Relation of testosterone level and other factors with bone mineral density in male kidney transplant recipients: a cross-sectional study.

BACKGROUND: Although testosterone has a pivotal role in bone health, its correlation with bone mineral density (BMD) is understudied in kidney transplant recipients who are at high risk of osteoporosis. This study aimed to elucidate if there is any correlation between serum free testosterone and BMD in this population. PATIENTS AND METHODS: Sixty male kidney transplant recipients were enrolled in this cross-sectional study, and they were subjected to history taking, clinical examination, and laboratory investigations (including total and free testosterone). BMD was assessed in three regions (forearm, hip, and lumbar spine) using DEXA scan. RESULTS: The mean age of the included patients was 45.55 ± 13.58 years. Serum total and free testosterone had mean values of 5.17 ± 1.4 ng/ml and 95.46 ± 28.24 pg/ml, respectively, with all levels within the normal range. DEXA scan detected osteoporosis and osteopenia in 9 (15%) and 30 (50%) patients in the lumbar region, 3 (5%) and 36 (60%) in the hip region, as well as 21 (35%) and 33 (55%) in the forearm region, respectively. BMD of the lumbar region had a significant positive correlation with free testosterone, phosphorus, and eGFR, while it had a significant negative correlation with platelets and patient age. BMD of the hip region was positively correlated with serum phosphorus, parathyroid hormone, and duration since the transplant, whereas it was negatively correlated with platelets and total testosterone level. BMD of the forearm had a significant positive correlation with eGFR, whereas it had a significant negative correlation with age and duration since transplantation. In addition, forearm BMD was significantly lower in patients with a radiocephalic AVF. CONCLUSION: Even within the normal range, free testosterone has a significant positive correlation with lumbar spine BMD with no significant association with the forearm or hip BMD.

Ciprofloxacin infusion versus third generation cephalosporin as a surgical prophylaxis for percutaneous nephrolithotomy: a randomized study.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered a clean-contaminated surgical procedure. The American Urological Association has recommended different preoperative antimicrobial prophylaxis for various urological procedures to prevent surgical site infections, postoperative fever, and possible sepsis. The European Association of Urology (EAU) antibiotic guidelines endorse giving either a second or third-generation cephalosporin, trimethoprim-sulfamethoxazole, fluoroquinolone or aminopenicillin with a ß-lactamase inhibitor. The aim of the present study is to prospectively compare two different protocols of antibiotic prophylaxis in PCNL. MATERIAL AND METHODS: Successfully consented patients with sterile urine preoperatively who were awaiting percutaneous nephrolithotomy were randomized into two groups. The first group (n = 41) was given a single dose of 200 mg ciprofloxacin infusion, while group two (n = 43) was given 2 mg of cefotaxime divided into 2 doses; during induction of anesthesia and 12 hours later. The occurrence of perioperative infection-related events would be compared in both groups. RESULTS: Both groups had similar age, sex, Body Mass Index, and stone composition. No statistical difference was found regarding stone size, stone culture, irrigation fluid volume, operative time and urine pelvis culture result in both groups (Table 2). Two patients (5%) developed postoperative fever in the 1st group compared to 12 patients (28%) in the second group (p = 0.02). CONCLUSIONS: A prophylactic regimen consisting of a single dose ciprofloxacin infusion during induction of surgery showed a higher efficacy as a preoperative antibacterial preparation, compared to cefotaxime, in protection against postoperative fever in patients undergoing PCNL.

Occult hepatitis C virus infection among haemodialysis patients.

