Rosmarinic acid attenuates hepatic fibrogenesis via suppression of hepatic stellate cell activation/proliferation and induction of apoptosis

OBJECTIVE@#To investigate the antifibrotic role of rosmarinic acid (RA), a natural polyphenolic compound, on HSCs activation/proliferation and apoptosis in vitro and in vivo.@*METHODS@#The impact of RA on stellate cell line (HSC-T6) proliferation, activation and apoptosis was assessed along with its safety on primary hepatocytes. In vivo, rats were divided into: (i) normal; (ii) thioacetamide (TAA)-intoxicated rats for 12 weeks; (iii) TAA + silymarin or (iv) TAA + RA. At the end of experiment, liver functions, oxidative stress, inflammatory and profibrogenic markers, tissue inhibitor metalloproteinases type-1 (TIMP-1) and hydroxyproline (HP) levels were evaluated. Additionally, liver histopathology and immunohistochemical examinations of alpha-smooth muscle actin (α-SMA), caspase-3 and proliferation cellular nuclear antigen (PCNA) were determined.@*RESULTS@#RA exhibited anti-proliferative effects on cultured HSCs in a time and concentration dependent manner showing an IC of 276 μg/mL and 171 μg/mL for 24 h and 48 h, respectively, with morphological reversion of activated stellate cell morphology to quiescent form. It significantly improved ALT, AST, oxidative stress markers and reduced TIMP-1, HP levels, inflammatory markers and fibrosis score (S1 vs S4). Furthermore, reduction in α-SMA plus elevation in caspase-3 expressions of HSCs in vitro and in vivo associated with an inhibition in proliferation of damaged hepatocytes were recorded.@*CONCLUSIONS@#RA impeded the progression of liver fibrosis through inhibition of HSCs activation/proliferation and induction of apoptosis with preservation of hepatic architecture.

Rosmarinic acid attenuates hepatic fibrogenesis via suppression of hepatic stellate cell activation/proliferation and induction of apoptosis

Objective To investigate the antifibrotic role of rosmarinic acid (RA), a natural polyphenolic compound, on HSCs activation/proliferation and apoptosis in vitro and in vivo. Methods The impact of RA on stellate cell line (HSC-T6) proliferation, activation and apoptosis was assessed along with its safety on primary hepatocytes. In vivo, rats were divided into: (i) normal; (ii) thioacetamide (TAA)-intoxicated rats for 12 weeks; (iii) TAA + silymarin or (iv) TAA + RA. At the end of experiment, liver functions, oxidative stress, inflammatory and profibrogenic markers, tissue inhibitor metalloproteinases type-1 (TIMP-1) and hydroxyproline (HP) levels were evaluated. Additionally, liver histopathology and immunohistochemical examinations of alpha-smooth muscle actin (α-SMA), caspase-3 and proliferation cellular nuclear antigen (PCNA) were determined. Results RA exhibited anti-proliferative effects on cultured HSCs in a time and concentration dependent manner showing an IC

Glutathione S-transferase gene with susceptibility to juvenile idiopathic arthritis

Introduction: Juvenile idiopathic arthritis [JIA] is a chronic autoimmune disease of unclear etiology. It is the most common inflammatory arthritis worldwide with major individual and health service coast. GSTs play important roles in detoxification mechanisms. It is known to be polymorphic and the presence of polymorphisms has been implicated in susceptibility of JIA

Aim: The aim of this study was to explore the association between GST gene and susceptibility to JIA

Subjects and methods: 40 patients with JIA and 40 apparently healthy controls matched with age and sex were genotyped using allelic discrimination by PCR

Results: the frequency of GSTM1 null genotype polymorphism was significantly higher in JIA patients than in controls [OR= 0.4, CI= 0.16-0.98, P= 0.04]. No significant association was found regarding GSTT1 null gene polymorphisms in JIA patients [OR= 0.417, CI- 0.15- 1.13, P= 0.8]. GSTMlnuII gene polymorphism is more prevalent in females than males [P= 0.004], whereas no significant association was found in GSTT1 gene polymorphism [p= 0.4]

Conclusion: Higher frequency of GSTMI null genotype polymorphism in patients of JIA suggesting that it might be associated with susceptibility of JIA, severity and outcome. GSTTI null gene polymorphism had no association with JIA susceptibility

disintegrin and metalloproteinase 33 [ADAM33] gene polymorphism association with asthma in Egyptian children

