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Copper-graphene nano composite is prepared with 0.25,0.50,0.75,1.00,1.25 and 1.50 wt.% graphene nano sheets. Powder metallurgy technique is used for the preparation process. In which copper powder is mechanically milled with nano graphene sheet by 10: 1 ball to powder ratio, and 400 rpm for 12 hr. milling time. The mixtures are compacted by a uniaxial press under 700 Mpa pressure. The compacted samples are sintered under controlled atmosphere at 950 oC for 1.5 hrs. A comparison between methanol & hexane as a process controlling agent is established. In which Cu-GNSs are mixed with methanol or hexane by 10% to study their effects on the tribological properties of Cu-GNSs composite. Their effects on the microstructure & tribological properties of the prepared Cu/Graphene nanocomposites were studied. All results indicated that hexane samples have the more homogeneous microstructure, low porosity, higher wear resistance & coefficient of friction than those of methanol samples. Also, the density is decreased by increasing graphene percent for both groups. For methanol group 0.25wt. recorded the lowest wear rate. and good microstructure while for hexane group 1.00 wt. percentage graphene is the best one.

A centrifugal mixing method was developed to disperse ceramic particles inside a thermosetting polymer. Horizontal centrifugal equipment was used to fabricate cylindrical rods from epoxy reinforced with silicon carbide particles. Silicon carbide particles (SiC) are used for the outer coating of epoxy to increase wear resistance. In the centrifugal mixing process, there are three important variables: rotational speed, ceramic percentage and, ceramic size which affect ceramic particle distribution. This paper aims to find the relationship between these variables and the distribution of ceramic particles then determine the optimum conditions to get maximum wear resistance and hardness. From the experiment and analysis, it can be concluded that when mixing speed was greater than 600 rpm, the possibility of air bubbles formation was increased especially for ultrafine particles. Otherwise, the maximum wear resistance and hardness values were found in ultrafine size SiC samples reinforced with 30 wt% which were mixed at a low speed of 300 rpm.

Recurrent nerve laryngeal schwannoma is a rare benign tumor that, in expert hands, can be treated by transoral CO2 laser surgery.

Room-temperature ball milling technique has been successfully employed to fabricate copper-zinc graphene nanocomposite by high-energy ball milling of elemental Cu, Zn, and graphene. Copper powder reinforced with 1-wt.% nanographene sheets were mechanically milled with 5, 10, 15, and 20 wt.% Zn powder. The ball-to-powder weight ratio was selected to be 10:1 with a 400-rpm milling speed. Hexane and methanol were used as a process control agent (PCA) during composite fabrication. The effect of PCA on the composite microstructure was studied. The obtained composites were compacted by a uniaxial press under 700 MPa. The compacted samples were sintered under a controlled atmosphere at 1023 K for 90 min. The microstructure, mechanical, and tribological properties of the prepared Cu-Zn GrNSs nanocomposites were studied. All results indicated that composites using hexane as PCA had a uniform microstructure with higher densities. The densities of sintered samples were decreased gradually by increasing the Zn percent. The obtained composite contained 10 wt.% Zn had a more homogeneous microstructure, low porosity, higher Vickers hardness, and compression strength, while the composite contained 15 wt.% Zn recorded the lowest wear rate. Both the electrical and thermal conductivities were decreased gradually by increasing the Zn content.

