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   2013| July-December  | Volume 26 | Issue 2  
    Online since January 31, 2014

 
 
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ORIGINAL ARTICLES
Dual diagnosis and psychosocial correlates in substance abuse in Menoufia, Egypt
Nabil R Mohamed, Samy A Hammad, Lamia G El Hamrawy, Afaf Z Rajab, Mohamed S El Bahy, Mohamed R Soltan
July-December 2013, 26(2):114-121
DOI:10.4103/1110-2098.126139  
Objectives To study the comorbid psychiatric disorders among substance abusers in Menoufia and to identify whether there is a correlation between the type of substance and the comorbid disorder that occurred, and also to determine whether there are specific risk factors that can cause this comorbidity. Background A dual diagnosis presents a challenging problem to clinicians as substance use disorders occurring together with mental health disorders represent a major health problem. Participants and methods Study participants comprised 120 Egyptian substance abusers. They were subjected to the following: semistructured interview sheet, Fahmy and El Sherbini Social Classification scale, semistructured clinical interview for DSM-IV (SCID) both SCID-I for Axis-I diagnosis and SCID-II for Axis-II diagnosis, Addiction Severity Index scale, and a urine screening for substance abuse. Results The findings of the study suggested that 20% of the studied participants were tramadol abusers, 10% were both alcohol and cannabis abusers, 23% were other substances abusers, and 37% were polysubstance abusers. With respect to psychiatric comorbidity, 63.3% of the participants had comorbid psychiatric disorders and comorbid personality disorders (PDs). On studying risk factors for substance abuse, major depressive disorder was found to be the strongest predictor of alcohol abuse. Dependent PD and schizophrenia were the strongest predictors of cannabis abuse. Major depressive disorder and borderline PD were the strongest predictors of opioid abuse. Anxiety disorders and borderline PD were the strongest predictors of sedative abuse. On studying risk factors for comorbid psychiatric disorders in the participants studied, young age (<25 years) and being single were found to be the strongest predictors of comorbid Axis-I disorders. Conclusion Individuals with psychiatric disorders are at an increased risk of having a comorbid substance abuse disorder and vice versa.
  7 5,040 382
Molecular and phenotypic characterization of hospital-associated and community-associated isolates of Enterococcus spp.
Labib Z Azza, Mahmoud B Ahmed, Al Ragehy A Nahed, Zahran A Wafaa, Elmasry A Eman
July-December 2013, 26(2):108-113
DOI:10.4103/1110-2098.126138  
Objectives The aim of our study was to estimate the extent of spread of enterococcal infection as well as vancomycin-resistant enterococci (VRE) colonization at Menofia University Hospitals. and also to delineate occurrence and species prevalence, characterize VRE phenotypes and genotypes by multiplex PCR, and detect esp virulence genes in the enterococcal isolates from different sources. Background Enterococci are part of normal intestinal flora of both humans and animals; however, they have also emerged as significant community-acquired pathogens and are a leading cause of nosocomial infection. Patients and methods In this study, patients were classified into three groups. Group 1 included 195 hospitalized patients. Group 2 included 65 patients from group 1 and group 3 included 50 healthy individuals to detect VRE colonization. Culture was performed using selective media for enterococci (bile esculine agar); detection of the antibiotic susceptibility pattern for enterococcal isolates and detection of VRE were performed. Detection of vanA and vanB genes in VRE using multiplex PCR and PCR detection of the esp gene were also performed. Results The most commonly isolated Enterococcus spp. were Enterococcus faecium (48%) followed by Enterococcus faecalis (32%), Enterococcus durans (12%), Enterococcus avium, and Enterococcus gallinarum (4%). Of the 36 enterococcal isolates, 22 (61.1%) were identified as VRE by minimum inhibitory concentration. The Van A genotype was more common than van B. Of the 36 enterococcal isolates, 16 (77.82%) isolates had the esp gene. A high percentage (10.7%) of hospitalized patients showed colonization with VRE. The occurrence of the esp gene was higher in VRE clinical isolates of group I patients than isolates in stool specimens of patients in group II. Conclusion E. faecium is more common than E. faecalis as a nosocomial pathogen and it also has a great ability to show drug resistance. Emergence of multidrug-resistant enterococci to high-level aminoglycoside and vancomycin is an alarming situation. Fortunately, all VRE isolates are susceptible to linezolid. The Van A genotype is the predominant genotype among different species. A higher rate of gastrointestinal tract colonization by VRE is detected in hospitalized patients.