A disintegrin and metalloproteinase-encoding gene [ADAM33], was recently identified as an asthma susceptibility gene. ADAM33 protein is expressed in smooth muscle cells of bronchi and pulmonary fibroblasts, playing a major role in airway remodeling. Earlier studies, have mostly confirmed a link between ADAM33 and asthma as well as bronchial hyperresponsiveness. This work studied a group of Egyptian asthmatic children for 3 ADAM33 single nucleotide polymorphisms [SNPs], previously identified as putative risk alleles: T1 G > A[rs2280091], T2 A > G[rs2280090], V4 G > C[rs2787094] using Polymerase Chain Reaction - restriction fragment length polymorphism [PCRRFLP] with emphasis on their relation to clinical [severity, smoking, family history, and atopic manifestations] and laboratory data [Ig Immunoglobulin E [Ig E] level and absolute eosinophilia] and pulmonary functions. Sixty [3-12 years old] asthmatic children and 32 matched controls were recruited. The genotype distribution for the SNPs showed no significant difference between the patients and the controls. A higher frequency of the [AA] genotype of T1 polymorphism was found in controls [75%] than in patients [41%], while the [AG] variant was higher in cases [46.6%] than in controls [21.9%] but with no statistically significant difference. Also the [GG] genotype was higher in cases [11.6%] than in controls [3.1%] but with no statistical significance. The allelic frequencies of T1 showed a higher [A] allele in controls [85.93%] than cases [65%] and higher [G] allele in cases [35%] than controls [14.06%], showing a high significant difference. No correlation was found between [T1, T2, and V4] and the demographic, clinical and laboratory parameters, except SNP T1 showing a positive correlation with Ig E level, and SNP V4 showing a positive correlation with passive smoking as a precipitating factor and borderline significance with absolute eosinophilia. In conclusion, no significant association was detected between these SNPs and asthma susceptibility in this study

Cholecysto cholangiography versus cystic duct cholangiography in laparoscopic cholecystectomy: a prospective controlled randomized trial

This study evaluated the safety and effectiveness of cholecysto-cholangiography [CCC], an extremely rapid and easy way of imaging the biliary tree during laparoscopic cholecystectomy and a viable alternative to cystic duct cholangiography in the era of minimal invasive surgery. Sixty patients with symptomatic gallbladder stones were studied in this series, 30 were evaluated for cholecysto-cholangiography and other 30 for transcystic-cholangiography. The success rate in cholecysto-cholangiography approached 80% with excellent quality films obtained. Delineation of anatomy approached 85%; 75% for cholecysto-cholangiography and transcystic cholangiography respectively. Exposure time to radiation compares favourably with cystic duct cannulation with a mean time 2.4 min. Cholecysto-cholangiography added less than 11 mins to the procedure; mean 10.4 mins, while transcystic cholangiography added an extra 30 mins; mean 31 mins. There were no cholangiogram related complications or false positive findings with a smooth for two months follow up

Skin manifestations of chronic hepatitis C virus infection in Cairo, Egypt

We assessed the dermatological manifestations associated with chronic hepatitis C virus [HCV] infection and their association with liver status. Of 155 patients with chronic HCV infection in Cairo, Egypt, 71 [45.8%] had dermatological manifestations: pruritus without evident skin lesions [21.3%], pigmented purpuric eruption [5.2%], aphthous ulcer and lichen planus [3.9% each], leukocytoclastic vasculitis [2.6%], psoriasis [1.9%], tinea versicolor [1.3%] and other conditions [5.8%]. Shrunken liver, splenomegaly and ascites were significantly associated with the presence of skin lesions [relative risk 8.0, 2.7 and 1.8 respectively], and shrunken liver was significantly associated with pruritus [relative risk 2.1]. Sex was not associated with any of the skin lesions

In vitro cultivation for detection and phenotypic study of blastocystis spp. in stool samples