BACKGROUND AND STUDY AIMS: Hepatitis C virus (HCV) infection is a severe problem among patients on maintenance haemodialysis who are at particular risk for blood-borne infections because of prolonged vascular access and potential for exposure to contaminated equipment. Occult hepatitis C virus infection (OCI) is defined as the presence of HCV RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable HCV antibody or HCV RNA in the serum. In this study, we aimed to investigate the existence of occult hepatitis C virus infection in PBMCs of haemodialysis (HD) patients in one center. Moreover, we tried to link the condition to risk factors associated with HCV infection in those patients. PATIENTS AND METHODS: We included 40 patients with renal diseases undergoing regular haemodialysis who were repeatedly anti-HCV negative. HCV RNA detection was tested by Quantitative Real time PCR in serum and PBMCs. RESULTS: The results of this study revealed that 23% of our haemodialysis patients have occult hepatitis C virus infection. There was a highly significant increase in ALT levels in patients with OCI versus the negative group. Also, there is a significant increase of history of blood transfusion in patients with occult HCV (p = 0.03) while the duration of haemodialysis showed no statistical significant difference between both groups. The viral load of the occult hepatitis C virus infection subjects ranged from 581to 74,307 copies/ml. CONCLUSION: These results highlight the potential risk of hepatitis C virus transmission from patients within haemodialysis units in Egypt. Isolation of patients on dialysis machines depending on the results of hepatitis serological markers is not enough. Testing for hepatitis C virus -RNA in peripheral blood mononuclear cells is more reliable in identifying patients with an OCI when a liver biopsy is not available.

Effect of bone marrow derived mesenchymal stem cells on healing of induced full-thickness skin wounds in albino rat.

BACKGROUND AND OBJECTIVES: Mesenchymal stem cells have delivered new approaches to the management of wound healing in severe skin injuries. This work was planned to evaluate the effect of bone marrow-derived mesenchymal stem cells (BMSCs) on healing of induced full thickness skin wounds in albino rats using topical & systemic injections. METHODS AND RESULTS: Forty adult male albino rats were classified into 2 groups after induction of full thickness skin wound; untreated group and stem cell-treated group. The latter was further subdivided into topically and systemically treated ones. BMSCs were isolated & labeled by PKH26 before injection. Healing of wounds was evaluated grossly. Skin biopsies were obtained one & three weeks after wound induction. Sections were stained with Hematoxylin & Eosin, Masson's trichrome and immunohistochemichal stain for vascular endothelial growth factor (VEGF). Epidermal thicknesses and mean area percent of both collagen fibers & VEGF immunopositive cells were measured using image analyzer & results were subjected to statistical analysis. PKH26 fluorescent-labeled cells were found in the regenerated epidermis, hair follicles and dermis in BMSCs-treated groups. By the end of the third week, the wounds of BMSCs-treated groups showed full regeneration of epidermis, re-organization of collagen and decrease in VEGF immunopositive cells. Delayed wound healing was seen in 20% of systemically treated rats. Significant increase in the mean area percent of collagen fibers was detected in topically treated group. CONCLUSIONS: Both methods of BMSCs injection were effective in healing of full thickness skin wound but topical method was more effective.

A study comparing chemical peeling using modified Jessner's solution and 15% trichloroacetic Acid versus 15% trichloroacetic acid in the treatment of melasma.

BACKGROUND: Melasma is a symmetric progressive hyperpigmentation of the facial skin that occurs in all races but has a predilection for darker skin phenotypes. Depigmenting agents, laser and chemical peeling as classic Jessner's solution, modified Jessner's solution and trichloroacetic acid have been used alone and in combination in the treatment of melasma. OBJECTIVES: The aim of the study was to compare the therapeutic effect of combined 15% Trichloroacetic acid (TCA) and modified Jessner's solution with 15% TCA on melasma. MATERIALS AND METHODS: Twenty married females with melasma (epidermal type), with a mean age of 38.25 years, were included in this study. All were of skin type III or IV. Fifteen percent TCA was applied to the whole face, with the exception of the left malar area to which combined TCA 15% and modified Jessner's solution was applied. RESULTS: Our results revealed statistically highly significant difference between MASI Score (Melasma Area and Severity Index) between the right malar area and the left malar area. CONCLUSION: Modified Jessner's solution proved to be useful as an adjuvant treatment with TCA in the treatment of melasma, improving the results and minimizing postinflammatory hyperpigmentation.