This work investigates the feasibility of using friction stir welding (FSW) process as a groove filling welding technique to weld duplex stainless steel (DSS) that is extensively used by petroleum service companies and marine industries. For the FSW experiments, three different groove geometries without root gap were designed and machined in a DSS plates 6.5 mm thick. FSW were carried out to produce butt-joints at a constant tool rotation rate of 300 rpm, traverse welding speed of 25 mm/min, and tilt angle of 3o using tungsten carbide (WC) tool. For comparison, the same DSS plates were welded using gas tungsten arc welding (GTAW). The produced joints were evaluated and characterized using radiographic inspection, optical microscopy, and hardness and tensile testing. Electron back scattering diffraction (EBSD) was used to examine the grain structure and phases before and after FSW. The initial results indicate that FSW were used successfully to weld DSS joints with different groove designs with defect-free joints produced using the 60° V-shape groove with a 2 mm root face without root gap. This friction stir welded (FSWed) joint was further investigated and compared with the GTAW joint. The FSWed joint microstructure mainly consists of α and γ with significant grain refining, the GTWA weld contains different austenitic-phase (γ) morphologies such as grain boundary austenite (GBA), intragranular austenite precipitates (IGA), and Widmanstätten austenite (WA) besides the ferrite phase (α) in the weld zone (WZ) due to the used high heat input and 2209 filler rod. The yield strength, ultimate tensile strength, and elongation of the FSWed joint are enhanced over the GTAW weldment by 21%, 41%, and 66% and over the BM by 65%, 33%, and 54%, respectively. EBSD investigation showed a significant grain refining after FSW with grain size average of 1.88 µm for austenite and 2.2 µm for ferrite.

Background. Fabry disease (FD) is a rare genetic lysosomal disease with an estimated prevalence of 1:100000. Mutations on the GLA gene lead to alpha-galactosidase deficiency and multiorgan involvement due to sphingolipid accumulation. Our aim was to present and analyze the demographic and clinical characteristics of the Fabry patients in Romania. Methods. All known Fabry patients in Romania between 2015-2018 were prospectively included in the study. Data on personal history, family history and clinical parameters were collected and statistically analyzed. Results. The study included 42 patients with a mean age of 47±15 years, of which 19 (45%) were men and 23 (55%) women. Women were significantly older (52±15 years vs. 40±13 years, p=0.006) and presented similar prevalence of cardiac, renal, neurologic, ophthalmologic and otologic burden. The majority of patients presented organ damage, most prevalent being cardiac (48%), cutaneous (45%) and neurologic (52%) involvements. There were 20 families in total, comprising on average of 2.1 members each. Of the 20 families, only two had the same pathogenic GLA mutation. Conclusion. FD patients in our country show a significant degree of multiorgan involvement with important psychological and social impact on the patients and their families. Women with Fabry disease show similar disease burden as men, but at a later age.

In the modern economy the import substitution is an exceptional and temporary measure in the modern term. All states use or have used protectionist policies in their history due to the fact that there is a positive relationship between protectionism measures and the growth of gross national income. Active course on import substitution taken in Russia in 2014 after the introduction of Russian and anti-Russian economic sanctions. On August 4, 2015, at a meeting of the Government of the Russian Federation the decision was made to establish a Government Commission on Import Substitution. Resolution of the Government of the Russian Federation of August 4, 2015 No. 785 “On the establishment of a government commission on import substitution”, in which the composition of the commission is approved, were signed by the Prime Minister Dmitry Medvedev. Analysis of the current state of the pharmaceutical and medical industry indicates its lag behind similar industries of economically developed countries in the range of products. While maintaining this trend the health of citizens of the Russian Federation as the most important component of the national security of the Russian Federation becomes dependent on foreign economic conditions. In this regard the innovative development of the domestic pharmaceutical and medical industry, especially for the production of drugs that are actively used in pediatrics, including neonatology, is one of the priorities of the modernization of the economy of the Russian Federation. Conclusion. Pneumococcal infection causes most severe cases of pneumonia, sepsis, meningitis, and otitis, especially dangerous for those for one reason or another weakened immune system. In this regard WHO recommends vaccination as the most effective way to prevent infectious diseases, including those caused by pneumococcal infection.