  2 2,738 289
Malassezia species isolated from lesional and nonlesional skin in patients with pityriasis versicolor
Mohamed A Shoeib, Mohamed A Gaber, Azza Z Labeeb, Ola A El-Kholy
July-December 2013, 26(2):86-90
DOI:10.4103/1110-2098.126115  
Objectives This study aimed to identify Malassezia species found in pityriasis versicolor (PV) patients as well as to establish whether there is any association between the various species of Malassezia isolated from lesional and from nonlesional skin of those patients. Background PV is a common, benign, superficial cutaneous fungal infection caused by Malassezia species usually characterized by hypopigmented or hyperpigmented macules and patches on the chest and back. These lesions are scaly and their color varies from red, pale, yellow brown to dark brown. Patients and methods A total of 100 patients with PV were included in the study. The samples were obtained by scraping the skin surface, both from lesional and from nonlesional skin, and then incubated on Dixon's agar. The yeast isolated were identified using conventional biochemical tests and Tween assimilation. Results Skin lesions were 100% KOH positive for Malassezia species and 10% KOH positive in healthy skin. Growth from skin lesion was obtained on Dixon's agar in 83 patients (83%). The most common species was Malassezia furfur as it was detected in 47 samples (47%), followed by Malassezia globosa (23%) and Malassezia sympodialis (13%). From healthy skin of patients, growth of Malassezia was obtained from 19 specimens, M. furfur was detected in 13%, and M. globosa was detected in only three patients (3%) and M. sympodialis in three patients (3%). Conclusion M. furfur in its mycelial phase was the predominant species involved in the etiology of PV and M. globosa was the second most common species. The most frequently isolated species from clinically healthy skin was M. furfur and was recovered from healthy skin only in yeast form. We found no difference in the distribution of Malassezia species between lesional and nonlesional skin. Furthermore, no species predominance was observed whether with hyperpigmented or hypopigmented lesions as M. fufur was the most common species in both lesions in PV patients.
  2 2,688 291
Immunolocolization of CD29 in keloid
Mohamed A Basha, Rehab M Samaka, Ola Bakry, Iman M Elwan
July-December 2013, 26(2):91-97
DOI:10.4103/1110-2098.126128  
Objective To shed light on the role of mesenchymal stem cells (MSCs) in keloid pathogenesis. Background Keloids are fibroproliferative scars that show a benign yet quasineoplastic behavior and morphology, as evidenced by high recurrence and aggressive invasion into the surrounding skin. MSC populations originate from bone marrow (BM) stroma, which can give rise to stromal mature mesenchymal cells and aid regeneration of the BM microenvironment. Human BM-derived MSCs may contribute toward keloid pathogenesis. Patients and methods A total of 30 skin biopsy specimens from keloid lesions were used and 15 healthy volunteers were used as a control. Histopathological examination of hematoxylin and eosin-stained sections of keloid was carried out for the evaluation of histopathological parameters. The expression of CD29 was examined immunohistochemically. Results There were statistically significant differences between CD29 immunostaining in normal skin and lesional area of keloid in favor of keloid. There were no significant differences between different epidermal intensities of CD29 expression in keloid. Conclusion MSCs may share in keloid pathogenesis. The future therapy of keloid scars may have to target MSC differentially in order to deprive these tumors of their regenerative cell pools. This may represent an innovative method for keloid treatment.