Blastocystis spp. is an unusual enteric parasite of human and many animals. Recent observations indicate that humans are hosts to different pathogenic and non-pathogenic genotypes, many of which are zoonotic. The aim of the present study is to determine the usefulness of short term in vitro cultivation of stool samples in detection of Blastocystis spp. over routine techniques. Also to study the different morphological forms and reproductive modes from longer term cultures and stool samples. One hundred stool samples from symptomatic patients were processed for short term in vitro cultivation using Jones'medium. Direct microscopy of culture samples was compared to that of wet preparation and modified trichrome staining of stool samples. Longer term cultivation of Blastocystis positive samples was conducted to study different morphological forms and reproductive modes of the parasite using direct microscopy of stained and unstained samples, ocular micrometer, phase contrast microscopy [PCM] and scanning electron microscopy [SEM]. Short term in vitro cultivation of stool samples significantly increased the recovery of Blastocystis spp. over examination of wet preparation by 42.86% [p=0.0001] and over permanent staining using modified trichrome stain by 28.57% [p=0.000 1]. Examination of stained and unstained samples from stools and longer term cultures of positive samples revealed five different morphological forms; vacuolar, granular and amoeboid, multivacuolar and cyst forms. As regards the reproductive modes of Blastocystis, the present study identified five modes of reproduction from stool and culture samples: binary fission, multiple fission, budding, endodyogeny and plasmotomy. Schizont-like cells were also seen in some stool and culture samples. Short term in vitro culture of stool samples is a highly recommended diagnostic tool for Blastocystis spp. Infection. Long term culture is a useful tool to study different morphological forms and reproductive modes. More studies are required to verif' some reproductive modes of the parasite

Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult especially with recent onset RA before articular damage and erosions develop. To assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor in distinguishing between rheumatoid arthritis and HCV related polyarthropathy. Anti-CCP antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared to RF [95.4% Vs 18.2%]. However the sensitivity of anti-CCP was comparable to that of RF [83.3% Vs 90%]. Anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy

Validity of platelet count/spleen diameter ratio as a predictor of esophageal varices in patients with liver cirrhosis

Portal hypertension commonly accompanies the presence of liver cirrhosis, and the development of esophageal varices [OV] is one of the major complications of portal hypertension. To evaluate platelet count/splenic size ratio as a non-invasive parameter to predict the presence or absence of esophageal varices in patients with liver cirrhosis. Eighty-six cirrhotic patients who underwent digestive upper endoscopy, were classified into Group 1 which is formed of 60 patients who had endoscopic evidence of OV and Group 2 which is formed of 26 patients who had no endoscopic evidence of OV. All the patients underwent thorough clinical examination, laboratory and ultrasonographic evaluation. Laboratory investigations were done in the form of complete blood count including platelet count [PLT]; liver function tests [aspartate transaminase [AST], alanine aminotransferase [ALT], serum bilirubin and prothrombin time [PT]], schistosomal antibodies, hepatitis B surface antigen [HBsAg] and hepatitis C virus antibodies. Abdominal ultrasonography and upper gastrointestinal endoscopy were done for all patients. Patients with OV had lower mean platelet count and higher mean spleen diameter than patients without OV [p=0.003 and p=0.01 respectively]. The mean values of the ratio of platelet count/spleen diameter was significantly lower among OV group when compared with patients who had no endoscopic evidence of OV [p=0.002]. There was no significant difference in the platelet count/spleen diameter ratio between different grades of OV. Large OV was associated with increased portal vein diameter [p=0.05]. Lower platelet count/splenic size ratio is associated with the presence of OV yet it cannot be used as a predictor of OV and so the endoscopy remains the standard screening test for OV among patients with liver cirrhosis

Production of cytochalasin B by Helminthosporium solani under different culture conditions and its effect on the mitosis of onion root cells

The optimum temperature for maximum production of cytochalasin B [CB] by Helminthosporium solani was 30°C. The optimum pH value was 5.5 - 6.0, and the maximum CB production was attained after nine days of incubation. Glucose and sodium nitrate were the best carbon and nitrogen sources for CB production. CB at the concentration of 30 microg/ml decreased the mitotic index [MI%] of Allium cepa L. [onion, Giza, 20] roots from 8.42 to 4.83%. The spindle constituents [microtubules] were affected in a way that gave rise to a number of chromosomal abnormalities, namely; stickiness, un-oriented, bridges, free and distributed spindles without multinucleated cells production. CB at this concentration decreased onion seed production by 5.7% compared with the control. CB also induced morphological changes to roots and decreased the root length

effect of portal vein branch plus heterochronous hepatic artery branch ligation on liver regeneration [Experimental study]