Helicobacter pylori (H. pylori) is a global health threat, and the World Health Organization has included H. pylori among 12 bacterial species that require high priority future strategies for the development of new antibiotics due mainly to its high rates of resistance. Metallic nanoparticles are known for their antimicrobial properties. The FDA (Food and Drug Administration) has approved zinc oxide nanoparticles (ZnONPs) as biocompatible antimicrobials. Green synthesis of ZnONPs was performed based on Oak galls extract (OGE) and was characterized by UV, IR, DLS, TEM, and SEM measurements. In addition, LC-MS/MS was used for the identification of OGE constituents. A checkerboard assay was used to evaluate the activity of synthesized Qi-ZnONPs and OGE against H. pylori, and their synergistic effects with amoxicillin were evaluated. LC-MS/MS analyses identified 20 compounds as major gallic acid conjugates. The ZnONPs had average particle sizes of 5.5 nm (DLS) and 7.99 nm (TEM). Both OGE and Qi-ZnONPs exhibited moderate activity against H. pylori. Amoxicillin and Qi-ZnONPs combinations (1:2 and 1:4 amoxicillin:/Qi-ZnONPs) significantly decreased the MIC90 by two-fold and four-fold, respectively, and FIC values for the combinations were more significant than with OGE alone. OGE is rich in phenolics. The synergism between Qi-ZnONPs and amoxicillin can provide an alternative safe agent of low cost to combat H. Pylori infections.

Isolation and identification of new microbial isolates capable of producing cholesterol oxidase enzyme (CHO) is of great potential in the field of biotechnology of industrial enzymes. Four producing strains of actinomycetes were isolated from Egyptian soils demonstrated high activity in cholesterol degradation compared to the other isolates. Based on different standard morphological, biochemical as well as molecular techniques using 16S rRNA sequencing, these actinomycetes were identified as Streptomyces sp. strain NHIA_CH3 MK680299, Streptomyces sp. strain NHIA_CH5 MK680300 , Streptomyces griseus strain NHIA_CH6 MK680301 and Streptomyces drozdowiczii strain NHIA_CH10 MK680302. In order to optimize the CHO enzyme activity, different fermentation media were tested in submerged cultures at shake flask level. Maximum activity (23.7 U/mL) was observed in culture of Streptomyces sp. strain NHIA_CH5 which was scaled up to the 5L volume of the stirred tank bioreactor. Results of the batch fermentation showed an earlier production of CHO enzyme with 4% increase in activity compared to that obtained from shake flask cultures indicated that Streptomyces sp. strain NHIA_CH5 could be a potential source of CHO enzyme for commercial purpose.

Handset charger is device which charges a cellphone from an available direct current (DC) source. Moreover, a DC cellphone charger forms as an integral part of a cellphone package which is being used in conjunctions with san alternating current (AC) power supply. A simple off-line fly back switch mode buck converter charger is designed and implemented to charge cell phone from an AC source. The circuit is targeted to operate on universal input voltage range of 85 to 265 V AC. Minimizing cost and size, the circuit was designed to operate on a high frequency transformer. The design was first conducted on MULTISIM software to ascertain its working conditions before the construction procedure. Tools and materials were chosen based on their simplicity and availability in most of our local electronics shops. The charger was tested on different cell phones and found working satisfactory. The performance analysis shows that its power rating is about 4 watts.

Purpose: In this study, effects of sports and science high school students’ sports activity levels on their body composition and bone development level were investigated. Material and Method: A total of 59 participants were voluntarily included in the study in which 29 people were the experimental group from Elazıg Kaya Karakaya Sports High School with a mean age of 17.10±1.25 (years) and 30 people were the control group fr om Diyarbakır RekabetKurumu High School with a mean age of 17.70±1.67 (years ). Sports activity of Sports High school students was found to include (in the first two years 384 hours, a total of 1088 hours in four years) and sports activity of science high s chool students was found to include ( in the first 2 years 94, a total of 158 hours in four years). Those who had any disease that could have an effect on their bone mineral density and body compositions were not included in the study. Height and weight w ere measure with standardSecaStadiometre . Body Mass Index (BMI), Basal Metabolic Rate (BMR), Body Fat Percentage (BFP), Body Fat Mass (BFM), Fat - Free Body Mass (FBM), Total Body Water (TBW) , which constitute body composition and are accepted as sub parame ters, were measured with Bioelectrical Impedance Analyser (BIA - Tanita BC 418) . Bone densitometry device (DEXA; Hologic Discovery 4500 QDR) was used in the measurements of bone mineral density. SPSS 16.0 was used in the process of the raw data obtained and T - Test was applied for independent samples. Findings : HEIGHT, WEIGHT, BMI, BMR, %BFP, BFM, FBM, TBW measured mean values of the E xperimental group are 171.62±7.078 (cm), 58.88±8.679 (kg), 19.89±1.745 (kg/m²), 3435.6 ± 2660.55 (kcal), 13.64±2.446 (%),8.100± 2.150 (kg), 50.81±7.165 (kg) respectively. HEIGHT, WEIGHT, BMI, BMR, %BFP, BFM, FBM, TBW measured mean values of the Control group are 170.21±8.514 (cm), 59.77±9.749 (kg), 19.63±1.439 (kg/m²), 2362.85 ± 2010.71 (kcal), 13.83±2.556 (%), 8.048±1.708 (kg), 5 0.2 45±6.280 (kg), 36.785±4.59 (kg) respectively. It was determined that there was no statistically significant difference between these means of the variables compared (p>0.05). Yet, a statistically significant difference was found (p