  1 2,419 212
Evaluation of rhegmatogenous retinal detachment treatment by pars plana vitrectomy alone versus pars plana vitrectomy with a scleral buckle
Hamouda H Ghoraba, Saber H El Sayed, Khaled G Said, Amin F Ellakwa, Adel G Zaky
July-December 2013, 26(2):122-126
DOI:10.4103/1110-2098.126142  
Objective The aim of this study was to compare and report the anatomic and functional results of primary vitrectomy with scleral buckling versus primary vitrectomy without scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD). Background RRD is one of the commonly encountered retinal problems where timely treatment could prevent irreversible vision loss. A variety of options, including scleral buckling, pars plana vitrectomy (PPV) with scleral buckling, pneumatic retinopexy, and a temporary balloon buckle, have been described as methods for repair of RRD. Patients and methods A prospective, interventional, comparative case study was carried out. This study included 170 consecutive cases of vitrectomy for primary RRD at two vitreoretinal centers. They were divided into two groups: group I included 95 patients who underwent PPV alone and group II included 75 patients who underwent PPV with a scleral buckle. The main outcome measures were single-surgery anatomic success (SSAS) and final visual acuity (VA). Results SSAS was obtained in 160 eyes [89 (93.7%) in group I and 71 (94.7%) in group II]. From overall 111 phakic retinal detachments, SSAS was achieved in 104 eyes [52 in group I (92.9%) and 52 in group II (95.5%)], whereas from overall 59 aphakic or pseudophakic retinal detachments, SSAS was achieved in 56 eyes [37 in group I (94.8%) and 19 in group II (90%)]. VA improvement was greater in the PPV group (P = 0.021). Conclusion Both surgical procedures had similar reattachment rates. Intraoperative and postoperative complications were similar considering both the procedures. VA improved significantly in group I (vitrectomy without scleral buckling).
  1 2,309 212
Predictive ability of first-day serum bilirubin and haptoglobin for subsequent significant hyperbilirubinemia in healthy-term and near-term newborn
Fady M El-Gendy, Fahima M Hassane, Ahmed A Khattab, Dalia M El-Lahony, Noha M Ashour
July-December 2013, 26(2):127-131
DOI:10.4103/1110-2098.126143  
Objective Predicting significant neonatal hyperbilirubinemia using cord blood haptoglobin and bilirubin on the first day of life. Background Neonatal jaundice is the result of an imbalance between the production and elimination of bilirubin. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute toward the development of hyperbilirubinemia. Hemolysis plays a significant role in bilirubin increase in newborns. When hemolysis takes place, a decrease in the haptoglobin blood level-binding hemoglobin in the environment occurs. Patients and methods A total of 61 healthy newborns of at least 35 weeks' gestation were followed in the first 5 days of life for the development of significant hyperbilirubinemia. All newborns were subjected to cord blood haptoglobin and bilirubin measurement soon after delivery. Total serum bilirubin (TSB) was measured on the fifth day of life. Only 46 newborns were brought in on the fifth day for follow-up. Results A total of 25/46 newborns (54.3%) developed significant hyperbilirubinemia (TSB on the fifth day≥17 mg/dl) and were considered as positive cases. A significant negative correlation was found between cord blood haptoglobin levels and the TSB values on the fifth day. A significant positive correlation was found between cord blood bilirubin levels and the TSB levels on the fifth day. A cut-off level of haptoglobin in cord blood of 7.5 mg/dl was determined to have the highest sensitivity (100%), specificity (81%), and positive predictive value (89%) in the prediction of occurrence of significant hyperbilirubinemia, whereas a cut-off level of cord blood TSB 2.73 mg/dl had the highest sensitivity (100%), specificity (90%), and positive predictive value (93%) in the prediction of significant neonatal hyperbilirubinemia. Conclusion The haptoglobin value and TSB value taken from the blood of the umbilical cord can be used as a guiding indicator to demonstrate the future occurrence of significant hyperbilirubinemia in newborns.
