Choroidal thickness in patients with diabetic macular edema and its correlation to macular thickness and vision

Purpose: To investigate the relationship between subfoveal choroidal thickness, central macular thickness, visual acuity and the presence of diabetic macular edema [DME] using spectral domain optical coherence tomography [SD-OCT]

Methods:A prospective, nonrandomized case control study of 124 eyes was included in the study and divided into three groups: Group I: 56 eyes having NPDR without macular edema, Group II: 27 eyes having NPDR with DME, Group III: 41 eyes of normal healthy subjects. Central macular thickness [CMT] and subfoveal choroidal thickness [SFCT] were measured on the OCT images and statistically compared. Pearson correlation analysis used to evaluate the relationships between choroidal thickness, macular thickness and visual acuity

Results: A total of 124 eyes of 76 patients; mean age 52.56 +/-8.91years were included in the study. Mean bestcorrected visual acuity LogMAR was better in the control group [0.20 +/- 0.40] than diabetic groups [0.42 +/- 0.40 in group I, 0.80 +/- 0.45 in group II] and the difference was significant among the groups [P= 0.01]. Mean CMT was thicker in DME group [374.63microm +/- 105.43] than the other 2 groups [246.66+/- 24.85 microm in group I, 227.05 microm +/- 21.97 in group III] and the difference was significant among the groups [P= 0.00]. Mean SFCT was thinner in DME group [234.93 microm +/- 42.68] than d the other 2 groups [246.41 microm +/- 44.37 in group I, 250.20 microm +/- 53.10 in group III] but the difference was not statistically significant [P= 0.41]. A significant correlation was found between LogMAR and CMT in group II [r=0.391, P=0.044] indicating that the vision may decrease as the central macular thickness increases in diabetic groups. A weak inverse correlation was found between LogMAR and SFCT in all groups indicating that the vision may decrease as the choroidal thickness decrease. A weak negative correlation was found between CMT and SFCT in diabetic groups [r=-0.142 in group I, r=-0.152 in group II] indicating that the choroidal thickness may decrease as the central retinal thickness increases in diabetic groups

Conclusion: In diabetic eyes, there is an overall thinning of the choroid. SFCT is directly related to vision and macular thickness

Accuracy of the SRK/T formula using partial coherence interferometer, AL-scan after phacoemulsification

Purpose: To evaluate the accuracy of SRK/T formula used for IOL power calculation by partial coherence interferometer in patients undergoing phacoemulsification surgery

Patients and methods: A prospective interventional clinical study included 40 eyes of 34 patients who underwent uncomplicated phacoemulsification with IOL implantation from March 2015 to March 2017. Biometries were measured using ultrasound or AL-scan and intraocular lens power was calculated using the SRK-T formula. Patients were divided into 2 groups based on device used for IOL power calculation: ALscan or ultrasound ; Axial length: >=25 mm or < 25mm; or lens opacity: Cataractous or clear lens. The mean error [ME] was calculated from the difference between the formula predicted refractive error and the actual post operative refractive error by the end of the followup [3 months postoperative]

Results: Mean axial length measured preoperatively was 27.47 +/- 316mm [21.55-34.05] mm. 60 percent of the patients were within 0.5 D of the predicted refractive error and 90 percent were within 1.0 D. There was no statistically significant difference in the overall performance of the SRK/T formula between the mean error when dividing the patients into 2 groups according to: device used for IOL power calculation [P= 0.274]; Axial length [P= 0.46]; or lens opacity [P= 0.18] in precision of predicting postoperative refraction

Conclusions : SRK/T formula helps in improvement of the accuracy of IOL power calculation and decreasing the postoperative refractive error. By using SRK/T formula, there was no statistically significant difference between the AL-scan or applanation ultrasound used in biometry

role of impulse oscillometry in assessment of airway obstruction in smokers and ex-smokers

Impulse oscillometry provides useful clinical information that prominently includes functional assessment of small, peripheral airway behavior beyond that available from commonly used pulmonary function tests [PFT]. The aim of this study was to assess the role of impulse oscillometry in assessment of airway obstruction in smokers and ex-smokers. Sixty subjects divided into three groups [asymptomatic smokers, ex-smokers and non smoker healthy subjects as a controls] all were assessed by spirometry and IOS. Based on the IOS results in smokers, there was 17 negative cases and only 3 diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was only 33% as it was able to detect one diseased case from a total of three cases .In ex-smokers, there was 13 negative cases and only 7 diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was only 42.8% as it was able to detect 3 diseased case from a total of 7 cases. In controls, there was 18 negative cases and two diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was 50% as it was able to detect 1 diseased case from a total of 2 cases. IOS is an effective, easy to perform, and a non invasive method for the assessment of airway obstruction in obstructive pulmonary disorders. Although, there is no significant difference between impulse oscillometry and spirometry parameters in early detection of airway obstruction in smokers and ex-smokers groups