The purpose of this study is to analyse the relationship between conditional parameters ( leg strength, back strength, velocity 30 Mt, flexibility) by measuring some physical (height, body w eight) and physiological (systole, diastole, KAH) characteristics of male football players of Karakopru Belediyespor and Harran University. According to the results obtained from the measurements, mean age was 23, 46±3,50 /years); as a part of physical cha racteristics ,mean height was 176,20±5,10 (cm) and mean body weight was 70,16±5,21 (kg) . As a part of physiological characteristics, mean Systolic Blood Pressure was 123,87±14,23 (mmhg) , mean Diastolic Blood Pressure was 73,60±16,42 (mmhg) and mean Resting Heart Rate was 64,50±10,48 (beats/min ) . As a part of conditional parameters, mean leg strength was 101,83±40,48 (kg), back strength was 75,83±19,43 (kg), flexibility was 34,16±6,65 (cm) and mean velocity in 30 Mt. was 4,15± 0,20 (sec). It was observed that there was a relationship between 30 meters velocity and leg strength parameters (r= - , 407 ). There was no relationship between 30 meters velocity and back strength parameters (r=, 429); and between 30 meters velocity and flexibility param eters (r=, 659) . As a result, while the relationship between velocity and back strength values of the amateur football players was not significant (p>0.05) ; the relationship between velocity and leg strength values was found to be significant (p

Nagla Salem,1 Lamyaa Salem,2 Sally Saber,2 Ghada Ismail,2 Martin H Bluth1 1Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA; 2Department of Clinical and Chemical Pathology, Ain Shams University, Cairo, Egypt Abstract: Corynebacterium urealyticum is a Gram positive, slow-growing, lipophilic, multi-drug resistant, urease positive micro-organism with diphtheroid morphology. It has been reported as an opportunistic nosocomial pathogen and as the cause of a variety of diseases including but not limited to cystitis, pyelonephritis, and bacteremia among others. This review serves to describe C. urealyticum with respect to its history, identification, laboratory investigation, relationship to disease and treatment in order to allow increased familiarity with this organism in clinical disease. Keywords: Corynebacterium urealyticum, cystitis, pyelonephritis, bacteremia, micro-organisms

This article describes the still relatively recent changes in Turkey’s attitude towards foreign direct investment (FDI), the wave of FDI inflows as well as Turkey’s commitment to international investment instruments as contained in bilateral investment treaties (BITs) and the Energy Charter Treaty (ECT). Further, this article identifies certain potential catalysts for investment claims against Turkey, describing perceived shortcomings in Turkey’s legislative and administrative system which might carry the potential to trigger such claims by foreign investors against Turkey. This article concludes that the national policy-makers in Turkey should carefully analyze legislative and administrative reform decisions in light of Turkey’s commitments contained in the international investment instruments to which Turkey has subscribed.