  1 3,147 316
Relationship between MTHFR polymorphism and side effects of high-dose methotrexate in pediatric acute lymphoblastic leukemia
Farida H El Rashedy, Seham M Ragab, Ashraf A Dawood, Mahmoud A El-Hawy
July-December 2013, 26(2):138-144
DOI:10.4103/1110-2098.126146  
Objectives To study the relationship between plasma methotrexate (MTX) level, methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, and the occurrence of complications associated with high-dose methotrexate (HDMTX) in pediatric acute lymphoblastic leukemia (ALL). Background ALL is the most common type of cancer in children. Administration of HDMTX, followed by leucovorin rescue is an important component in the treatment of childhood ALL. MTX toxicity mainly includes mucositis, myelosuppression, and hepatic toxicity. MTX toxicity can vary with genetic variability in folate-metabolizing enzymes (e.g. MTHFR). Patients and methods A total of 26 ALL children were studied. Clinical assessments, laboratory detection of complete blood count parameters, detection of liver and renal functions before and after HDMTX, detection of MTX level after HDMTX, and PCR (restriction fragment length polymorphism) for the MTHFR polymorphism (C677T and A1298C) were carried out. Results The plasma MTX level was found to be related to HDMTX toxicity, especially mucositis. For the C677T MTHFR polymorphism, neutrophil recovery days were higher in TT, followed by CT and CC polymorphism, platelet recovery days were higher in TT, followed by CT and CC polymorphism, and days required for plasma MTX level to decrease to less than 0.1 μmol/l were higher in TT, followed by CT and CC polymorphism. For the A1298C polymorphism, postinfusion platelet count was lower in AA than in AC and CC polymorphism and platelet recovery days were lower in AA than in CC and AC polymorphism. Neutrophil recovery days and days required for plasma MTX level to decrease to less than 0.1 μmol/l were higher in AA, followed by AC and CC polymorphism. For the A1298C polymorphism, AC patients had a significantly higher overall survival than CC and AA patients. Conclusion The increase in plasma MTX level after HDMTX might be associated with an increase in the risk for complications. Genotyping of folate polymorphisms might be useful in ALL to optimize MTX therapy, reducing the associated toxicity with possible effects on survival.
  1 4,437 378
Cardiac troponin I as an early predictor of perinatal asphyxia
Ahmed T Mahmoud, Maha El-Bassuny, Ayat Shebl
July-December 2013, 26(2):145-150
DOI:10.4103/1110-2098.126148  
Objective The objective of this study was to test the hypothesis that cardiac troponin I (cTnI), a known marker of myocardial injury, is also an early predictor of both severity and mortality in cases of perinatal hypoxia. Background Delivery is a stressful and risky event that poses a risk to newborns. The mother-dependent respiration has to be replaced by autonomous pulmonary breathing immediately after delivery. If delayed, it may lead to deficient oxygen supply, compromising the survival and development of the central nervous system. The outcomes of perinatal asphyxia are devastating and permanent, making it a major burden for the patient, the family, and society. Thus, there has been considerable focus on the early identification of newborns exposed to perinatal asphyxia and development of therapeutic strategies to reduce long-term morbidity and mortality. Troponin is an inhibitory protein complex located on the actin filament in all striated muscles and consists of three subunits: T, C, and I. cTnI was measured as an indicator of cardiac injury for a long time, but it has been of interest for the prediction of poor neonatal outcome in perinatal asphyxia. Aim of the study The aim of this work was to test the hypothesis that cTnI, a known marker of myocardial injury, is also an early predictor of both morbidity and mortality in cases of perinatal hypoxia. Materials and methods This study was carried out between October 2011 and June 2012. It included 40 neonates with perinatal asphyxia admitted to the neonatal ICU, El-Ahrar Zagazig General Hospital. Twenty healthy neonates matched for both age and sex were selected randomly as a control group. Blood samples were collected from the two study groups. cTnI was measured in relation to neurological sequelae, and deaths in both the groups were also evaluated. Results The mean cTnI of asphyxiated neonates was 4.6 ΁ 4.4 ng/ml, significantly higher than that of the control neonates, which was 0.55 ΁ 0.6 ng/ml. This difference was statistically significant. Conclusion cTnI was markedly increased in perinatal asphyxia. This was related to the severity of perinatal asphyxia. It can also be used as an early predictor of neonatal morbidity and mortality in perinatal asphyxia.
