Anatomical variations of congenital diaphragmatic hernia during thoracoscopic repair :a two Egyptian centers experience

Background: Congenital diaphragmatic hernia is a major problem in pediatric patients specially neonates with subsequent high morbidity and mortality. Thoracoscopic repair is now being considered the primary choice in management of such patients. The present work aims at evaluating the different anatomical characteristics and variations of congenital diaphragmatic defects during thoracoscopic repair.Methods: Thirty patients with congenital diaphragmatic hernia were included in the study. Thoracoscopic inspection of the defect and its anatomical characters was followed by repair. Data were recorded regarding symptoms, radiological findings, anatomic landmarks and variations during the procedure itself.Results: A higher incidence of congenital diaphragmatic hernia in infantile male population was documented with a higher incidence of left sided defect (96.7%). Postero-lateraldefects were common (86.7%) compared to lateral defect. Hernial sac was absent in 90% of cases. Most of cases had anterolateral muscular rim (86.7%). Liver herniation occurred in only two cases (6.7%). The majority of patients had moderate organ displacement (70%). Thoracoscopic repair was successful in 90% of cases. Primary repair was done in all cases with no need of synthetic patches.Conclusion: The use of thoracoscope helps in creation of a strict phenotyping system that will enhance the ability to predict the clinical course of diaphragmatic defects and will aid in identifying developmental pathways responsible for the disease

Evaluation of glycated albumin to glycated hemoglobin ratio as a predictor for esophageal varices and its risk of bleeding

Background: Variceal hemorrhaging due to portal hypertension is a severe complication of liver cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy [EGD]. The ratio of glycated albumin [GA] to glycated hemoglobin [HbA1c] was reported to increase with the progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is related to the severity and bleeding risk of the varices

Aim of the work: goal of our study was to assess the value of Glycated albumin to Glycated hemoglobin ratio in the prediction of esophageal varices and assessing its risk of bleeding

Methods: We measured the GA/HbA1c ratio of HCV-related cirrhotic patients and analyzed its relationship with the presence and bleeding risk of varices

Results: The GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most significantly different parameter of all the factors examined, including the platelet count, prothrombin activity and albumin level

Conclusion: The GA/HbA1c ratio is increased in patients with varices and with the bleeding risk of the varices

Up-regulation of Hsp72 and keratin16 mediates wound healing in streptozotocin diabetic rats

BACKGROUND: Impaired wound healing is a complication of diabetes and a serious problem in clinical practice. We previously found that whey protein (WP) was able to regulate wound healing normally in streptozotocin (STZ)-dia-betic models. This subsequent study was designed to assess the effect of WP on heat shock protein-72 (Hsp72) and keratin16 (Krt16) expression during wound healing in diabetic rats. METHODS: WP at a dosage of 100 mg/kg of body weight was orally administered daily to wounded normal and STZ-diabetic rats for 8 days. RESULTS: At day 4, the WP-treated diabetic wound was significantly reduced compared to that in the corresponding control. Diabetic wounded rats developed severe inflammatory infiltration and moderate capillary dilatation and regeneration. Treated rats had mild necrotic formation, moderate infiltration, moderate to severe capillary dilatation and regeneration, in addition to moderate epidermal formation. Hsp72 and Krt16 densities showed low and dense activity in diabetic wounded and diabetic wounded treated groups, respectively. At day 8, WP-treatment of diabetic wounded animals revealed great amelioration with complete recovery and closure of the wound. Reactivity of Hsp72 and Krt16 was reversed, showing dense and low, or medium and low, activity in the diabetic wounded and diabetic wounded treated groups, respectively. Hsp72 expression in the pancreas was found to show dense reactivity with WP-treated diabetic wound rats. CONCLUSION: This data provides evidence for the potential impact of WP in the up-regulation of Hsp72 and Krt16 in T1D, resulting in an improved wound healing process in diabetic models.

Nanoparticles improved drug radio protective activity.

Radioprotective agents are synthetic compounds or natural products that are immediately administrated before irradiation to reduce injuries caused by ionizing radiation. Toxicity, short duration, and the unfavorable routes of administration, have prevented the widespread use of most radioprotective agents in practice. This study aimed to evaluate the use of slowly release- long circulation biodegradable polymer Poly(lactide-co-glycolide) (PLGA) as carrier for certain water-soluble radioprotective agents. Penicillamine and Potassium Iodide (KI) were selected as examples of radioprotectors which can be used to protect against both internal radionuclide (chronic radiation exposure) and external-beam irradiation (acute radiation exposure). Emulsion-solvent evaporation method (ESE) was used to prepare hydrophilic-drug loaded PLGA Nanoparticles (PLGA- NPs) in an efficient and reproducible manner. The radioprotective efficacy was assessed by 30 days-survival percentage, relative body weights, and (liver & spleen) total cell counts. Results revealed that single oral administration of Penicillamine-NPs or KINPs was effective as free drug (for 5 successive days) which indicate that PLGA-NPs could be used to modulate radioprotective drug activity in biological system, and to improve drug efficacy in different body organs for longer duration than the equal dose of free drug.

