Study of serum osteoprotegrin [OPG], tumor necrosis factor-related apoptosis-inducing ligand [Trail] and fetuin-A in patients with chronic renal failure

Vascular and valvular calcifications are strong prognostic markers of cardiovascular disease mortality in chronic kidney disease [CKD] patients especially those on hemodialysis. It has been demonstrated that CKD patients with osteodystrophy have increased atherosclerosis and, more recently, increased coronary artery calcification. Was to evaluate the link between renal failure, atherosclerosis, vascular calcification and inflammation by determining the role of serum osteoprotegrin [OPG], tumor necrosis factor-related apoptosis-inducing ligand [TRAIL], and Fetuin A in the development of vascular calcification in patients with End stage renal failure disease [ESRD]. The study included, thirty patients on maintenance hemodialysis [HD] and fifteen patients with conservatively managed chronic renal failure [CRF] for whom dialysis was not performed. Both groups were compared to fifteen age and sex matched healthy individuals who constituted the control group. To all the subjects clinical examination, and 12 lead electro-cardiography were done. To all subjects the following investigations were performed: routine biochemical analysis, serum OPG, Fetuin A and plasma TRAIL Also serum parathyroid hormone [PTH], Calcium [total and ionized], phosphorus [Ph], and C- reactive protein [CRP] were measured. Finaly carotid ultra sonography of the pelvis and hand, and calculation of vascular calcification score were done. Carotid intima media thickness [CIMT] was found to be significantly higher in both undialyzed [CRF] patients and dialyzed [HD] patients when compared to controls [p<0.001 leach]. Also the difference between both groups of patients was statistically significant [p: 0.014]. Calcification score was found to be significantly higher in CRF and HD patients when compared to controls [p: 0.047 and < 0.001 respectively] Serum OPG level was significantly higher in both undialyzed CRF and dialyzed HD patients when compared to the control group [p: 0.041 and < 0.001 respectively].The level was also found to be significantly higher in the HD group when compared to CRF patients [p< 0.001]. Serum fetuin A level was found to be significantly lower in both CRF and HD patients when compared to the control group [p: 0.02, 0.05 respectively]. As regards TRAIL levels, no significant difference was found between the three studied groups. The level of the PTH was significantly higher in CRF undialyzed and HD patients when compared to control group [p: 0.021 and < 0.001 respectively]. CRP level was significantly higher in both patients groups when compared to controls [p< 0.001, 0.04 respectively].In the total patients group: there was a positive significant correlation between VC score and both PTH and AP. There was a positive significant correlation between OPG and [CIMT, Fetuin, AP and total Ca]. There was also a positive significant correlation between Fetuin A and both TRAIL and Albumin. By performing multiple logistic regression, only serum PTH was significant independent predictor of vascular calcification [p=0.006] and serum OPG was significant independent predictor of inflammation. [p=0.029]. The only parameter with significant ROC curve was PTH. It could be finally concluded that the increased level of OPG in CRF and HD patients might be a compensatory self defensive response against other factors that promote vascular calcification, or may possess potentially damaging properties, while the decreased level of Fetuin A reflects an inadequate response against the development of VC. Also the increase level of CRP denotes an ongoing inflammatory state and this causes down regulation of fetuin A which may represent the essential link between chronic inflammation and vascular calcification. PTH was found to be the best diagnostic marker of VC of all studied parameters, and was also the most independent predictor of VC, while OPG was the most independent predictor of inflammation

Efficacy and safety of sevelamer. Comparison with calcium carbonate in thereatment of hyperphosphatemia in hemodialysis patients