  1 3,494 5,419
Study on the use of impulse oscillometry in the evaluation of children with asthma
Fathea M El-Nemr, Mohamed I Al-Ghndour
July-December 2013, 26(2):151-158
DOI:10.4103/1110-2098.126149  
Objective The aim of this study was to determine the use of impulse oscillometry in the evaluation of children with asthma and to analyze lung parameters, order effect, and utility, compared with spirometry. Background Asthma is a disease characterized by ongoing inflammation of the airway, overproduction of mucus, and airway constriction due to tightened muscles, which results in permanent structural changes in the lungs, a condition often called airway remodeling. In turn, these changes usually lead to accelerated declines in lung function, including irreversible decreases in airflow because of narrowed air passages. The Impulse Oscillometry System measures respiratory impedance using short pulses (impulses) of air pressure. Impulse oscillometry has been used with success to assess lung function in healthy and asthmatic children, as well as in adolescents. Materials and methods This case-control study was carried out on 66 children divided into two groups: group 1 included 46 children who were previously diagnosed as asthmatic, and group II (control group) included 20 children without a history of asthma. All studied children were subjected to full history taking; clinical evaluation, including general examination and local chest examination; pulmonary function testing; impulse oscillometry before and after spirometry. Pulmonary function testing (impulse oscillometry and spirometry) was repeated in group 1 after bronchodilator administration. Results Asthma prevalence was increased among children with a family history of atopy and among those with family members who smoked. Postbronchodilator impulse oscillometry results were significant, especially R5% and X5pred.-X5. Performing forced expiratory maneuvers during spirometry causes a marked decrease in lung function, detected using impulse oscillometry. Conclusion Impulse oscillometry is useful in the evaluation of children with asthma.
  - 3,652 290
Impact of stone density on the outcome of extracorporeal shock wave lithotripsy
Sultan M Sultan, Tarek M Abdel-Elbaky, Eid A Elsherif, Mohamed H Hamed
July-December 2013, 26(2):159-162
DOI:10.4103/1110-2098.126152  
Objectives This study aims to evaluate the attenuation of renal calculi measured by Hounsfield unit (HU) by noncontrast spiral computerized tomography (NCSCT) as a predictor of calculus fragmentation by extracorporeal shock wave lithotripsy (SWL). Background The outcome of extracorporeal SWL is measured in terms of stone fragmentation and clearance. Some authors have suggested that HU of renal calculi by NCSCT may predict stone-free rates after extracorporeal SWL. Patients and methods This prospective nonrandomized open study included 100 patients with renal stone up to 20 mm in size. Stone attenuation was measured by HU on NCSCT. Patients were grouped according to stone attenuation as group (1), less than 500 HU, (2), 500-1000 HU, and (3), greater than 1000 HU. Patients were treated subsequently with extracorporeal SWL. The outcome was categorized as stone free, clinically insignificant stone fragments, and residual fragments more than 3 mm. Results The rate of stone fragmentation was 100% (41 of 41 cases) in group 1, 95.7% (44 of 46) in group 2, and 0% (0 of 13) in group 3. A statistically significant association was found between SWL treatment outcome and stone density. When we correlated the absolute stone HU measured with the number of shock waves required for complete fragmentation, we found that the mean number of shock waves was 248 122 in group 1, 334 826 in group 2, and 726 077 in group 3 (P < 0.001). Conclusion Stone attenuation measured by HU by NCSCT is a predictor of outcome of SWL and suspected number of shock waves required for fragmentation.