The proliferative capacity of non-ligated liver lobes was designned experimental study on dogs in which portal vein and hepatic artery ligation was done either simultaneously or heterochronously. Dogs were divided into four groups: G I [control G]; laparotomy was performed without vascular ligation, G II; dogs were subjected to ligation of the right lateral and median branches of portal vein alone, G III, dogs were subjected to hepatic artery branches ligation 48h after portal vein branches ligation. G IV, dogs were subjected to ligation of the same branches of the portal vein and hepatic artery simultaneously. Dogs from each group were subjected to a liver biopsy before and 24, 48, 72, and 168h [one week] after surgery. Standard serum liver functions were tested before ligation, 72 hs and one week after ligation. Hepatic regeneration in the non-ligated lobe was assessed through histopathological study, DNA quantitation of the hepatic nuclei by the computerized image analysis system and estimation of proliferation marker in hepatic tissue. In this study, the labeling index of the nuclear factor NF Kappa B [PI05], a novel monoclonal antibody specific for PI05 protein, was determined immunohistochemically. Results showed induction of the NK kappa B [P105] labeling index showed maximum levels G III. Quantitative determination of serum glutamicoxaloacetate transaminase [GOT] showed peak levels in G IV at 24h after surgery. Our finding for this index that heterochronous partial portal vein and hepatic artery ligation [i.e., G III] is effecttive, because this procedure leads to an increase in the compensatory hypertrophy of the nonligated liver lobes that depends on the regenerative capacity of the lobes themselves. In contrast, in G IV [i.e., synchronous ligation of portal vein and hepatic artery branches] liver regeneration did not occur due to the severe systemic damage induced by infectious necrosis in the ligated lobe. The serial changes in liver function in G III indicate that the use of this technique may minimize dysfunction in the remaining hypertrophied liver lobes, similar to findings in G II. So, the PVBL plus heterochronous HABL procedure is safer and more effective than PVBL alone, or PVBL plus simultaneous HABL. A better knowledge of the events following such heterochronous ligation should improve the clinical outcome of hepatic resection for liver diseases

Association of chlamydia pneumoniae infection with coronary heart disease

C. pneumoniae is an obligatory intracellular bacterium responsible for upper and lower respiratory tract infections. This work was carried out to study the association between C. pneumoniae infection and coronary heart disease [CHD]. This study included 70 patients, divided into two groups[Group I ,included 55 patients with acute coronary syndromes: 32 patients with acute myocardial infarction and 23 patients with unstable angina Group II, It included 15 patients with previously diagnosed chronic coronary heart disease]and healthy Control Group [Group III],It included 22 healthy subjects as control. Venous blood samples were collected from all patients and controls for: determination of total blood cholesterol level, detection of C. pneumoniae-specific IgG by ELISA and detection of C. pneumoniae DNA in the peripheral blood mononuclear cells by PCR The results of this study showed that: C. pneumoniae-specific IgG was detected by ELISA in 83.6% of the acute patients, 73.3% of the chronic patients, and 68.2% of the healthy control subjects.There was no statistically significant difference among the different studied groups as regarding the prevalence of C. pneumoniae-specific IgG antibodies.C. pneumoniae IgG seropositivity among the CHD patients was correlated with smoking but not with age, male sex, hypertension, diabetes mellitus or hypercholesterolemia. C. pneumoniae-specific DNA was detected by PCR in the PBMCs of 61.8% of the acute patients, 26.7% of the chronic patients, and 18.2% of the healthy control subjects. Positive PCR results were significantly higher among the whole studied CHD patients [acute plus chronic] compared to the control subjects. Also, positive PCR results were significantly higher among the acute patients than both the chronic patients and the healthy controls. In contrast, the difference between the chronic patients and healthy controls as regarding the prevalence of C. pneumoniae DNA in the PBMCs was not statistically significant. C. pneumoniae DNA positivity among the patients [either the whole patients or acute patients only] was not significantly correlated with age, sex or any of the studied classic coronary risk factors [smoking, hypertension, diabetes mellitus and hypercholesterolemia]. After adjustment for the classic coronary risk factors and demographic characteristics in the multiple logistic regression analysis, C. pneumoniae infection [as indicated by PCR positivity] was associated with the CHD.No statistically significant difference was found between C. pneumonia DNA positive and C. pneumoniae DNA negative patients [either the whole patients or acute patients only] as regarding the prevalence of C. pneumoniae-specific IgG. This study concluded that: C. pneumoniae DNA detection in the PBMCs was found to be an independent predictor for CHD, particularly acute coronary events.The prevalence of C. pneumoniae DNA in the peripheral blood was found to be higher among the acute CHD patients with recurrent attacks than those with first attacks.C. pneumoniae IgG seropositivity was unreliable predictor for the presence of C. pneumoniae DNA in the CHD patients