Relation between postmenopausal histological changes in the human iliac bone and osteoprotegerin protein expression

Postinenopausal bone resorption is influenced by a variety of factors that result in increased activation of osteoclasts. Osteoblasts were reported to secrete an osteoclast inhibiting protein named osteoprotegerin and this secretion was found to be influenced by the estrogen hormone level. So, the aim of this study was to investigate osteoprotegerin protein expression in human female bone and assess its relation to structural bone changes occurring after menopause. This study was conducted on 34 specimens from the iliac crest of female subjects undergoing bone grafts after taking their consent. They were divided into 3 groups. Females of group. I were in the premenopausal period. Those of group II were um the early postmenopausal period while those of group ill were in the late postmenopausal period. Osteoprotegerin protein expression was seen mainly in the cytoplasm of osteogenic cells and osteoblasts lining the bone trabeculae of the iliac crests. This expression was significantly higher in the premenopausal women as compared to both postmenopausal groups with no significant difference between early and late postmenopausal groups. Specimens taken from postmenopausal women showed significant decrease in the trabecular thickness together with significant increase in the trabecular separation and eroded surface. These changes were more prominent In late postmenopause. There was a significant positive correlation between osteoprotegerin expression amid serum estradiol, bone volume and trabecular thickness. Meanwhile, there was a significant negative correlation between osteoprotegerin protein expression and trabecular separation and eroded surface. It was concluded that decrement of osteoprotegerin plays an important role in the pathogenesis of postmenopausal osteoporosis and it is recommended to use osteoprotegerin in future therapeutic interventions in osteoporosis

Non invasive assessment of renal failure: comparison between the different available techniques to discriminate different causes of acute renal failure [ARF] from chronic renal failure [CRF] with normal kidney size

Forty-one uremic cases presenting to the emergency of nephrology section and 10 normal control subjects [N] were assessed clinically and biochemically [serum levels of urea, creatinine, uric acid, sodium, potassium, calcium and phosphorus and estimation of FENa] by abdominal ultrasonography, color Doppler of renal arteries and static [DMSA] and dynamic [DTPA] renal scintigraphy. Clinical assessment, follow up and/or renal biopsy showed that uremic cases had ARF due to acute tubular necrosis [ATN] in 16, obstructive uropathy[OBST] in 12 and CRF in 13. ATN showed very high FENa [17.7 +/- 10.5% vs 0.69 +/- 0.19, 13.4 +/- 12.9 and 10.1 +/- 5.6 in ATN, N, OBST and CRF cases, respectively], normal DTPA perfusion with poor DTPA accumulation, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. OBST showed pelvic caliectasis by US, impaired DMSA uptake, impaired DTPA perfusion with fair DTPA accumulation, rising renogram during the excretory phase with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. CRF had very high resistivity indices, impaired DTPA perfusion and accumulation with poor excretion, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. Follow up of ATN and OBST cases showed incomplete normalization of US, D and [DTPA] renal scintigraphy in spite of clinical and chemical recovery. The study concluded that the most reliable noninvasive tool in discriminating cases presenting acutely with uremia is radioisotopic static [DMSA] and dynamic [DTPA] renal scintigraphy. Moreover, clinical, biochemical, ultrasonographic and Doppler studies are neither specific nor sensitive tools in such field. Also, the kidneys did not usually recover completely after ARE

T-cell function in long term haemodialysis patients: impact of secondary hyperparathyroidism, oral one alpha calcidol and dialysis duration