Effects of Melatonin on Sleep after Laparoscopic Cholecystectomy: A Randomized, Placebo-Controlled Clinical Trial Objective: We set out to investigate whether administration of an oral dose of 5 mg melatonin in the evenings after laparoscopic cholecystectomy could reduce sleep disturbances measured by actigraphy. Methods: We performed a double-blinded, placebo-control, randomised clinical trial where 54 patients received 5 mg melatonin or placebo approximately 30 minutes before bedtime three nights postoperatively. Participants were monitored with actigraphy two nights preoperatively and three nights postoperatively. Likewise sleep, pain, general wellbeing, and fatigue were measured via visual analogue scales. Results: Melatonin administration in the postoperative period did not affect any of the objectively determined sleep parameters compared with placebo. No group difference was observed during the night time or daytime even though the overall sleep was disturbed postoperatively. Melatonin intervention did not result in improvements in the subjective parameters. Conclusions: We did not show an effect of 5 mg melatonin administration on sleep after laparoscopic cholecystectomy.

Using theoretical results about the homogeneous weights for Frobenius rings, we describe the homogeneous weight for the ring family $R_k$, a recently introduced family of Frobenius rings which have been used extensively in coding theory. We find an associated Gray map for the homogeneous weight using first order Reed-Muller codes and we describe some of the general properties of the images of codes over $R_k$ under this Gray map. We then discuss quasitwisted codes over $R_k$ and their binary images under the homogeneous Gray map. In this way, we find many optimal binary codes which are self-orthogonal and quasicyclic. In particular, we find a substantial number of optimal binary codes that are quasicyclic of index 8, 16 and 24, nearly all of which are new additions to the database of quasicyclic codes kept by Chen., Comment: Submitted to be published

A steady-state three-dimensional mathematical model for the dispersion of pollutants from a continuously emitting ground point source in moderated winds is formulated by considering the eddy diffusivity as a power law profile of vertical height. The advection along the mean wind and the diffusion in crosswind and vertical directions was accounted. The closed form analytical solution of the proposed problem has obtained using the methods of Laplace and Fourier transforms. The analytical model is compared with data collected from nine experiments conducted at Inshas, Cairo (Egypt). The model shows a best agreement between observed and calculated concentration.

BACKGROUND: The effect of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) on sexual function continues to be a controversial issue. The aim of this study was to evaluate sexual functions in Saudi patients suffering from BPH before and after TURP. PATIENTS AND METHODS: The influence of TURP on libido, erection and ejaculation was prospectively studied in 179 patients undergoing TURP for BPH. The risk factors studied for erectile dysfunction (ED) were old age, polygamy, comorbidities, late presentation, intraoperative bleeding, intraoperative capsular perforation and bacteriuria. Patients reporting ED underwent intracavernosal injection (ICI) of 20-40 AA(1/4)g of prostaglandin E1 (PGE1) before and/or after surgery. RESULTS: Before surgery, ED was present in 33/179 patients (18%) and was significantly associated with old age and comorbidities but not with polygamy or late presentation. In the patients with normal erection before surgery, dry ejaculation, ED and diminished libido developed after TURP in 71/134 (53%), 20/137 (15%), and 22/137 (16%), respectively. Postoperative ED was significantly associated with diminished libido (P=0.001), but not with postoperative dry ejaculation. The only significant risk factor associated with ED following TURP was capsular perforation. The response to ICI before and after TURP was comparable. CONCLUSION: ED associated with TURP is most likely of neurogenic origin due to capsular perforation, or of psychogenic nature as suggested by the significant association with diminished libido.

Purpose: To enhance clavulanic acid production using UV-mutagenesis on Streptomyces sp. NRC77.Methods: UV-mutagenesis was used to study the effect of Streptomyces sp. NRC77 on CA production. Phenotypic and genotypic identification methods of the promising mutant strain were characterized. Optimization of the fermentation medium and culture conditions were investigatedResults: Out of the screened mutants, 120A3 mutant isolate was selected as promising. The phenotypic properties of 120A3 mutant showed culture characteristics similar to those of Streptomyces species. Phylogenetic analysis of 16S rRNA gene sequence indicate that this strain has similarity (99 %) to Streptomyces sp.T2-7; therefore it was suggested as Streptomyces sp. MU-NRC77 and has Gen Bank accession no. KT953342.Conclusion: Improvement of CA yield by 48 % was obtained from fermentation medium and culture condition optimization. Further optimization by addition of H2O2 and activated charcoal to the production medium increased CA yield to 646.12 and 682.94 mg/L respectively, i.e., 83 % more than that obtained prior to addition.Keywords: Clavulanic acid, Medium optimization, Phenotypic and Genotypic identification, Streptomyces sp. MU-NRC77, UV-Mutagenesis