Sling operations in the treatment of stress urinary incontinence: How to adjust sling tension

To find an objective method to adjust slings tension in order to avoid postoperative urinary obstruction. 35 Female patients with Type II/III and Type Ill SUI were treated using sling procedure. Pubovaginal facial sling is employed in 20 patients and polytetrafluoroethylene patch sling with nylon sutures in 15 patients. The urinary bladder is semifull while the patients under spinal or epidural anesthesia is asked to cough and strain. The proper tension effectively prevent urine leakage is selected and the corresponding suture length is marked. An objective new method to adjust slings tension is employed using the abdominal bulge index to be added to the suture length before tying. Short term follow up of 6-12 months showed that 33 out of 35 patients reported no leakage of urine [94%]. Two patients have unsatisfactory urge incontinence. We do not encounter postoperative urinary retention in any patient. No significant post voiding residual urine was reported. None of our patients in this series complain of difficulty on micturation or need to strain during voiding. Proper adjustment of slings tension using the abdominal bulge index has eliminated the postoperative urinary retention, obstructed urine flow as well as any appreciable amount of post voiding residual urine. This method is found objective and reproducible

Biocontrol of peanut southern blight [sclerotium rolfsii] by bacillus subtilis

The effective strains of Bacillus subtilis for antagonism against Sclerotium rolfsii in dual cultures were selected. The effects of substrates and cultural conditions on the antagonism of B. subtilis were also studied. S. rolfsii Sacc. caused southern blight disease of a wide range of hosts including leguminosae. The tested peanut plants showed different pre-emergence and post-emergence infection responses towards the four tested S. rolfsii isolates. S. rolfsii isolate number 1 was the most virulent one. Sixteen out of 30 isolates of Bacillus species showed antagonistic activity against S. rolfsii isolate number 1. Richard's medium gave the maximum antagonistic activity. The optimum environmental conditions needed for B. subtilis to give maximum antagonistic activity were 72 hr incubation period, 35C incubation temperature and pH 6. Sucrose and potassium nitrate proved to be the best carbon and nitrogen sources, respectively. MnSO4 [0.01 g/l] was needed to give the maximum antagonistic activity

Cervical lympho-venous shunt versus denver shunt in management of intractable ascites [analysis of 170 cases]

The present study was conducted on 170 patients with intractable ascites secondary to liver cirrhosis. The present study showed that both peritoneo-venous and lympho-venous shunts are technically simple procedures that could be done under local anesthesia in nearly similar time duration. However, Denver shunt is expensive, it costs between LE 4000-6000. Lympho-venous shunt is a biological cheap procedure. It can be concluded from this study that patients with intractable ascites could be offered surgical therapy with either shunts with a high success rate. Cervical lympho-venous shunt appears to be a simple, safe, cheap and effective method for achieving a long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascetic fluid with almost negligible complications. Failure does not interfere with the future use of the expensive peritoneo-venous Denver shunt. Denver peritoneo-venous shunt is a good device to relieve ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. However, its high cost limits its wide scale application. A careful patient selection is mandatory for optimal results

randomized controlled study of the immunosuppressive versus of whole blood transfusion versus packed red blood cells transfusion in patients undergoing elective colorectal surgery

In a randomized study, the effect of whole blood transfusion versus packed RBCs transfusion on CD4+:CD8+ ratio, the levels of soluble interleukin 2 receptor [sIL-2R] and interleukin IL-6 as well as on the development of the postoperative wound infection and intra-abdominal abscess, was assessed in 45 patients undergoing elective colorectal surgery. The patients were subdivided into three groups: Group A included 13 patients who were randomly selected received whole blood transfusion when blood transfusion was indicated, group B included 13 patients who were randomly selected received packed RBCs when blood transfusion was indicated and group C included 19 patients who did not receive any blood transfusion. The samples were obtained prior operation and 3, 7 and 30 days postoperatively. The study demonstrated that transfusion with whole blood in elective colorectal surgery was followed by a significant depression in immunocompetence and this depression is attenuated by the use of packed RBCs transfusion