  - 4,545 364
The role of transrectal ultrasound-guided biopsy in diagnosis of prostate cancer
Basma A El-Moniem Dessouky, Waleed A El-Fattah, Samer T Gaffer
July-December 2013, 26(2):163-169
DOI:10.4103/1110-2098.126155  
Objectives The aim of this study was to evaluate the role of transrectal ultrasonography (TRUS)-guided biopsy in the detection of prostate cancer in patients on the basis of elevated prostate-specific antigen levels and abnormal digital rectal examination (DRE) results. Background The TRUS-guided biopsy technique was regarded as the golden standard method for diagnosis of prostate cancer. This study aimed to identify an appropriate prostate biopsy protocol for the detection of prostate cancer. Materials and methods This study included 30 patients having symptoms suggestive of prostatic diseases. All these patients were subjected to DRE, serum prostate-specific antigen testing, transabdominal ultrasound examination and TRUS, as well as biopsy taking. Results Among the 30 patients studied, final diagnosis by TRUS-guided biopsy revealed benign prostatic hyperplasia in 16 patients (53.3%), which was the most common pathology, precancerous lesions in seven patients, prostatitis in four patients (13.3%), and prostatic adenocarcinoma in three patients (10%). Among the patients with precancerous lesions, five (16.7%) had prostatic intraepithelial neoplasia and two (6.7%) had atypical adenomatous hyperplasia. Conclusion Correlation of prostate-specific antigen levels and findings from DRE and TRUS images with biopsy results is considered the most useful method to improve sensitivity of prostate cancer detection.
  - 3,197 205
Ultrasonography diagnostic validity in structural and functional laryngeal disorders
Hazem A.A. Shalaby, Mohamed A Maaly, Tarek F Abdella
July-December 2013, 26(2):170-176
DOI:10.4103/1110-2098.126158  
Objectives The aim of the study was to assess the role of ultrasound in detecting and characterizing laryngeal anatomy with a special focus on vocal cords and study of some laryngeal disorders and their possible ultrasonographic appearance. Background Laryngeal examination with rigid endoscopy has the advantages of producing large, bright images. Unfortunately, patients with a sensitive gag reflex, patients with limited jaw or neck mobility, or those with stridor may not tolerate laryngeal endoscopic examination. It is also difficult in most infants and children. Thus, high-resolution (frequency) laryngeal ultrasonography may provide an alternative diagnostic tool. Patients and methods The study group included 50 patients who had complaints related to the larynx such as hoarseness of voice, chronic cough, chocking attacks, stridor, or neck swelling. These patients were referred from the ENT outpatient clinic. Results In the present study, of the 50 patients with laryngeal complaints, 10 patients (20%) were normal, 10 (20%) had vocal fold palsy, 10 (20%) had laryngeal tumor, four (8%) had vocal fold ulcer, four (8%) had vocal fold nodules, three (6%) had vocal fold polyp, three (6%) had vocal fold cyst, two (10%) had vocal fold dysfunction, two (10%) had interarytenoid edema, and two (10%) had laryngocele. Conclusion High-resolution laryngeal ultrasound can be used for assessment of vocal fold lesions, tumors, and mobility. Because of its real-time ability and noninvasive nature, ultrasonography is considered an effective diagnostic tool for the proper assessment of the vocal fold mobility rather than other diagnostic modalities, but is less effective in vocal cord ulcers and small lesions because of a limitation of the air-mucosa interface
  - 4,597 422
Methods and applications for mesenchymal stem cells
Eman A Ahmedy, Samia H Kandel, Samia H Rizk, Hala M Gabr, Khaled A Khalifa, Samar M Kamal
July-December 2013, 26(2):71-77
DOI:10.4103/1110-2098.126094  
