Prevalence of Plateau Iris in Primary Angle Closure Glaucoma: An Egyptian Hospital Based Ultrasound Biomicroscopy Study.

PURPOSE: To determine the distribution and the anatomical characteristics of plateau iris (PI) in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). METHODS: Fifty UBM images of PACG cases were studied over one year by retrospective analysis. The data from UBM images including angle opening distance at 500 and 750 µm (AOD500 and AOD750), trabecular-iris angle (TIA), angle recess area at 750 µm (ARA750), maximum ciliary body thickness (CBTmax), anterior placement of ciliary processes (APCP), central anterior chamber depth (CACD), axial lens thickness (ALT), and ciliary sulcus status were analyzed and compared between the PI and non-PI cases. RESULTS: Eighteen cases had PI (36%). The mean AOD500, AOD750, and TIA were significantly smaller in PI than in non-PI eyes (P = 0.01; P = 0.046; and P = 0.026). Values of the ARA750 and CBTmax were not significantly different between the two groups (P = 0.208 and P = 0.368). CACD was deeper in the PI group (P = 0.011). ALT was higher in the non-PI group (P = 0.001). The mean APCP of the PI group was more than those of the non-PI group (P < 0.001). The number of cases with obliterated ciliary sulcus in more than two quadrants was significantly more in the PI group (P < 0.001). CONCLUSION: Around one-third of PACG eyes were found to have PI on UBM imaging. The number of obliterated ciliary sulcus and APCP were important UBM parameters that help in PI diagnosis.

Multiple infections with hepatitis A virus and development of rheumatoid arthritis among waste water treatment plant workers.

INTRODUCTION: In the present work, we studied the association between multiple exposure of waste water treatment plant workers to infection with existing hepatitis A virus in waste water and development of rheumatoid arthritis, taking in consideration number of working years as an indicator for frequency of exposure to infection, compared to non waste water treatment plant workers. METHODOLOGY: A total of 105 waste water treatment plant workers and 48 NWWTPWs were included in the study. Exclusion criteria were positivity for HBV and/or HCV IgG, negativity to HAV IgG and suffering from rheumatic diseases other than rheumatoid arthritis. RESULTS: 96.2% of waste water treatment plant workers were anti-HAV-IgG positive, of whom 5 had high antibody titer indicating ongoing infection and were anti-HAV-IgM negative excluding primary infection. These 5 samples were further subjected to quantification of liver enzymes, glutamate oxaloacetate trasaminase and glutamate pyruvate transaminase and HAV-RT-PCR to check viremia and results showed increase of glutamate oxaloacetate trasaminase and glutamate pyruvate transaminase as well as viremea in all of them. Rheumatoid arthritis diagnosis was carried out by detection of C-reactive protein, rheumatoid factor and anti-cyclic citrullinated protein. Rheumatoid arthritis development was 19% in the waste water treatment plant workers with >10 working years and 8% for < 10 working years. Also, disease development started earlier (Age 30-40 years) among the waste water treatment plant workers compared to non waste water treatment plant workers (age: 40-50 years). CONCLUSIONS: Multiple exposures of waste water treatment plant workers to HAV might be one of the etiological stimuli of rheumatoid arthritis.

iStent versus iStent inject implantation combined with phacoemulsification in open angle glaucoma.

PURPOSE: To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification. METHODS: This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure. RESULTS: One hundred ninety-seven eyes of 148 patients were included (122 iStent, 75 iStent inject). Both groups achieved significant IOP and medication reduction at months 6/12 (P < 0.05). At month 6, IOP was significantly lower in iStent inject vs. iStent eyes (P = 0.003), but the difference was insignificant by month 12 (P = 0.172). Medication number was comparable in both groups at months 6/12 (P > 0.05). More iStent inject eyes achieved IOP ≤15 mmHg at month 6 (P = 0.003) and 12 (P = 0.047). Surgical success was comparable in both groups at months 6/12 (P > 0.05). Kaplan-Meier survival analysis showed similar cumulative rate of surgical failure at year-1 in both groups (P = 0.644). The multivariate model identified older age (P = 0.017) and lower baseline IOP (P = 0.002) as the strongest predictors of surgical failure. CONCLUSION: Compared to iStent, iStent inject achieved lower IOP at month 6 and higher proportion of eyes achieved IOP ≤15 mmHg at month 6/12. However, surgical success was similar in both groups. Predictors of surgical failure were older age and lower baseline IOP rather than the stent type.

Diagnotic value of some Fasciola gigantica antigens.

The present study was aimed to select the specificity of antigens for Fasciola gigantica depending on its diagnostic utility and field applications. The tested antigens were coproantigen, excretory-secretory (ES) antigen and egg antigen. Coproantigen and Copro Hyperimmune serum were able to reflect the lowest level of cross-reaction with other tested F. gigantica antigens. By using SDS-PAGE, a structural homology was observed in F. gigantica ES and egg antigens. Intense cross reaction was observed between ES and egg antigens by ELISA technique even when there was no cross-reaction with coproantigen. The 27.6 kDa band proved to be the most specific in F. gigantica coproantigen and was different from the band at the same molecular weight by ES antigen. The results conclude that coproantigens show specific diagnostic ability for Fasciola and have low numbers of cross-reaction proteins reflecting its high specificity. Moreover, detection of coproantigen in faeces offers a new potential for diagnostics as compared to serum samples. This fact holds promise for a more accurate diagnostic technique in the near future for suspected Fasciola infection.

Neuropathies in hepatitis C-related liver cirrhosis.