Current phosphate binders used in hemodialysis patients include calcium-based binders that result in frequent hypercalcemia. The use of a calcium- and aluminum-free phosphate-binding polymer in hemodialysis [sevelamer] disclosed efficacy in the short and long-term studies. However, due to race differences we performed a short-term study on the Saudi hemodialysis patients and compared sevelamer with a standard calcium-based phosphate binder. An open-label, randomized, cross-over study was performed to evaluate the safety and effectiveness of sevelamer hydrochloride in controlling hyperphosphatemia in hemodialysis patients. After a 2-week phosphate binder washout period, stable hemodialysis patients were given either sevelamer or calcium carbonate, and the dosages were titrated to achieve phosphate control over an 8-week period. After a 2-week washout period, patients crossed over to the alternate agent for 8 weeks. Twenty patients from the Dialysis Unit of King Fahd Hospital, Jeddah, Kingdom of Saudi Arabia, were recruited for the study between March 2003 and June 2003. There was a similar decrease in serum phosphate values over the course of the study with both sevelamer [-3.3 +/- 2.2 mg/dL] and calcium carbonate [-3.9 +/- 2.8 mg/dL]. Fifty-two% of patients developed serum calcium greater than 2.75 mmol/L [11.0 mg/dL] while receiving calcium carbonate versus 26% of patients receiving sevelamer [p<0.05]. The incidence of hypercalcemia for sevelamer was not different from the incidence of hypercalcemia during the washout period. Patients treated with sevelamer also sustained a 13% mean decrease in serum cholesterol levels. Sevelamer was effective in controlling hyperphosphatemia without resulting in an increase in the incidence of hypercalcemia seen with calcium carbonate. This agent appears quite effective in the treatment of hyperphosphatemia in hemodialysis patients, and its usage may be advantageous in the treatment of dialysis patients

Cephalometric evaluation of different methods for recording denture position

In the follow up studies, it was recommended to use cephalometric X-ray technique to study the changes of denture position. It was advised, according to the results, to follow the light contact condition technique in keeping the upper denture in place during successive exposures

Fibrinolytic activity in varicella

This study included 22 children with varicella without haemorrhagic manifestations [group IIA] and 8 cases with haemorrhagic manifestations [group IIB]; in addition to 10 normal children [group I] as controls. The present work showed that bleeding time was prolonged in both varicella groups and coagulation time showed no significant change between both varicella groups and control group. Platelet count showed marked decrease in both varicella groups especially group [IIB]. The present work also showed increased fibrinolytic activity in varicella group with haemorrhagic manifestation as evidenced by the presence of fibrin degradation products in 100% of the cases in group [IIB] and 9% of the cases in group [IIA]. Also, euglobulin lysis time was shortened in group [IIB] and was within normal in group [IIA]. Antithrombin III showed marked decrease in group [IIB] and was within normal in group [IIA]. Serum alpha-1-antitrypsin showed significant increase in both varicella groups. Serum alpha-2macroglobin showed significant increase in group [IIA] and no changes in group [IIB]

problem of mandibular resection in intraoral tumours

A total of 50 patients with intra-oral carcinomas were examined and treated at the N.C.I. during the period 1979 - 1980. All these cases were treated surgically by traditional Commando's operation. The mandibular bone, its covering periosteum and neurovascular bundle were examined separatly. The study showed that 56% of the cases, under went bone resection without actual malignant invasion i.e the bone could be spared. This work stresses the fact that conservative mandibular resection can be done safely so long as there is normal tissue clearance even a few milimeters between tumour, bone and a negative X-ray results preopratively. This gives the patients a good functional and cosmetic results

comparative study of ileal loop conduit and rectosigmoid bladder as methods of urine diversion after radical cystectomy for bilharzial cancer bladder

A prospective study including 177 patients with T[2] and T[3] bilharzial cancer bladder for whom radical cystectomy was done, followed by rectal bladder for 115 patients and ileal loop conduit for 62 patients. Per-operative blood loss averaged 1500 cc in rectal bladder and 1800 c.c. in ileal loop conduit. Post-operative morbidity and mortality were higher after ileal loop conduit than after a rectal bladder diversion. The renal function studies showed no superiority of one method over the other. But evaluation of the bladder substitute showed that the rectal bladder was mere suitable for our patients as it acted as a reservoir which can hold up to 700 c.c. of urine with a frequency of evacuation every 4-6 hours and diurnal and nocturnal continence in 24% of cases, diurnal continence in 66%, and incontinence in the remaining. 10% of cases

Effect of gastro-oes ophageal decognestion "Hassab's operation" on liver functions in patients with hepatic schistosomiasis and ascites

A battery of liver function tests including estimations of serum bilirubin, turbidity tests, serum protein, prothrombin activity, serum alkaline phosphatase and transaminase, was done before and after Hassab's decongestion operation in twelve male hepatic schistosomiasis patients with resistant ascites. Decrease of zinc sulphate turbidity, serum enzymes, total globulins together with increase of serum albumin and prothrombin activity was recorded after operation. Improvement of hepatic and intestinal blood flow, splenectomy, amelioration of hepatic functions and renal haemodynamics are supposed to be underlying factors