The aim of this work was to study T-lymphocyte function in relation to secondary hyperparathyroidism, oral one alpha-calcidol treatment and dialysis duration. Eighty chronic renal failure patients who were maintained on regular haemodialysis treatment for 6-144 months [CRF] and 20 normal control subjects [N] were studied. Cases known to have autoimmune diseases, other diseases, which would affect the immune system or receiving medications known to affect immunity were excluded. CRF cases were 45 males and 35 females and their age was 43.06 +/- 11.1 years, while N cases were 12 males and 8 females and their age was 35.6 +/- 9.79 years. A11 CRF cases were receiving 1-alpha-calcidol orally as 1 mug/day for at least 3 months before the study onset. CRF and N cases were clinically examined and were tested for serum urea and creatinine, serum calcium and phosphorus, serum level of intact parathormone [RIA] beside the in vitro assessment of lymphoblastoid transformation of peripheral blood lymphocytes with and without phytohaemagglutinin [PHA] stimulation. The serum level of intact parathormone varied significantly among CRF cases; it was < 40 pg/ml in 13 [CRF1], 40-80 in 14 [CRF2] and > 80 in 53 [CRF3]. Among these 3 subgroups, pre-activation of T-lymphocytes was significantly higher in CRF3 [28 +/- 3.94 vs. 33.7 +/- 5.44 vs. 37.36 +/- 3.58% in CRF1, 2, 3 respectively],while PHA induced T-cell proliferation was significantly higher in CRF1 [77.54 +/- 3.97 vs. 73.7 +/- 4.83 vs. 59.9 +/- 7.37% in CRF1, 2, 3, respectively]. Duration of dialysis [DX] was significantly shorter in CRF1 [15.6 +/- 5.94 vs. 33.57 +/- 11.9 vs. 79.7 +/- 30.2 months in CRF1, 2, 3, respectively]. There was no significant difference between the 3 subgroups in dose or duration of 1-alpha-calcidol treatment. CRF1 had significantly higher s-phosphorus and s-PTH, significantly lower PHA induced T-cell proliferation and insignificant difference in serum calcium and T-lymphocytes pre-activation when compared to N [5.32 +/- 0.41 vs. 3.39 +/- 0.64 mg%, 30.08 +/- 4.89 vs. 19 +/- 4.57 pg/ml, 77.54 +/- 3.97 vs. 84.8 +/- 2.8%, 9.73 +/- 1.07 vs. 9.92 +/- 0.48 mg% and 28 +/- 3.94 vs. 29.2 +/- 4.73%,respectively]. DX had a significantly +ve correlation with either PTH level or T-lymphocytes pre-activation and a significantly -ve correlation with PHA induced T-cell proliferation. PTH had a significantly +ve correlation with T-lymphocytes pre-activation and a significantly -ve correlation with PHA induced T-cell proliferation. The study concluded that increased DX duration is responsible for: Significant increase in s-PTH; increased resistance of parathyroid to suppression by 1-alpha-calcidol and progressive deterioration of T-cell function as proved by increased T-lymphocytes pre-activation and decreased PHA induced T-cell proliferation

Bronchial mucosal changes in patients with chronic hepatitis C virus infection

Hepatitis C virus [HCV], being both a hepatotropic and lymphotropic virus represents a chronic stimulus for the immune system. So, various extra hepatic immunologic abnormalities have been shown to occur frequently in patients with chronic hepatitis C virus. Among the systemic manifestations of chronic HCV infection, lung involvement has been described. Also the possibility that HCV infects extra hepatic cells has been widely discussed. So we aimed in this study to detect HCV antigen in the bronchial mucosa and broncho-alveolar lavage [BAL]. Together with, the study of histopathological changes in the bronchial biopsy and the cellular content of the BAL in patients with chronic HCV infection.Our study included 50 patients suffering from chronic liver disease due to Hepatitis C virus infection complaining of recurrent cough with negative clinical chest finding and normal X-ray chest.The patients were subdivided into: three groups according to Child-pugh classification.Bronchoalveolar lavage and bronchial biopsy were obtained through the use of fibre optic bronchoscopy. And detection of HCV antigen in the BAL and biopsy using immunohistochemistry was done. Alsostudy of the histopathological changes of bronchial biopsy and lavage were performed

In our results, HCV in bronchial biopsy and BAL fluid was detected in 42% [21/50] of our patients. And BAL showed increase in the neutrophils and lymphocytes percentage especially in patients in group II "Child B".Pulmonary permeability is mostly affected in cases of HCV infection, noticed by increase of the albumin level in the BAL of patient of Child "C" [group III]. Also Variable degrees of pathological changes have been noticed in the bronchial mucosa of the patients. These variations are affected by the severity of liver disease.So we conclude that the presence of inflammatory cell infiltration together with pathological changes of the bronchial mucosa may induce bronchial inflammation as a sequel of HCV infection which could explain the occurrence of the recurrent cough in our patients, and may lead to progressive fibrosingalveolitis