INTRODUCTION: Neurological complications occur in a large number of patients with chronic hepatitis C virus (HCV) infection and range from peripheral neuropathy to cognitive impairment. We studied the association between neuropathy and HCV-related chronic liver disease. METHOD: Fifty patients with HCV-related chronic liver disease were enrolled in this prospective case-control study. Patients were classified into two groups: mild and severe corresponding to a model for end-stage liver disease (MELD) score <14 and a MELD score >14, respectively. Complete neurological examination and nerve conduction studies have been done for all patients. All patients in addition to 25 healthy control subjects were tested for their serum B12 levels. RESULTS: Twenty-two percent of patients had sensory abnormality, 18 % had motor abnormality, while 10 % had both sensory and motor abnormalities. Autonomic function tests and nerve conduction studies revealed that 23 patients (46 %) had evidence of neuropathy and 10 patients (20 %) had both peripheral and autonomic neuropathy. Neuropathies were not related to the severity of the liver disease. Serum B12 level had a very wide range among patients with no relation between its level and neuropathy. Vitamin B12 level was significantly and directly correlated to MELD score and age. CONCLUSION: Peripheral and autonomic neuropathy has high prevalence in patients with HCV-related chronic liver disease. On the other hand, vitamin B12 level is high in those patients and there is no role for vitamin B12 in the liver cirrhosis-related neuropathy.

Ultrasound biomicroscopy as a diagnostic tool in infants with primary congenital glaucoma.

PURPOSE: Studying the role of ultrasound biomicroscopy (UBM) in detection of anterior segment changes in infants with primary congenital glaucoma (PCG). METHODS: Cross-sectional study that included 25 eyes of 15 patients suffering from PCG and a control group of 15 eyes of ten age- and sex-matched participants. Diagnosis of PCG was based on clinical data (intraocular pressure, corneal diameter, fundus examination and amplitude-modulation scan measurement of axial length). UBM examination was done for all participants for measurement of central corneal thickness, anterior chamber depth, lens thickness, iris thickness (measured 2 mm from the iris root and again at the thickest point near the pupil), zonular length, posterior chamber depth, and angle of anterior chamber. Qualitative evaluation was done for abnormal angle membranes, iris insertion level, and ciliary processes position and configuration. RESULTS: Mean age ± standard deviation was 10.32±3.59 months in the study group and 14.54±5.9 months in the control group. The central corneal thickness, anterior chamber depth, zonular length, and angle of anterior chamber were significantly larger in the study group than in the control group, with mean values 700±190 µm, 3.55±0.32 mm, 1.02±0.15 mm, and 58.47°±5.57°, respectively. The posterior chamber depth had a mean of 0.33±0.06 mm, which was significantly smaller than that of the control group. In the study group, the mean iris thickness 2 mm from the iris root was 0.32±0.04 mm, the mean iris thickness at the thickest point near the pupil was 0.38±0.08 mm, and the mean lens thickness was 3.32±0.18 mm. These three parameters were smaller than the control group but the difference was insignificant. Loss of normal iris configuration was detected in all eyes of the study group. Anterior iris insertion was detected in 56% of the eyes in the study group, and abnormal angle membrane was found in 12%. CONCLUSION: UBM is a useful tool for detection of anterior segment changes in PCG, which is helpful especially in cases with opaque cornea or cases with borderline clinical findings.

Detection of Coproantigens by Sandwich ELISA in Rabbits Experimentally Infected with Fasciola gigantica.

BACKGROUND: The study was targeted to report the appearance of coproantigens in feces and circulating antibodies in the serum of Fasciola gigantica experimentally infected rabbits. METHODS: Copro Hyper Immune Serum (HIS) and Excretory-Secretory Hyper Immune Serum (ES HIS) antigens were used in a sandwich ELISA for the detection of F. gigantica antigens in feces of 12 rabbits experimentally infected with different doses of F. gigantica encysted metacercariae (EMC) (10, 25 and 30 EMC). The relation between time of appearance of coproantigens in feces and anti-Fasciola antibodies in serum was evaluated. RESULTS: The earliest diagnostic coproantigen was recorded at 21(st), 25(th) and 28(th) day post-infection (p.i.) in groups of rabbits infected with 30, 25 and 10 F. gigantica EMC respectively. Both HIS and ES HIS were able to detect coproantigens in feces of rabbits infected with 30 EMC at day 21 p.i. The appearance of F. gigantica coproantigens in feces of infected rabbits was concurrent to the appearance of anti-Fasciola antibodies in blood (3(rd) week p.i.). However, coproantigen has specific ability for direct assessment of active infection with minimal cross-reaction with other heterologous parasitic infections. CONCLUSION: The findings hold promise for a more accurate diagnostic technique in the near future for suspected Fasciola infection.

Comparative study between serological and molecular methods for diagnosis of toxoplasmosis in women and small ruminants in Egypt.

Routine serological diagnosis of toxoplasmosis provides high sensitivity, but specificity varies depending on the test used; false-positive results (IgM) have been reported. Blood samples were collected from 88 women (59 pregnant and 29 nonpregnant) and 86 contact animals (62 sheep and 24 goats) at El Fayoum Governorate during the period from October 2005 to December 2006. All collected samples were tested for Toxoplasma gondii infection by serological tests (ELISA IgM & IgG and Sabin-Feldman dye test) and polymerase chain reaction (PCR). Results revealed specific IgG in 45.8% and 41.4%, IgM in 30.5% and 24.2%, and positive Sabin-Feldman dye test in 23.7% and 17.2% in pregnant and nonpregnant women, respectively. Positive PCR products were detected in 32.2% and 27.6% in pregnant and nonpregnant women, respectively. Regarding animals, positive ELISA IgG and PCR were detected in 98.4% and 67.7% of sheep and 41.7% and 25.0% of goats, respectively. It was concluded that serological tests can detect higher rate of toxoplasmosis than PCR, so ELISA combined with the PCR technique is a recommended tool for accurate diagnosis of toxoplasmosis.