This study compared the antihypertensive effect and acceptability of a perindopril-based group with that of an atenolol-based group in Indian hypertensive type 2 (non-insulin-dependent) diabetic patients.100 ambulant patients aged between 35 and 69 years were recruited into this monocentric, randomised, double-blind study in two parallel groups for 1 year after a 1-month washout period on placebo. The setting was a tertiary care institution.All patients had stable, essential hypertension between 95mm Hg and 115mm Hg, type 2 diabetes with glycosylated haemoglobin (HbA(1C))12%, and albuminuria between 300mg and 3.5g/24 hours. There were 50 patients per treatment group and two patient population groups were studied, intention-to-treat (ITT) and per-protocol (PP). The former constituted all patients, whilst the latter included those without major protocol deviation and who completed the 12-month study.The study drugs were perindopril 4 to 8mg once daily or atenolol 50 to 100mg once daily. In each group therapeutic adjustment was planned by doubling the dose and then by the addition of hydrochlorothiazide 25mg daily. Nifedipine 30 to 60mg daily was subsequently added if the desired drop in blood pressure was not obtained. The ITT group was analysed by Student's t-test, and a 2-way analysis of variance was performed for the PP population.A comparison of the control of hypertension, biochemical abnormalities, blood sugar and adverse effects was performed in the atenolol group versus the perindopril group.On single-dose therapy after 1 month 17 patients (60%) had normal blood pressure [diastolic blood pressure (DBP)/=90mm Hg] on atenolol 50mg daily, while 13% (30.23%) had normal blood pressure (DBP/=90mm Hg) on perindopril 4mg daily (p = 0.013). In the ITT group the sitting systolic blood pressure (SBP) decreased by 14.4 +/- 22.3mm Hg at the end of the treatment period on atenolol from 174.4 +/- 17.9mm Hg at the initial period, and the sitting SBP decreased by 21.6 +/- 20.3mm Hg at the end of perindopril treatment from an initial value of 172.1 +/- 20.3mm Hg (probability 0.091). The sitting DBP decreased by 18.6 +/- 8.7mm Hg on atenolol from 100.5 +/- 4.8mm Hg at the initial period and by 15.8 +/- 9.1mm Hg on perindopril from 100.6 +/- 5.2mm Hg (probability 0.112). Glycaemic control was similar for HbA(1C) fasting and postprandial glucose in the ITT population, while fasting glucose increased over time from 10.7 +/- 4.1 to 12.0 +/- 3.4 mmol/L; p0.001 in the PP population in the atenolol group.The percentage of normalised patients (sitting DBP/=90mm Hg) was similar in both groups. Patients on perindopril monotherapy required more additional antihypertensive drugs compared with atenolol monotherapy. There was a significant increase in fasting blood sugar in the atenolol-based group (p0.001).

Summary The prognostic importance of hypertension at the onset of clinical lupus nephritis is not well established. We studied retrospectively 44 patients with lupus nephritis in order to ascertain the prevalence of hypertension at presentation and to investigate a possible association between hypertension and renal functional impairment. A correlation was also sought between hypertension and histological class of lupus nephritis. Hypertension was graded as mild (diastolic 95–99 mmHg), moderate (100-114) or severe (> 115). Impaired renal function (creatinine > 120 mumol/l) was graded as mild (120-200 mumol/l), moderate (200-350 mumol/l), or severe (> 350 mumol/l). Histological class and the presence of hypertensive renal vascular lesions was recorded. The prevalence of hypertension was 38%. There were 17 hypertensives and 27 normotensives. The incidence of renal impairment was greater in the hypertensives, 47% vs 18.5% (p = 0.04). Mean serum creatinine was also higher higher in this group (p = 0.02). The presence of hypertensive renal vascular lesions identified a high-risk subgroup who had a higher incidence of renal functional impairment and worse renal function than the hypertensive group as a whole. Even at an early stage, hypertension and hypertensive renal vascular lesions correlated well with renal functional impairment. Aggressive treatment of hypertension is therefore essential in early lupus nephritis in order to prevent further deterioration of renal function as the disease evolves.

