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Table of Contents
January-April 2016
Volume 22 | Issue 1
Page Nos. 1-40
Online since Tuesday, May 17, 2016
Accessed 22,404 times.
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ORIGINAL ARTICLES
Management of acquired punctal stenosis in trachomatous patients using single versus double silicone tube insertion (a pilot study)
p. 1
Rania A Ahmed, Sarah A Azzam
DOI
:10.4103/1687-4625.182551
Objective
This study compares the effect of double versus single bicanalicular silicone tube in reducing tear meniscus and degree of tolerance to their presence in patients with punctal stenosis.
Materials and methods
The interventional case series included 30 eyes of 15 patients with acquired epiphora with bilateral visible stenotic puncti defined by inability to insert a 26-G cannula into the punctum without dilation. Under general anaesthesia, punctal dilation and bicanalicular silicone intubation were performed: one on the right side and two on the left side. Tear meniscus height was evaluated using a slit-lamp scoring system (Z-IV) at 1 week, 1 month, 6 months (when tubes were removed) and 12 months. Patients' satisfaction was evaluated by another scoring system (from 1 to 5) in addition to punctal shape and complications.
Results
All patients had trachoma associated with punctal stenosis. Tear meniscus was reduced compared with the preoperative status at every follow-up in both groups, especially at 1 and 6 months in favour of the double intubation group (
P
< 0.05). No difference was found following tube removal. High patient satisfaction and tolerance were reported while tubes were in place in both groups, with minimal complications.
Conclusion
Double bicanalicular silicone intubation is as well tolerated as single tubes and could be considered in the management of acquired punctal stenosis, especially in patients with trachoma, mostly because of punctum overstretch with more potential space for tear drainage. Further studies are required to evaluate retaining of the stent to prevent recurrence following tube removal.
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Is low cystatin C in acute stroke a blessing or a curse? a pilot study on Egyptian patients
p. 7
Elham M Sobhy, Yasser M Abdelhamid, Enas Hamdy, Mona M Adam
DOI
:10.4103/1687-4625.182552
Introduction
Cerebrovascular stroke is a costly disease. Elevated cystatin C levels were independently associated with both ischemic and hemorrhagic stroke. In contrast, cystatin C has been found to play protective roles in the nervous system.
Aim
The aim of the present study was to find out the relationship between serum cystatin C level and the outcome of acute cerebrovascular stroke in middle aged and elderly Egyptian patients.
Patients and methods
This study was conducted on 49 patients with recent stroke and normal kidney functions and 30 healthy matched controls. All patients were followed up for 1 week. Cystatin C was determined for both patients and controls.
Results
Cystatin C level tended to be lower in patients than in controls, both below and above the age of 60. Females tended to have higher levels of cystatin C. There was a gradual decrease in the cystatin C level according to the outcome, being least in the deteriorated group. However, the differences were insignificant.
Conclusion
The results suggest that low cystatin C level - in a patient with normal kidney function - may predict worse prognosis. Accordingly, creatinine estimation is mandatory in assessing the kidney function in these patients and cystatin cannot replace it, as it may represent another risk factor.
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Thrombotic microangiopathy in lupus nephritis patients
p. 12
Hanan A Kotb, Abir N Mokbel, Ahmed A Elmaghraby, Sawsan AE Fadda
DOI
:10.4103/1687-4625.182553
Objective
The aim of the present study was to evaluate the impact of thrombotic microangiopathy (TMA) on renal involvement in patients with lupus nephritis (LN).
Patients and methods
This study included 50 systemic lupus erythematosus patients with LN who had been referred for renal biopsy. Patients underwent clinical and laboratory assessment for disease activity and damage. The biopsy specimens were classified according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification, activity and chronicity indices, and assessed for renal TMA lesions.
Results
TMA was found in 7/50 LN patients (14%). Patients with TMA lesions had significantly higher systolic and diastolic blood pressure (
P
= 0.018 and 0.019, respectively), higher serum creatinine (
P
= 0.031), lower estimated glomerular filtration rate (
P
= 0.023) and higher consumption of C3 (
P
= 0.002) than that of those without TMA lesions. Lupus anticoagulant positivity was significantly more frequent in patients with TMA (
P
= 0.001). There was a significant association between the detection of TMA and LN class IV. LN patients with TMA had significantly higher renal activity indices (
P
= 0.022). Chronicity index was higher in patients with TMA, but it did not reach a statistical significance.
Conclusion
TMA is not an uncommon vascular change in patients with LN, especially in those with diffuse proliferative glomerulonephritis (class IV LN). It is associated with lupus anticoagulant positivity, C3 hypocomplentemia and higher renal biopsy activity index. TMA was significantly associated with renal impairment and systemic hypertension. Thus, TMA may be an important cause of renal injury and renal dysfunction in a subset of patients with LN, a histological entity associated with worse renal prognosis.
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Renal histopathological changes and clinical characteristics of antiphospholipid nephropathy in lupus nephritis patients
p. 18
Hanan A Kotb, Abir N Mokbel, Ahmed A Elmaghraby, Sawsan AE Fadda
DOI
:10.4103/1687-4625.182554
Objective
The aim of the present study was to evaluate the renal histopathological changes and clinical characteristics associated with antiphospholipid nephropathy (APSN) in lupus nephritis (LN) patients.
Patients and methods
This study included 50 LN patients referred for renal biopsy. Patients underwent clinical and laboratory assessments for disease activity and damage. The biopsy specimens were classified according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification, activity, and chronicity indices, and assessed for renal vascular lesions of APSN - acute (thrombotic microangiopathy) and chronic (fibrous intimal hyperplasia, fibrous arterial/arteriolar occlusion and focal cortical atrophy).
