Predictors of microvascular complications in children and adolescents with type I diabetes mellitus

Diabetes mellitus is characterized by microangiopathy and increased angiogenic response. Several angiogenic factors are involved in vascular endothelial growth. This work was designed to study serum levels of angiogenic factors: vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF], angiogenin and transforming growth factor-beta 1 [TGF-beta1] and their relationship to metabolic control in children and adolescents with type I diabetes mellitus and to evaluate whether these angiogenic factors can predict and identify cases at greater risk to develop diabetic retinopathy or persistent microalbuminuria in a follow-up period of 12 months. The present study included 20 type I diabetic cases aged 6-18 years and 15 healthy controls. Diabetic cases were subjected to detailed history taking, clinical examination, fundus examination, electroretinography [ERG] and repeated estimation of glycosylated hemoglobin [HbA1C%] and fasting blood glucose in addition to urinary albumin excretion [UAE] ug/minute/1.73m[2] in repeated 24 hours collection of urine. These data were collected at the baseline [at the beginning of the study] and after 12 months follow-up period. Baseline investigations included the determination of blood urea, serum creatinine and assessment of serum angiogenic factors: VEGF, bFGF, angiogenin and TGF- beta1 by ELISA. At the beginning of the study, diabetic cases had significantly higher serum levels of VEGF, bFGF and angiogenin and significantly lower oscillatory potentials amplitude [Ops] than the control group. When diabetic cases were followed up for 12 months, 4/20 cases developed background retinopathy in fundus examination and 5/20 developed incipient nephropathy [persistent microalbuminuria] Development of microvascular complications was associated with significantly higher HbA1C%, serum VEGF, bFGF and angiogenin than uncomplicated cases. Furthermore, cases with diabetic retinopathy had significantly higher UAE and significantly lower baseline Ops than those without. Angiogenic factors as VEGF, bFGF and angiogenin and ERG examination could be used as predictors for identification of diabetic cases at high risk to develop diabetic retinopathy with a sensitivity of 75-100% and specificity of 81.25-93.75% and in prediction of incipient diabetic nephropathy with a sensitivity of 60-100% and a specificity of 86.67-93.33%. Angiogenic factors were correlated with HbA1C% and repeated blood glucose. The medical management of diabetes mellitus should be focused not only on metabolic control but also on measurement of angiogenic factors and ERG examination to predict cases at high risk of microvascular complications for early and more effective intervention that may include in the future antagonists to angiogenic factors

Antioxidant activity in hematological diseases in children

Several hematological diseases are accompanied by oxidant stress. The objective of this work was to study antioxidant status in children with some hematological diseases and to relate the results to metabolic alterations and complications of these diseases. Red blood cells glutathione content [GSH], glutathione-related enzymes, catalase, and superoxide dismutase [SOD], in addition to plasma total radical trapping antioxidant capacity [TRAP], and vitamins E and C in blood samples from 20 children with acute G-6-PD hemolytic anemia [favism] before transfusion, 20 with homozygous beta-thalassemia and 20 with acute lymphoblastic leukemia [ALL], in addition to 20 healthy children as controls. Children with favism as well as those with beta-thalassemia had significantly lower TRAP activity, GSH, catalase, vitamins E and C than the controls. Thalassemic cases had negative correlations between ferritin levels and vitamins E and C. On the other hand, leukemic cases showed TRAP activity that was not significantly different from the controls and increased activity of GSH peroxidase and reductase enzymes. It could be concluded that antioxidant defenses are not defective in ALL, however, a pronounced defect is present in cases with favism and beta-thalassemia major. Therefore, administration of antioxidants in addition to optimal iron chelation therapy may be warranted

Coagulopathy: influence of Schistosoma mansoni and Hbs Ag altered equilibria in post-partum preeclamptic states