Respiratory and dermatological hazards among workers in textile dyeing

This study was done to find out the prevalence of respiratory and dermatological disorders among workers exposed to textile dyes and to investigate the dyes most probably associated with respiratory and dermatological disorders among exposed workers. It was carried out on 200 workers in dye houses in the textile dyeing industry in Al-Mahalla Al-Koubra as a study group and 200 workers not exposed to dyes as a control group. The results of this study revealed that: there was no statistically significant difference between both groups as regards age. marital status, residence, social class and educational level. The prevalence of smoking in both groups was almost the same with no significant difference. Inquiry about chronic cough, chronic phlegm and chronic bronchitis showed high prevalence rates in both groups but there were no significant differences between them. On the other hand, chest tightness, dyspnea, asthma and conjunctivitis were found to be significantly higher among the exposed group than among the non exposed group. In the present work, the longer duration of work exposure was found to be related to higher prevalence rate of respiratory and irritant symptoms, the difference between the groups was significant. Regarding the relationship between smoking habit and the prevalence rate of chronic respiratory symptoms, the current study demonstrated that there was significant difference between the three groups of exposed workers [smokers, non- smokers, ex-smokers], as regards chronic cough, chronic phlegm, chronic bronchitis and asthma. On studying the ventilatory functions, significant differences between exposed and non exposed groups of workers were found in the mean values of FVC% predicted, FEV1% predicted. FEV1/FVC% and FEF 25-75% predicted. Further more, these parameters were significantly lower among smokers and when the duration of dye exposure was prolonged. Multiple regression analysis was done to prioritize the factors affecting the ventilatory function parameters among the exposed workers and it revealed that, although the exposure to dye had a powerfull effect, yet smoking [number of cigarettes smoked per day and duration of smoking] had the strongest effect. Eczema was observed among 10% of the exposed group, while no cases of eczema were detected among the control group. About 86% [18 workers] of the workers having eczema gave positive reactions to the dye allergens. The prevalence of positive patch test reaction was found to be higher to disperse dye than to the reactive dye in the current study. This study proves that textile dyeing workers suffer from high prevalence of respiratory and dermatological disorders and the prevalence of positive patch test reaction was found to be higher to disperse dye than to the reactive dye

Ophthalmologic changes associated with pediatric nephrotic syndrome and chronic renal failure

This work aimed to assess ocular changes that may occur in pediatric nephrotic syndrome and chronic renal failure to verify the importance of ophthalmologic examination as a prognostic and follow up parameter in pediatric chronic renal diseases. It was conducted on 121 patients with chronic renal diseases [50 with nephrotic syndrome, 40 were on steroid treatment [group A] and ten weaned from any medications [group B]] in addition to 71 patients with chronic renal failure [21 were on conservative treatment [group C] and 50 were on regular hemodialysis [group D]]. Ocular evaluation of group A revealed decreased visual acuity, recurrent infections and posterior subcapsular cataract. Patients of group B showed cataract, decreased acuity and recurrent infections. The examination of patients of group C revealed decreased acuity and snowflake cataract and glaucoma. It could be concluded that patients with chronic renal diseases were at an increasing risk of ocular affection likelihood cataract, glaucoma, decreased visual acuity, recurrent infections and corneal calcification, especially children with renal failure on long duration hemodialysis and nephrotic syndrome patients under maintenance steroids for long duration

Prolactin in prepubertal children with juvenile rheumatoid arthritis. The efficacy of bromocriptine as a non-standard adjuvant therapy