Results
APSN lesions were found in 17/50 patients (34%); furthermore, 7/50 patients (14%) had thrombotic microangiopathy lesions, whereas chronic APSN lesions were detected in 15/50 patients (30%). LN patients with APSN had significantly higher age and Systemic Lupus International Collaborating Clinics scores (
P
= 0.032 and 0.004, respectively), but there were no differences in renal and antiphospholipid syndrome manifestations. Lupus anticoagulant positivity was significantly more frequent in patients with APSN (
P
= 0.002). LN patients with APSN had significantly higher renal chronicity scores (
P
= 0.033) with more frequent interstitial fibrosis and tubular atrophy (
P
= 0.006 for each). There was no significant difference in the distribution of LN classes in patients with and without APSN.
Conclusion
APSN is frequently found in LN patients irrespective of the LN class and antiphospholipid syndrome manifestations. It is associated with lupus anticoagulant positivity, higher disease damage, and renal biopsy chronicity indices, particularly interstitial fibrosis and tubular atrophy. Only the identification of intrarenal vascular lesions could characterize these patients, thus is it not time to revisit the ISN/RPS classification of LN to include renal vascular lesions of APSN.
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Anti-inflammatory and metabolic effects of remote ischemic preconditioning and postconditioning on the contractile performance of the diaphragm in endotoxemic rats
p. 24
Ola M Tork, Amal F Dawood, Nermeen B Sadek, Manal M Mahmoud, Laila A Rashed, Samah Selim
DOI
:10.4103/1687-4625.182555
Background
Respiratory failure is a major cause of mortality during septic shock and is due in part to the decreased ventilatory muscles contraction. These muscles depend mainly on fatty acid oxidation as an important source of ATP. We investigated the effects of remote ischemic preconditioning and postconditioning (RpostC) on the contractile functions of the diaphragm in relation to metabolic functions during systemic inflammation in lipopolysaccharide (LPS)-induced endotoxemia model.
Materials and methods
A total of 24 adult male albino rats were divided equally into four groups: (i) the control group (group 1); (ii) LPS group (group 2), in which rats were treated with a single intraperitoneal injection of LPS (0.8 mg/kg intraperitoneal single dose); (iii) preconditioned group (group 3), in which remote ischemic preconditioning was induced with three ischemia/reperfusion cycles of the right hind limbs just before LPS injection; and (iv) postconditioned group (group 4), in which remote ischemic postconditioning was induced as in group 3 just after LPS injection. The animals were killed 5 days after the treatment. Among all groups, the contractility of the diaphragm was examined and the gene expressions of the carnitine palmitoyl transferase 1β (
CPT-1
0β), the nuclear receptor peroxisome proliferator-activated receptor-α (
PPAR
α), peroxisome proliferator-activated receptor γ coactivator-1α (
PGC-1
α), and the nuclear factor erythroid 2-related factor 2 (
Nrf2
) - the master of antioxidant response element - by real-time reverse transcription-PCR in the rat diaphragm tissue were determined; in addition, the serum levels of inflammatory markers, tumor necrosis factor α (TNFα) and interleukin-6, and lipids were measured.
Results
Both types of remote ischemic, preconditioning and postconditioning, significantly improved the contractile performance of the diaphragm (
P
< 0.001) compared with rats in the LPS group. These improvements were accompanied with significant elevation in the diaphragmatic expression of PPARα, PGC-1α, and CPT-1β, together with decreased serum lipids. In addition, there was a significant improvement in Nrf2 with a reduction in serum TNFα and interleukin-6.
Conclusion
Our results showed that the improvement of contractile performance of the diaphragm during sepsis was related to the improvement in the expression of nuclear hormone receptors involved in fat oxidation and modulation in oxidative stress and its consequences on inflammatory response. On the basis of these findings, we can suggest that early rational postconditioning interventions may be one of the promising strategies in the management of sepsis.
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Wuchereria bancrofti
microfilariae and quantitative circulating antigen detection in selected endemic areas in Egypt
p. 34
Iman R Abdel-Shafi, Eman Y Shoeib, Samar S Attia, Jose M Rubio, Ayman A El-Badry
DOI
:10.4103/1687-4625.182556
Back ground and objective
Wuchereria bancrofti
is responsible for 90% of cases of lymphatic filariasis throughout the tropics and in some subtropical areas worldwide, including Egypt. To combat this disease, the WHO has launched a program aiming to eliminate lymphatic filariasis by the year 2020 in all the endemic countries using mass drug administration (MDA) to interrupt the disease's transmission. The aim of the present work was to study
W. bancrofti
infection in selected endemic areas in Egypt by performing parasitological examination and enzyme-linked immunosorbent assay (ELISA) antigen detection test, and to analyze the demographic, clinical, and MDA data of the study population in relation to
W. bancrofti
infection.
Patients and methods
A total of 300 blood samples were collected from residents in endemic areas in five governorates. Parasitological examination and Og4C3 ELISA test were performed to identify
W. bancrofti
infection.
Results
Microfilariae were identified in one individual while circulating filarial antigens (CFAs) were detected in 10 individuals. Statistical analysis of the collected data showed that CFAs were significantly higher in the male population than in the female population, whereas analysis regarding other demographic, clinical, and MDA data showed no statistical significance.
Conclusion
The study results showed that CFAs are still detected in endemic communities in Egypt, and that the prevalence is higher in the male population than in the female population. Although the Og4C3 ELISA test is a useful research tool for the study of
W. bancrofti
infections, its cost and format hinder its wide use in endemic areas.
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