The anticoagulants, protein C [PC], protein S [PS] and thrombin-antithrombin complex [TAT] were assessed in four selected groups involving non-pregnant cases [Group I[A]IV[A]] [G I[A]; were considered as controls, G II[A]: with active schistosomiasis, G III[A]: with hepatitis B surface antigen [Hbs Ag] carrier inactive state and G IV[A]: with S. mansoni and Hbs Ag carrier inactive state], and allied cases immediately after delivery [Group I[B]-IV[B]]. A similar category of selected groups were assessed for those suffering from preeclampsia [PE] prior to delivery [Group I[C]-IV[C]]. The groups involved normal control group [G I], a group with schistosoma mansoni [G II], a group that were inactive Hbs Ag carrier [G III] and a group with schistosoma and inactive Hbs Ag carrier state [G IV]. Reduced PC, PS vs elevated TAT [G IV[A] > G II[A] > G III[A] > G I[A]] were presented in non-pregnant states. Assessed values immediately after delivery showed greater-magnitude of change in PE than those with normotensive pregnancies with significantly higher TAT. A relative decrease of PC and PS levels [G Iv[C] > G lic > G III[C] > G I[C]] compared to [G IV[B] > G II[B] > G III[B] > G I[B]] was apparent. Significant decrease of PC and PS were evident only in G Iv[C]. In conclusion, preeclamptic schistosomal cases with inactive Hbs Ag carrier state presented greater risk of thrombotic complications owing to inadequate complementary compensatory mechanism between PC and antithrombin III [AT III]

Effect of short and long term exercise on serum libpid profile

The impact of an aerobic exercise on serum lipid profile, apolipoproteins A-1 and B and lipid peroxides were studied. Forty males [age ranged 19 - 24 years] were selected among healthy non-smoker volunteers. Twenty volunteers performed short term exercise that consisted of 400 m swimming for 15 minutes. The other 20 volunteers performed long-term exercise that consisted of 2 hours swimming for 5 days per week for 6 weeks. In both cases fasting blood samples were drawn before and after the exercise session. Serum was separated from each blood sample and all parameters were analyzed biochemically. Physical exercise may produce favorable metabolic results in lipid and lipoprotein profile. On the other hand, in order to avoid harmful effects of lipid peroxidation, adequate supply of antioxidants [e.g. vitamins A, C and E] is suggested

Immunohistochemical detection of Chlamydia trachomatis in ectopic tubal pregnancies

This study was conducted to evaluate the possible association of Chlamydia trachomatis with ectopic pregnancies. In a case-control study, comprising 18 cases with surgically confirmed ectopic tubal pregnancy and 11 fallopian tubes excised for sterilization purpose which served as controls. All women were between the ages of 16-42 years. An immunohistochemical staining using peroxidase for Chlamydia trachomatis monoclonal antibody was performed on the paraffin section of these specimens. Chlamydia trachomatis antigen was detected in 13/15 [18.13%] of ectopic pregnancies and only in 3/10 [30%] of the control group. Thus, the prevalence rate of chlamydia antigen was significantly higher in women with ectopic pregnancy versus control [P <0.012]. No chlamydia antigen was found in the chorionic villi indicating the absence of current infection. Only 3 of the ladies recall having pelvic inflammatory disease indicated that most of the infections passed unnoticed. This study further supported the hypothesis that subclinical infection of the tube with Chlamydia trachomatis which might underlay ectopic pregnancies

effect of infra red laser on the healing process and on the immune functions in cesarean section patients

This study was carried on forty volunteer women delivered by cesarean section, twenty of them received infrared laser [IRL] and the others did not, it was found that IRL increased significantly the erythrocyte rosette formation, the amount of immunoglobulin G and the phagocytic index, IRL increased the number of cases with no bacterial growth. These results confirm that IRL has a remarkable effect on the healing process

Estrone sulfatase activity in endometrial carcinoma

Estrone sulfatase activity was measured in ten normal and ten neoplastic endometrial tissues, the samples were incubated with 4 methylumbelliferone sulfate for 30 minutes at 37C. After the reaction was stopped by adding carbonate buffer, the liberated methylumbelliferone was measured fluorometrically. The enzyme activity in cancer tissue was significantly higher than in normal tissue. It was concluded that estrone sulfatase may play a role in regulating the estrogen action by shifting the intracellular equilibrium between free estrogens and estrogen sulfate, this help to support the tumor growth

Detection of HPV in cervical smears and vulval warts by an in situ hybridization technique