possible role of serum prolactin analysis in diagnosis of multiple sclerosis

Prolactin [PRL] belongs to the growth and lactogenic hormone family and has potent immunomodulating properties. Mild hyperprolactinemia has been found to enhance several autoimmune diseases and increased PRL plasma levels have been described in multiple sclerosis [MS]. As studies of PRL serum levels in MS patients have led to conflicting results we tried in this study to clarify the question of prolactin alterations in MS. We correlated serum PRL baseline value in 15 MS patients with disease course, activity and clinical severity compared with 20 sex and age- matched healthy controls. We excluded conditions leading to rise in PRL; such as pregnancy and lactation. Serum PRL levels were measured in fasting blood samples. We recorded the duration, subtypes, clinical manifestation and the expanded disability status score [EDSS] for each case of the MS patients. There was a statistically significant difference between patients and control groups. There was a high percentage of subjects with elevated PRL levels among the patient group[20%] [p=0.036*]. There was no statistical significant relationship between the patients with elevated serum PRL levels and the duration, activity and EDSS of the disease. The results were discussed from the fact that PRL does not seem to be relevant as an activity marker in whole MS patients. It is not clear whether PRL is primarily involved in the pathogenesis of MS or just exists as a secondary phenomenon depending on the localization of MS plaques

Progressive ischemic cerebrovascular stroke: frequency and predictive factors

To determine the frequency of progression in patients with ischemic stroke and to identify clinical, laboratory and radiological factors that could lead its to early prediction. Two hundred patients with ischemic stroke presented within 24 hours from onset of symptoms were included in the study. They were 121 males and 79 females with mean age [60.5 +/- 11.2] years. The following predictors were assessed: clinical predictors: age, sex, TIA, cardiac disease, diabetes mellitus, hypertension, cigarette smoking, time to admission, Glasgow coma scale, systolic and diastolic blood pressure and body temperature. Laboratory predictors: random and fasting blood sugar, prothrombin time, partial thromboplastin time, liver enzymes, serum creatinine, erythrocyte sedimentation rate, serum cholesterol, high and low density lipoprotein, C-reactive protein and serum ferritin. Radiological predictors: early focal hypodensity and initial mass effect in admission CT brain scan and site and size of infarction, mass effect and hemorrhagic infarction in follow up CT scan [7days]. Neurological deficits were assessed by Scandinavian Stroke Scale on admission, 24 hours and 7 days after admission to diagnose progressive stroke. Early progressive stroke was considered when progression occurred within 24 hours after admission. Late progressive stroke was considered when progression occurred between 24 hours and 7 days. The frequency of progressive stroke was 20% [13% early progression and 7% late progression]. History of hypertension, high systolic and diastolic blood pressure, low Glasgow coma scale, short time to admission, elevated serum glucose, cholesterol, C-reactive protein and ferritin, early focal hypodensity in the initial CT and cortico-subcortical and medium size infarction in follow up CT were significantly frequent in patients with progressive stroke. Admission hyperglycemia and high ferritin level were significantly frequent in early progressive stroke patients, while high serum C-reactive protein and cholesterol levels and were significantly frequent in late progressive stroke patients

Effect of triple therapy for helicobacter pylori eradication on hepatic encephalopathy: a randomized controlled trial

Helicobacter pylori [H. pylori] infection could potentially contribute to the development and severity of hepatic encephalopathy due to strong urease activity in the stomach of H. pylori infected cirrhotic patients. To assess the effect of triple eradication therapy for H. pylori on hepatic encephalopathy. Open randomized controlled clinical trial with 4 arms. liver diseases unit in Suez Canal University Hospital - tertiary care. Forty four Hp+ [Group 1] and 44 Hp- patients [Group 2] [based on rapid urease test of gastric biopsy] with hepatic encephalopathy grade 1 - 3. Triple eradication therapy for H. pylori versus standard treatment for hepatic encephalopathy in group 1 and antimicrobial therapy [without Omeprazole] versus standard treatment in group 2 for 14 days. Blind assessment of the grade of encephalopathy before and within three days from end of treatment. One grade improvement was considered treatment success. Success rate was 18.2% in standard treatment and 63.6% in triple therapy [p< 0.001] in H pylori positive. While in H. pylori negative patients the success was 9.1% in standard treatment versus 59.1% [P< 0.001] in and antimicrobial therapy. Success rate was not significantly different between standard treatment or between triple therapy and antimicrobial therapy among both groups. Among other factors in logistic regression models both triple therapy [OR: 1.03<6.22<37.69, P= 0.047] and antimicrobial therapy [OR: 2.09<11.42<59.46, P= 0.02] were significant predictors of success in the respective groups. Both triple eradication therapy for H. pylori and antimicrobial therapy only, equally improve the outcome of management of hepatic encephalopathy. The improvement may be attributed to the effect of antimicrobial therapy on ammonia producing gut flora rather than H. pylori eradication. H pylori eradication therapy adds no benefit in hepatic encephalopathy

Dementia in Ismailia governorate: an epidemiological study

This cross sectional study was done to determine prevalence rate and demographics of dementia in the Ismailia Governorate. The study include 1000 persons over the age of sixty years [500 in a rural area and 500 in and urban area]. Mini mental state examination test was used as initial screening tool to pick up demented subjects who scored less than 24 points out of 30 [for literates] or scored less than 22 points out of 28 [for illiterates]. All demented subjects were subjected to full physical and neurological examination and computed tomographic brain scan. Prevalence of dementia among elderly over 60 years of age was 3.8 [2.5% vascular dementia and 0.8% Alzheimer's disease]. The mean age of demented subjects was 68.8 + 6.7 years. Dementia was significantly associated with age. Prevalence of dementia among age group of 60-64 years was 2.1%. while it was 30% among age group? 80 years. Vascular dementia was the most common type of dementia [65.8% of demented subjects] and its highest incidence was among the age group of 60-64 years old. Alzheimer's disease was the second most common type [21.1% of demented subjects] and its highest incidence was among the age group of 75-79 years old. Hypertension, diabetes mellitus and smoking and smoking were significantly associated with vascular dementia. No significant differences were found among demented subjects according to areas, gender and literacy