Spectrophotometric study of the reaction mechanism between DDQ as pi-acceptor and potassium iodate and flucloxacillin and dicloxacillin drugs and their determination in pure and in dosage forms.

Two simple and accurate spectrophotometric methods are presented for the determination of beta-lactam drugs, flucloxacillin (Fluclox) and dicloxacillin (Diclox), in pure and in different pharmaceutical preparations. The charge transfer (CT) reactions between Fluclox and Diclox as electron donors and 2,3-dichloro-5,6-dicyano-p-benzoquinone (DDQ) pi-acceptor and potassium iodate via oxidation reduction reaction where the highly coloured complex species or the liberated iodine have been spectrophotometrically studied. The optimum experimental conditions have been studied carefully. Beer's law is obeyed over the concentration range of 2-450 microg ml(-1) for Fluclox and 10-450 microg ml(-1) for Diclox using DDQ reagent and at 50-550 microg ml(-1) for Fluclox and 50-560 microg ml(-1) for Diclox using iodate method, respectively. For more accurate results, Ringbom optimum concentration range is calculated and found to be 6-450 and 15-450 microg ml(-1) for Fluclox and Diclox using DDQ, respectively, and 65-550 and 63-560 microg ml(-1) for Fluclox and Diclox using iodine, respectively. The Sandell sensitivity is found to be 0.018 and 0.011 microg cm(-2) for DDQ method and 0.013 and 0.011 microg cm(-2) for iodate method for Fluclox and Diclox, respectively, which indicates the high sensitivity of both methods. Standard deviation (S.D.=0.01-0.80 and 0.07-0.98) and relative standard deviation (R.S.D.=0.13-0.44 and 0.11-0.82%) (n=5) for DDQ and iodate methods, respectively, refer to the high accuracy and precision of the proposed methods. These results are also confirmed by between-day precision of percent recovery of 99.87-100.2 and 99.90-100% for Fluclox and Diclox by DDQ method and 99.88-100.1 and 99.30-100.2% for Fluclox and Diclox by iodate method, respectively. These data are comparable to those obtained by British and American pharmacopoeias assay for the determination of Fluclox and Diclox in raw materials and in pharmaceutical preparations.

Spectrophotometric determination of flucloxacillin and dicloxacillin in pure and dosage forms.

A simple, rapid and accurate spectrophotometric method for the determination of antibiotic drugs, flucloxacillin (Fluclox) and dicloxacillin (Diclox), in pure form and different pharmaceutical preparations has been developed. The charge transfer (CT) reactions between Fluclox and Diclox as electron donors and 7,7,8,8-tetracyanoquinodimethane (TCNQ) and tetracyanoethylene (TCNE) as pi-acceptors to give highly coloured complex species have been spectrophotometrically studied. The optimum experimental conditions for these CT reactions have been studied carefully. Beer's law is obeyed over the concentration ranges of 4-180 microg mL(-1) and 4-70 microg mL(-1) for Fluclox and Diclox drugs using TCNQ and TCNE reagents, respectively. The Sandell sensitivities (S) are found to be 0.016-0.035 microg cm(-2) and 0.011-0.016 microg cm(-2) for Fluclox and Diclox, respectively, which indicate the high sensitivity of the proposed method. The relative standard deviations (R.S.D.: 0.08-0.49 and 0.15-0.80) for the determination of Fluclox and (R.S.D.: 0.05-0.75 and 0.13-0.75) for Diclox were obtained for four to six replicates using TCNQ and TCNE reagents, respectively, refer to the high accuracy and precision of the proposed method. These results are also confirmed by the between-day precision and the percent recovery of 99.90-100.1 and 99.60-100.4 for Fluclox and 99.90-100.5 and 99.40-100.1 for Diclox using TNCQ and TCNE reagents, respectively. The results obtained for the two reagents are comparable with those obtained by the official method.