A retrospective study was done on the following groups of cases: First group included Papanicolaou [Pap] stained smears with variable degrees of dysplasia [5 cases], second group included normal Pap stained cervical smears [5 cases] used as negative control, third group included paraffin sections from vulval warts [7 cases] used as positive control, fourth group includes fresh frozen cytopreparation of cervical which was performed on 5 cases, and the fifth group consisted of Frank cancer cervix [5 cases]. Using a biotin labeled probe without prior amplification of DNA, only type II probe was applied in this study. Prior to probe application deparafinization of both vulval warts and cancer cervix sections was undertaken as well as decolorization of Pap stained smears after localizing the dysplastic cervical cells to be the target sites for probe application. The results showed positivity in all 7 vulval wart cases, in 3/5 of dysplastic cervical smear particularly in cells with koilocytosis, anisonucleosis and hyperchromatosis and in one out of the five fresh cytopreparation of cervical wash. All normal pap smear were negative, also all cervical cancer cases were negative. No background staining was seen with good visualization of HPV genome. The routine application of this method on Pap stained cervical smears positive for dysplasia was recommended in order to disclose the presence of HPV as an underlying causative factor

relationship between maternal moderate exercise and fetal well being during the third trimester of pregnancy

Thirty healthy pregnant women in the third trimester of pregnancy were subjected to moderate exercise. Both the maternal measurements [heart rate, respiratory rate and blood pressure] and fetal measurements [fetal breathing, fetal movements and fetal heart rate] with umbilical arterial resistance indices [systolic/diastolic, pulsatility index and resistance index] were taken before and after maternal exercise. The obtained data indicated that there was significant increase in maternal heart rate, respiratory rate and in systolic blood pressure with an insignificant decrease in diastolic blood pressure, and concerning fetal parameters, there was a significant increase in fetal breathing, fetal movement, fetal heart rate. In the mean time there was insignificant decrease in systolic to diastolic ratio, pulsatility and resistance indices in the umbilical artery. The above findings suggested that moderate maternal exercise was safe for both the mother and her fetus during the third trimester of pregnancy in healthy women

Study of thromboxane A2 in dysfunctional uterine bleeding

Thromboxane A2 [TXA2] level was determined in 25 cases with dysfunctional uterine bleeding [DUB] and in 10 cases with normal menstrual blood loss as control group. The patients were not taking anti prostaglandins or hormonal therapy during the last three months, the mean level of TXA2 in cases with DUB was 9.92 pg/0.1 ml plasma +/- 6.587, while in the control group the mean level of TXA2 was 26.7 pg/0.1 ml plasma at 9.03. The difference between the two groups was significant [P <0.001]. Thromboxane A2 being a potent vasconstrictor and a potent platelet aggregator is important in the control of bleeding from the uterus and its decrease level could be one of the etiological factors in the pathogenesis of DUB

Estrone sulfatase activity in uterine leiomyoma and overlying endometrial tissue

Estrone sulfatase activity was measured in endometrial, leiomyoma and myometrial tissues of the same uterus in 10 patients with uterine leiomyoma who did hysterectomy in the period between December 1991 and December 1992. Four samples were obtained from each uterus for analysis, the first from normal myometrium, the second from the leiomyoma, the third from the endometrium overlying normal myometrium, and the fourth from the endometrium overlying the leiomyoma. The samples were incubated with 200 um 4-methylumbeliferone sulfate for 30 minutes then the liberated methylumbeliferone was measured fluorometrically. The average value of estrone sulfatase was 0.799 nmol/hour/mg in normal myometrium, 0.711 nmol/hour/mg in leiomyoma, 2.255 nmol/hour/mg in endometrium over normal myometrium and 2.74 nmol/hour/mg in endometrium over leiomyoma. The estrone sulfatase was significantly higher [p <0.001] in endometrium overlying leiomyoma than in endometrium overlying normal myometrium. Estrone sulfatase activity in normal endometrium was significantly higher compared with that in leiomyoma or myometrial tissues. It was also found that estrone sulfatase activity was significantly different [p <0.02] between leiomyoma and normal myometrial tissues. These results suggested that an increase in estrone sulfatase activity in the local endometrium and not in leiomyoma is what may be related to enlargement of uterine leiomyoma