The aim of the present study was to explore the possible role of prolactin [PRL] expression in immune pathogenesis of juvenile rheumatoid arthritis [JRA], and its clinical relevance in terms of disease activity and severity. Also, to investigate the efficacy and safety of bromocriptine as a non-standard adjunctive therapy in pediatric age groups. This study was performed in sixty-five subjects, of whom, thirty-five patients had JRA and thirty were healthy age and sex matched subjects. Patients were recruited from the Pediatric Allergy and Immunology Clinic, Children 's Hospital, Ain-Shams University. Patients were subjected to detailed history taking, full clinical examination, Ritchie's Articular Index [RAI] score and laboratory markers of disease activity and severity. PRL assay was perfonned twice for all patients, initially at recruitment during active phase of the disease then after bromocriptine therapy. All patients with active non-life threatening JRA received bromocriptine daily [5-15 mg/day] during treatment phase [3 to 9 months] and were followed for 6 months after drug discontinuation. The mean serum PRL concentration [ng/ml] in all patients at baseline during activity before bromocriptine therapy was significantly higher in comparison to that of the control group [9.33 +/- 2.37 versus 5.57 +/- 0.58]. The frequency of hyperprolactinemia was 65.7%. The highest serum PRL level was noticed in polyarticular RF seropositive JRA [10.32 +/- 3.27 ng/ml]. Serum PRL concentrations during activity showed positive significant correlation with [RAI] score, ESR and CRP. The serum PRL levels were significantly higher in CRP ve JRA [60%] [9.13 +/- 2.43 ng/ml] compared to CRP-ve JRA [40%] [6.52 +/- 0.99 ng/ml]. Serum PRL concentration was significantly higher in ANA seropositive patients [10.82 +/- 3.19 ng/ml] compared to ANA seronegative patients [6.45 +/- 1.02 ng/ml]. Serum PRL concentrations correlated significantly with the duration of illness [6.5 +/- 2.7 years]. There was a significant reduction of serum PRL concentrations after bromocriptine therapy [more significant reduction with longer duration of therapy] from 9.33 +/- 2.37 to 5.59 +/- 7.79 ng/ml; so that when the levels were compared after therapy to that of the control group, no significant difference was noticed. The 7M7 score had decreased significantly after therapy from 12 +/- 5 to 4 +/- 2. ESR showed significant reduction from 52 +/- 22 to 21 +/- 10 mm/hr. Also, CRP decreased significantly from 8 +/- 3 to 2 +/- lmg/dl. Moreover, CRP +ve JRA patients [21 patients; 60%] showed significant reduction after therapy to 5.7% [2 patients]. In our study, 28.6% of patients experienced nausea, 11.4% experienced headache and 2.8% experienced insomnia. The above results imply the important role ofhyperprolactinemia in the immune-pathogenesis of JRA. Hyperprolactinemia correlated significantly with clinical and laboratory indices of disease activity md severity. Therefore, PRL can be considered as a good reliable marker of disease activity, severity and disease monitoring. Bromocriptine therapy especially for longer duration had result in significant reduction of serum PRL levels and improvement of clinical and laboratory markers of disease activity with subjective and objective improvements in the clinical status of most patients with a relatively safety profile and good tolerance. Based on this limited but encouraging clinical trial, the use of bromocriptine as a non-standard adjunctive therapy in controlling JRA activity in prepubertal children is warranted yet, additional investigation is needed to verify this conclusion and extend preliminary results

Is it worthy to perform appendectomy laparoscopically: clinical outcome and interleukin response

Laparoscopic appendicectomy [LA] was found to be as .safe as open appendicectomy [OA]. However, LA was also found to have higher cost than OA, Surgical injury and sepsis are known factors which stimulate the production and the release of a variety of cytokines that reflect the degree of stress, The aim of the present study was to find out if LA is less invasive than OA in terms of clinical outcome and interleukin response. Thirty patients clinically diagnosed as acute appendicitis were prospectively studied. Eight cases proved to have another pathology were excluded from the immunological study The two groups with proved acute appendicitis are: Group I [12 patients] operated upon by open approach and group II[10 patients] operated upon laparoscopically Assays for IL-1beta, IL-4 and IL-15 were performed by highly .sensitive in-house protocols assorted developed and standardized in our lab. The results showed an increase in IL-1 beta from preoperative level to a higher 2 hours level, thereafter the value declined. The values are higher in open surgery than in laparoscopic operations' although the difference did not reach statistical significance. IL-4 showed a decrease in open surgery and rather stable results in laparoscopic operations. IL-15 showed a blunted decrease to the lowest detectable level of the assay of 2pg/ml. Patients in groups II had shorter hospital stay, earlier return to activities and less wound infection. Laparoscopy allowed easier exploration and dealing with detected pathology. Based on the results of the present study, the laparoscopic technique is less stressfull. However it remains more expensive and needs more expertise. Moreover, it offers an extra value in doubtful diagnosis as it allows better abdominal exploration