the patients. The study concluded that adjunctive doxycycline is capable of improving and stabilizing RP lesions better than SRP alone and the major mechanism of this therapeutic potential might be antimicrobial in such cases. Moreover, GCF neutral protease activity might reflect the periodontal status of RP patients and could be valuable in monitoring the disease activity

Value of follow-up to design a cost oriented solid strategy in management of idiopathic iron deficiency anemia

The gastrointestinal tract is believed to be responsible for pathologic blood loss and subsequent iron deficiency anemia. This study aimed to design a cost oriented solid stratetegy for the management of patients with idiopathic iron deficiency anemia. Sevent eight patients with iron deficiency anemia were included in the study. Patients were classified according to the main gastrointestinal symptoms [GIS] into 4 groups: upper, lower, mixed and negative GIS. Patients with upper, mixed and negative GIS were investigated by upper gastrointestinal endoscopy [UGIE], those with negative results were prepared for pancolonscopy. Only negative patients were proceeded with the same preparation for entroclysis. Patients with lower GIS were investigated initially by pancolonoscopy. Negative patients were proceeded with the same preparation for UGIE +/- enteroclysis. All patients were treated by oral iron therapy for 6 months [plus specific treatment for the detected lesion]. All patients were re-evaluated after 6 months of therapy. Those with persistent iron deficiency anemia were reinvestigated. Small intestinal biopsy was included. The results revealed the following: [A] 32/35 patients [91.4%] with upper GIs showed lesions responsible for blood loss in UGIE [p< 0.0001], sensitivity 87.23%, specificity 87.1% [B] 18/21 patients [85.7%] with lower GIS showed lesions responsible for the blood loss in pancolonos copy [p< 0.0001], sensitivity 63.63%, spectivity 97.78% [C] The yield of UGI and pancolonscopy as initial investigation was not significant when studding the mixed and negative GIS groups. The followup study showed [1] cure of all patients with detected lesions for the blood loss with the exception of one patient "showed extension of ulcerative colitis" 63/64 [98.4], [2] 7/12 patients with negative initial investigation cured. 3 definitively diagnosed and 2 not diagnosed. The results concluded that upper gastrointestinal lesion are more common than lower gastrointestinal lesions. Two concomitant lesions in different sigments of the GIT as a cause for iron deficiency anemia are rare and we did not come across. Initial work-up should be directed by the site specific symptoms as this yield significant positive with high sensitivity and specificity with subsequent considerable cost reduction. Follow-up with re-evaluation of the non detected lesion will lead to further detection of the possible cause of anemia with subsequent decrease in the percentage of undiagnosed patients from 15% to 2.3%

Gastric histopathology of helicobacter pylori associated ulcer and non ulcer dyspepsia: effect of ulcer healing

Despite the strong association of Helicobacter Pylon [H. Pylori] with acid peptic disease; its pathogenic role has not been universally confirmed. The objective of this work was to investigate the gastric histopathological changes in H. Pylori positive dyspeptic patients [ulcer and non ulcer]. Hundred and fifteen dyspeptic patients were studied. All were subjected to upper gastrointestinal endoscopy during which paired antral mucosal biopsies were obtained and subjected to histopathological examination and H. Pylori identification using Haematoxylin and Eosin and Giemsa stains. The same investigations were repeated to patients with duodenal ulcer after 6 weeks treatment with H[2] antagonist. The initial endoscopy showed the presence of the lesion [s] causing dyspepsia in 67 [58 .26%] patients 'Ulcer dyspepsia group reflux oesophagitis in 4 patients, gastric acid peptic disease in 16 patients [gastric ulcer 1, gastric erosion 7 and gastritis 8], duodenal acid peptic disease in 19 patients [duodenal ulcer 12, duodenal erosion 5 and duodenitis 3] and mixed endoscopic findings in 28 patients. Negative endoscopic findings were observed in 48 [41.74%] patients "non ulcer dyspepsia group" H. Pylori positivity were 79.1% and 75.4% in ulcer and non ulcer dyspepsia respectively [rho>0.05]. Similarly, density of H. Pylori infection did not differ significantly in between the two dyspeptic groups. Histopathological studies revealed the presence of gastritis in 8 [70.4%] patients, active gastritis in 43 [37.4%] patients, erosions and or ulcerations in 33 patients, mucoid hyperplasia in 44 patients, dysplasia in 4 patients, atrophy in 3 patients and hypertrophy in 2 patients. H. Pylori positivity did not correlate significantly with either the presence of histological gastritis, its activity, severity or depth of inflammation. None of the histopathological type correlated significantly with H. Pylori positivity. The follow up studies done on the 20 patients with duodenal ulcers revealed persistence of H. Pylori infection in 80% of patients compared to 90% at the initial studies [rho>0.05], as well as persistence of histological gastritis in all patients despite 80% healing rate. The results concluded that despite the observed high prevalence of H. Pylori infection in the studied dyspeptic patients, histopathological studies did not support the pathogenic role of this organism in the genesis of dyspeptic disease. The relevance of the results to the sociodemographic data of the studied population were discussed