Neuropeptide Y: a modulator of apoptosis in systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is a multisystem disease characterized by the production of pathological autoantibodies and altered humoral and cellular immune responses. The death receptor Fas is known to induce apoptosis upon interaction with its ligand with consequent activation of caspases and is reported to have an important role in the pathogenesis of SLE. Recently, it has been reported that the nervous system interacts with and directly modulates the immune response through the production of certain neuropeptides as neuropeptide Y [NPY]. To assess the serum level of NPY in SLE patients and to investigate its correlation with the activity of the disease, the level of Fas expression on mononuclear cells and the incidence of apoptosis in SLE patients. The study was conducted on 20 SLE patients and 10 healthy controls. Fas expression was assessed with flow cytometry using mouse antihuman FITC conjugated anti-CD95. The% of apoptotic cells was assessed after cell culture with flow cytometry using propidium iodide staining. NPY was assessed with competitive radioimmunoassay kit for both patients and controls. Both Fas and NPY levels were found to be significantly elevated in SLE as compared with healthy controls [p< 0.01]. Moreover, both levels were found to correlate significantly with the activity score of the disease and with each other. However, despite the elevated Fas expression, the% of apoptotic cells are not significantly increased in SLE compared to healthy controls. Fas expression could be considered a marker of lymphocyte activation in SLE. The presence of high levels of neuropeptides as NPY reflects the link between nervous and immune system. NPY could play an important role as endogenous modulator of the immune response in SLE probably through their inhibiting effect on Fas ligand expression and so switch the lymphocytes to an apoptosis resistant phenotype, which could lead to the activation of autoreactive cells. Thus neuropeptide Y may play an important role in the pathogenesis of SLE

Tibial somatosensory evoked potentials as a new prognostic tool for predicting functional ambulation outcome in acute traumatic paraplegia

The study included 20 patients with post- traumatic paraplegia or paraparesis due to acute spinal cord injury with onset 72 hours to 2 weeks after trauma. Ten normal subjects of both sexes served as control. Aim of this work is to assess the efficacy and accuracy of tibial SEP as a prognostic ambulatory tool compared to clinical and radiological tools in acute paraplegic spinal cord injured individuals in order to efficiently plan the rehabilitation program. Patients underwent full medical history, thorough clinical and neurological examination according to the standards of ASIA [American Spinal Injury Association], radiological examination by X-ray, CT and/or MRI. SEP for both tibial nerves. All patients received complete rehabilitation program according to the stage of SCI. Neurological status and tibial SEP were assessed again after 12 months. Barthel score was used to grade functional outcome with assessment of ambulation status. The study revealed that 65% of patients were able to ambulate in the community at 1 year while 35% were non-ambulant at all. The initial Lower Extremity Motor Score [LEMS], pin prick sensory limb scores and tibial SEP were highly significantly correlated to the degree of ambulatory capacity finally achieved, while there was non-significant relation between the initial sense of position or CT grade with final ambulatory outcome

Neurophysiological profile of auditory neuropathy

Fifteen patients with auditory neuropathy were investigated for central and/ or peripheral nerve affection. Diagnosis of auditory neuropathy was based on the presence of hearing loss with disproportionate speech discrimination, normal transient otoacoustic emissions [TEOAEs] and absent or abnormal auditory brainstem response [ABR]. Neurological examination and electrophysiological testing of the median, ulnar, tibial, peroneal and sural nerves were performed for all patients. Ten normal subjects, matched in age and gender, served as a control group. The results revealed that all patients showed electrophysiological abnormalities either peripheral, central or combined. We conclude that auditory neuropathy is not an isolated disorder but rather part of generalized neuropathy

Enhanced fracture healing with pulsed electromagnetic field

Our study was designed to examine the effect of pulsed electromagnetic field [PEMF], capacitative technique, on the healing of fractures at different stages. Forty-four patients were included in the study. They were divided into three groups. The first group comprised twenty-three patients who were subjected to PEMF after application of plaster cast [early treatment group]. The second included six patients who received PEMF after removal of the cast at 8 weeks [late treatment group]. The third group comprised fifteen patients who were only treated with fixation in plaster cast and served as a control group. The three groups were investigated using cross-sectional osteocalcin level at the start and at 8 and 12 weeks. Plain x-rays were done every 2 weeks and bone mineral density [BMD] was assessed with the quantitative CT of periosteal callus and expressed as F [fracture] / N [normal]% at 8 and 12 weeks. Laboratory and radiological data were statistically analyzed. We concluded that PEMF accelerates bone healing as there was a statistically significant difference in osteocalcin level between early treated patients and controls at 8 weeks and a highly significant difference at 12 weeks for patients who continued treatment. Late treatment patients were found to have increased osteocalcin level too. Radiological results confirmed the laboratory results for the positive effect of PEMF on bone healing. We recommend the use of PEMF for enhancement of fracture healing in cases of delayed union and in old age