Portal hypertension treatment with candesartan plus propranolol for nine months restores normal portal circulation hemodynamic pattern

Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow [PVF] and intrahepatic resistances [IHR]. PVF is partially controlled by using both specific and non-specific beta blockers [NSBBs] that have insignificant effects on IHR. Angiotensin receptor blockers [ARBs] inhibit the activated hepatic stellate cell [HSC] contraction and thought to reduce the dynamic portion of MR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension [PH]. Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices [OV], were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index [DI], pulse Pulsatility index [PT], Portal Venous Flow [PVF] Volume, Portal Venous Peak Velocity [PVPV], and Portal Vein Diameter [PVD] were evaluated once every third month. Our study concluded that combined therapy [Propranolol + Candesartan] induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume and PVPV overtime compared to monotherapy regimens [P>0.001]. Data strongly recommended using Propranolol plus Candesartan in overtime management of portal hypertension

Detection of cytogenetics abnormalities in chronic lymphocytic leukemia using FISH technique and their prognostic impact

Chronic lymphocytic leukemia [CLL] is a clonal lymphoproliferative disorder characterized by progressive accumulation of morphologically and immunophenotypically mature lymphocytes. Characterization of genomic aberrations may help to understand the pathogenesis of CLL and may give prognostic information independent from conventional clinical markers for a risk-adapted management of CLL patients. The aim of the present study is to determine the most common cytogenetics abnormalities between patients with CLL and its prognostic impact. The present study was carried out on 20 adult patients presented with chronic lymphocytic leukemia. The patients were diagnosed on the basis of standard clinical [lymph node involvement and/or hepatosplenomegaly], hematological and immunophenotypic criteria for diagnosis of B-CLL. All cases were studied at the time of their diagnosis. FISH technique was successfully performed on PB samples using CLL LSI probes for ATM [11q22] / GLI [12q13] and 13q14/ p53 [17pl3]. For comparative statistical studies, the patients were divided into group I [patients with favorable outcome] and group II [patients with unfavorable outcome]. All patients showed one or more cytogenetic abnormality with the prevalence of p53 in 16 patients out of 20 that perfectly correlated with the poor outcome of the patients. This is followed by deletion in the 13q14 and to a lesser extent deletion in ATM gene, but no one has exhibited amplification in the 12q13 locus. p53 deletion as a sole abnormality has a higher prognostic power than other cytogenetics abnormalities. The cytogenetics study using FISH panel for CLL patients in a complementary fashion to the other clinical and laboratory findings may overcome the pitfalls in the diagnosis and may also assess the assignment of therapeutic protocols for CLL patients according to the results of their cytogenetic analysis at the time of diagnosis

Clinical significance of hTERC and C-Myc genes amplification in a group of egyptian patients with cancer cervix

Cervical cancer is the second most common cancer in women worldwide after breast cancer. Cervical cancer is a preventable disease. The implementation of cervical cancer screening programs has greatly decreased the morbidity and mortality, as precancerous lesions and early invasive cervical cancer could be detected and treated effectively. The detection of hTERC gene amplification was suggested as a possible diagnostic marker for use in routine cytological screening. The present study was designed to detect genomic gains of the hTERC and C-MYC genes using FISH technique and to investigate the relationship between genes amplification and the clinical data of the patients. The current study was carried out on twelve cases with cervical cancer at different grades [three cases were grade I, six cases were grade II and three cases were grade III]. Interphase FISH analysis using LSI probe, Cervical Cancer probe hTERC [3q26] and C-MYC [8q24], was successfully performed on 12 patients with cancer cervix. Interphase FISH analysis revealed positive hTERC gene amplification in all cases of cancer cervix [100%]. However C-MYC gene amplification was detected in four cases only [33.3%]. Statistical analysis of the data revealed significant correlation between hTERC amplification and grating. Also, there was significant correlation between C-MYC amplification and grading and highly significant correlation between C-MYC amplification and hTERC amplification. On the other hand hTERC and C-MYC genes amplification showed an inverse correlation with the ages of the patients. The present study highlights the importance of using hTERC and C-MYC genes FISH probes for cases with cancer cervix or pre-malignant lesions as a sensitive technique. This method provides an easy and effective applicable approach which helps in the diagnosis and prognosis, as an increased copy number is associated with a more advanced grade that could be detected in the early stages of the disease

Screening for diabetes in Kuwait and evaluation of risk scores

This study aimed to develop a simple risk score to identify individuals at high risk for undiagnosed diabetes in the Kuwaiti adult population and to assess the performance of previously published diabetes risk scores. A cross-sectional survey with a sample of 562 Kuwaiti public sector employees was carried out in 2007. Data were collected through a self-administered questionnaire and a blood glucose test. The overall prevalence of diabetes using American Diabetes Association 2003 criteria was 21.4% [4.1% newly detected]. The proposed score had 87% sensitivity and 64% specificity in predicting undetected diabetes using only 4 questions [age, waist circumference, use of blood pressure medication and diabetes in a sibling]. Most previously published risk scores were not applicable to this population

Carditis in experimental trichinosis

Eighty white rats were infected with 1000 larvae of Trichinella spiralis/rat. Serum samples and the hearts of infected animals were taken weekly for 20 weeks after infection. Tissues from the heart were stained with hematoxylin and eosin and Mallory stains to demonstrate histopathological changes and with peroxidase anti- peroxidase for the detection of specific antigen deposition. Early in the disease, myocardial changes were detected. Later on, pericarditis and interstitial myocarditis were found followed by patchy myocardial necrosis and fibrosis. Antigen deposition was demonstrated mainly on sarcolemmal sheath of myocardial muscle fibers and in endothelial cell lining of blood vessels. No larvae were found in heart sections throughout the study. The pathological changes were mainly attributed to the antigen deposition and subsequent immune reaction

Chronic prostatitis, clinical, bacteriologic and histopathologic studies

Sixty two men suffering from symptoms suggestive of chronic prostatitis were evaluated clinically as well as by microscopical and bacteriological examination of expressed prostatic secretion [EPS]. Chronic prostatitis was found in 80.6% in these patients and these patients were further examined with prostatic needle biopsy. Nonbacterial prostatitis was diagnosed in 40 patients while bacterial prostatitis was noted only in 8 patients and prostatodynia was found in two patients. Pain was the most prevalent symptom among chronic prostatitis patients. There was no significant relation between the count of white blood cells in EPS and tenderness of prostate, microbiologic results and histopathological pattern of inflammation. In conclusion, we found that routine prostatic localization studies provided clinically useful information in diagnosis of chronic prostatitis and we do not recommend prostatic needle biopsy for every case of chronic prostatitis

Evaluation of spironolactone treatment in acne vulgaris in females

Acne vulgaris is very common multifactorial disorder involving the pilosebaceous follicles occurring mainly in pubertal and postpubertal period until now it represents a clinical problem in its treatment inspite of recent and different modalities of therapy. Twenty females with acne vulgaris were treated with 100 mg spironolactone per day. Estimation of total serum testosterone [t[and sex hormone binding globulin [SHBG]was done by radioimmunoassay before and after 3 months of spironolactone. Ovarian ultrasound showed polycystic ovaries in 50%of cases 14 patients [70%] showed mild to marked response while 6 patients only showed no response to spironolactone treatment. After spironolactone therapy it was observed that mean serum T level of 14 patients significantly decreased while SHBG and free testosterone index were insignificantly changed after treatment it is concluded that this form of therapy for acne vulgaris, up to the dose used is safe, reliable, and accepted by the patient