Objective The aim of this work is to study neurogenesis using mesenchymal stem cells (MSCs) as a model of stem cells and then follow them as they form neurons. Background MSCs are multipotent adult stem cells present in all tissues. They are present in the bone marrow, and can differentiate in vitro into neurons, glial cells, and myofibroblasts. MSCs have been proposed as sources of stem cells for regeneration of the central nervous system. Thus, one of the goals of regenerative medicine is to ameliorate irreversible destruction of brain tissue and spinal cord by harnessing the power of stem cells to initiate neurogenesis in damaged areas of the brain. Materials and methods MSCs were cultured from bone marrow aspirate and detected morphologically and by flow cytometric analysis of surface markers CD44 and Oct3/4, then differentiated into neural cells using neural induction media, which consisted of a cocktail of retinoic acid dissolved in DEMSO, recombinant human basic fibroblast growth factor, recombinant human epidermal growth factor, and insulin-like growth factor I, and detected by glial fibrillary acidic protein (GFAP). Results The results of this study showed that MSCs could be isolated from the bone marrow and assumed the typical fibroblastoid morphology and reached 80-90% confluence at about 9 days. They expressed CD44 with a mean ± SD of 81.54 ± 11.58 and CD Oct3/4 with a mean ± SD of 56.12 ± 17.37. MSCs showed positive expression for double expression of CD44-OCT3/4, with a mean ± SD of 54.03 ± 17.42. A highly significant statistical correlation (P < 0.001) was found between age and double expression of CD44-OCT3/4. No statistically significant correlation (P > 0.05) was found between MNCs and double expression of CD44-OCT3/4. MSCs induced with neural induction media show morphological changes consistent with neurogenesis as compared with the symmetric morphologies of the uninduced cells, as shown by an inverted microscope. Induced cells showed positive staining with GFAP whereas uninduced cells showed negative staining. Conclusion MSCs can be isolated successfully from bone marrow aspirate and can be differentiated into GFAP-positive neural cells.
  - 3,323 3,553
Evaluation of nitric oxide and superoxide dismutase in different stages of chronic kidney disease
Emad F Abd-Elhalim, Gehan K El-Saeed, Seham A Khodeer, Mahmoud A Koura, Asmaa M El-Gamacy
July-December 2013, 26(2):78-85
DOI:10.4103/1110-2098.126099  
Objective The aim of this work was to evaluate nitric oxide (NO) and superoxide dismutase (SOD) as parameters of oxidative stress in different stages of chronic kidney disease (CKD) and their correlation with the lipid profile. Background CKD is a debilitating disease that leads to many complications, the most common being cardiovascular. Hence, this study was carried out to evaluate the oxidative stress that predisposes to cardiovascular diseases in these patients. Methods This study included 60 patients with CKD. In addition, 12 apparently healthy age-matched and sex-matched individuals were included as a control group. Patients were classified into five groups according to estimated glomerular filtration rate (eGFR) calculated using the CKD-EPI formula. We estimated serum creatinine, urea, lipid profile [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c)], serum NO, and SOD levels. Results There was a progressive increase in the mean value of TC, TG, and LDL-c from group I to group V, whereas HDL-c decreased progressively from group I to group V. There was a highly significant progressive decrease in the mean value of NO and SOD from group I to group V when compared with the controls and on comparison of groups with each other. There was no significant correlation between NO and SOD with other parameters in group I, group II, and group III. However, there was a significant positive correlation between NO and SOD with eGFR, HDL-c and a significant negative correlation between NO and SOD with urea, creatinine, TC, TG, and LDL-c in group IV and group V. Conclusion This study suggests that the progressive decline in kidney function could lead to decreased antioxidants levels along with disturbance in the lipid profile.