Puborectoplasty for anal incontinence, initial report

This is an initial report for a new technique administered by shafk for treatment of fecal incontinence. It was practiced in 12 patients with incontinence of formed stools. Incontinence was idiopathic in 5 cases, following repeated deliveries in 3 cases while 4 patients had history of repeated anal operations. The procedure comprises application of teflon sling 20x2 cm at its middle to the upper part of the rectal neck [anal canal]. The 2 limbs of the sling one sutured to the pubic bone. Satisfactory results have been achieved in 41.6%. The follow up period ranged from 8 weeks to 79 weeks [mean 43.2 w [s]]. Infection and graft rejection were the main complications occured in 10 patients [83.4%]. This procedure should be done only in cases with abscent muscle mass and after failure of other procedures like postanal repair. Also fascia lata should be used instead of teflon grafts and the results will be compared

Partial splenectomy in bilharzial hepatosplenomegaly

In Bilharzial splenomegaly splenectomy is indicated in huge spleen, in hypersplenism or in combination with devascularisation. The vital importance of both the immunological and haematological functions of the spleen necessitates preservation of this organ. Partial splenectomy was performed in 11 cases leaving a functional segment [about 25% of the enlarged spleen]. The operative technique depends on the segmental vasculature of the spleen so devascularisation of anatomic segments facilitates excision, haemostasis to the main bleeders, approximation of the capsule and row of haemostatic stitches was enough to control bleeding. The procedure was feasible, effective in relieving abdominal discomfort. Follow up ranged from 3 to 9 months with a mean of 5 months. There was improvement in the haematological profile of these cases. The residual spleen showed normal uptake of 99T C sulpher colloid. The immunological functions of the residual parts were not assessed and need further study, also the long term follow up of these cases will judge the efficacy of this procedure as an alternative to total splenectomy

Surgical treatment of complete rectal prolapse

Shafik levatorplasty operation has been used to treat 24 consecutive patients with complete rectal prolapse. The mean age in this group was 50 years and the average length of the prolapse was 10 cms. There was no postoperative mortality. The follow up ranged from 5-18 months with a mean duration of 11.5 months and so far there has been two recurrences. One of these has been successfuly treated by a second Shafik levatorplasty operation. The second will repeat the procedure. All the incontinent patients became continent except one became incontinent to flatus only. These favourable results in term of recurrence and function [incontinence] would encourage surgeons to do it as a first choice operation in complete rectal prolapse if longer periods of follow up showed the same results. The surgical treatment of complete rectal prolapse remains controversial. Most procedures are a variation of a few basic modes of therapy and depend on the surgeon's concept of the anatomic defect. The options for treatment include narrowing of the anal orifice [Thiersch 1891], obliteration of the peritoneal pouch of Douglas [Moschcowita 1912], restoration of the pelvic floor [Mc Cann 1928] . Resection of the bowel by abdominal [Muir 1955], perineal [Miles 1933] or sacral [Thomas and jen kins 1965] approaches and lastly suspension or fixation of the rectum to the sacrum or to other structures [Hughes 1949, Graham 1942, Ripstein 1965]. Recently Shafik introduced a new concept of pathogenesis of rectal prolapse [Shafik 1981] and accordingly he suggested a new technique for treatment [Shafik 1987] with favourable results. This encourages us to evaluate the procedure in our unit in Kasr-el-Eini hospital and all the admitted patients treated with this technique

Phenotypic and genotypic profile in Egyptian non-Hodgkin's lymphoma

All the cases of well differentiated lymphocytic neoplasm showed double arrangement along IgH and TCR "beta" genes. These immunogenetic data suggested that B cell well differentiated lymphocytic neoplasms are relatively homogeneous disorder. This double rearrangement was found to be 100% in grade I, 20% in grade II and 22% in grade III. This decrease in the frequency of double rearrangement along the line of differentiation may support the view point that small cell NHL arise from immature group and as the cell differentiates, commitment to the corresponding cell line is more and more achieved