  - 2,088 1,662
The role of soluble transferrin receptor in iron overload in children with chronic hemolytic anemia
Farida H El-Rashidi, Fathia M El-Nemr, Seham M Ragab, Samar M.K. El-Din Fathallah, Reda I Rakha
July-December 2013, 26(2):132-137
DOI:10.4103/1110-2098.126144  
Objectives The current study was conducted to study the pathophysiology of iron overload in children with chronic hemolytic anemia (thalassemia major, thalassemia intermedia, and sickle cell anemia) and to assess the utility of soluble transferrin receptor (sTfR) for the evaluation of iron overload. Background Iron overload is a major complication of repeated blood transfusion in patients with chronic hemolytic anemia. sTfR, one of the main regulators of cellular iron homeostasis, is the truncated form of the tissue receptor. Patients and methods Sixty children with chronic hemolytic anemia (20 thalassemia major, 20 thalassemia intermedia, and 20 sickle cell anemia) were included, together with 20 age-matched and sex-matched controls. Clinical evaluation was performed for each child. Complete blood count along with serum ferritin and sTfR levels (using the ELISA technique) was assessed for both patients and controls. Results Both serum ferritin and sTfR levels were significantly higher in patients (2109±1350 ng/dl and 4.5±1.1 μg/ml, respectively) compared with controls and in patients with thalassemia major compared with those with thalassemia intermedia and those with sickle cell disease. Serum ferritin and sTfR levels were significantly correlated with age and with each other. Each of them negatively correlated with age at disease onset, time space between blood transfusions, and with hemoglobin level. Conclusion The sTfR level could contribute to and be used for the evaluation of iron overload in children with thalassemia and sickle cell disease.
  - 3,111 350
Kidney injury molecule-1 as an early marker for acute kidney injury in critically ill patients
Ibrahim M Boghdady, Mostafa M EL Naggar, Mahmoud M Emara, Rania M EL-Shazly, Karim S Mahmoud
July-December 2013, 26(2):98-104
DOI:10.4103/1110-2098.126131  
Objective The aim of this study was to evaluate the role of kidney injury molecule-1 (KIM-1) as an early marker for acute kidney injury (AKI) in critically ill patients as compared with conventional markers (e.g. serum creatinine). Background Depending on traditional markers for renal functions, namely, blood urea and serum creatinine, has led to unacceptable delay in the diagnosis of AKI and in initiating treatment. Materials and methods This study included 89 individuals: 79 critically ill patients and 10 healthy individuals who served as controls. All patients were prospectively followed up from the time of ICU admission. Blood and urine samples were collected simultaneously at predetermined time points: at the time of ICU admission, 6 h after arriving, 12 h after arriving, and daily thereafter for a minimum of the next 2 days and a maximum of 5 days. Results KIM-1 can detect AKI as early as 6 h from its occurrence and before the elevation of conventional markers. KIM-1 is (unlike conventional markers) not influenced by age, sex, and BMI. Conclusion KIM-1 is a reliable indicator for early detection of AKI in critically ill patients.
  - 4,164 273
Calcium-sensing receptors, biology, and clinical significance: a systemic review
Ali Z Galal, Sabry A Shoeb, Ahmed R Tawfeek, Karam S Mostafa
July-December 2013, 26(2):105-107
DOI:10.4103/1110-2098.126134  
This is a study of calcium-sensing receptors (CaSR), biology, and clinical significance. The CaSR plays an essential role in the regulation of extracellular calcium (Ca 2+ ) homeostasis. CaSR is expressed in all tissues related to this control (parathyroid glands, thyroid C cells, kidneys, intestine, and bones) and also in tissues with apparently no role in the maintenance of extracellular Ca 2+ levels, such as the brain, skin, and pancreas. CaSR cloning was immediately followed by the association of genetic human diseases with inactivating and activating CaSR mutations: Familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism are caused by CaSR-inactivating mutations, whereas autosomal dominant hypoparathyroidism is secondary to CaSR-activating mutations. Study of CaSR functions aided the development of drugs that modify their functions either by stimulation (calcimimetic drugs) or by inhibition (calcilytic drugs). CaSR plays a major role in the maintenance of a physiological serum Ca 2+ concentration. There are a number of inherited and acquired conditions in which the level of expression and/or function of the CaSR are altered. Also, there are drugs that modify the function of calcium-sensing receptors (CaSR-based therapeutics).
  - 2,458 226