Objective: To establish the correlation between clinical and biochemical parameters and the urinary patterns of proteinuria detected by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) in preeclampsia.Methods: 34 severe preeclamptics (BP ± 110 mm Hg diastolic and s= + + proteinuria) who were < 34 weeks gestational age were included in the study. Blood and urinary samples were obtained and the following tests performed: full blood count, serum urea, electrolytes and urates, 24-h proteinuria and creatinine clearance, and SDS PAGE.Results: The patients were divided into two groups depending on whether they excreted only albumin or both tubular and glomerular proteins as detected by SDS PAGE. There were no significant differences in maternal age, parity, gravidity, and gestational age between the groups. Systolic and diastolic blood pressures were significantly higher in those who excreted both glomerular and tubular proteins than in those who excreted albumin only: 173/116 versus 156/106 ...

Objective: An ultrastructural evaluation of heparan sulfate proteoglycan macromolecules in the glomerular basement membrane of African women with early-onset preeclampsia and assessment of the relationship of these anionic sites to the degree of proteinuria in these patients.Design: Prospective, descriptive study.Setting: Obstetric wards. King Edward VIII Hospital (KEH), Durban, South Africa, a tertiary referral center serving an underprivileged community.Subjects: Ten patients with early-onset preeclampsia (i.e., between 24 and 34 weeks of gestation) and five controls from adult trauma patients undergoing partial nephrectomy.Main Outcome Measure: Quantitative analysis of polyethyleneimine-labeled anionic sites within the glomerular basement membrane (GBM).Results: There was a significant reduction in labeling within the lamina rara externa of the early-onset preeclampsia (EOPE) group compared to control specimens (P ± 0.02). There was a strong correlation (r = –0.79) between the severity of proteinuria a...

Objectives: To compare Alcian-Blue (AB) binding of erythrocytes in African women with preeclampsia and normotensive controls matched for age, race, and gestational age, and to correlate it with serum creatinine, serum albumin, and 24-h urinary protein excretion.Design: Prospective descriptive study.Setting: Obstetric wards, King Edward VIII Hospital (KEH), Durban, South Africa. Tertiary referral center serving an underprivileged community.Subjects: Eleven patients with early onset preeclampsia–i.e., between 24 and 34 weeks of gestation–and 11 pregnancy-matched controls.Main Outcome Measures: Alteration in AB binding in preeclampsia compared to matched controlsResults: AB binding was significantly decreased in the preeclamptic group [31.05 ng/106 cells compared to controls 65.12 ng/106 cells (P 0.7) between AB binding and serum creatinine but not with serum albumin and level of proteinuria.Conclusion: As altered erythrocyte charge may infer alterations in glome...

We studied alcian blue (AB) binding to red blood cells (RBC) [ABRBC] in 89 children and adults with a variety of glomerular diseases. ABRBC was significantly reduced in the group as a whole when compared with healthy controls (P < 0.001). A moderate correlation between the degree of proteinuria and ABRBC was detected in the children with renal disease (r = 0.43, P < 0.001), but not in adult patients. A significant reduction in ABRBC was detected in 30 of the above children who had Steroid Responsive Nephrotic Syndrome (MCNS) compared to their controls (40.57 +/- 16.6 v. 75.09 +/- 7.81, P = 0.001). A similar decrease from normal values was observed in other childhood glomerular diseases: focal glomerulosclerosis, post-streptococcal glomerulonephritis, membranous nephropathy (52.31 +/- 26.07 v. 79.44 +/- 5.88, P = 0.001). Mean ABRBC was lower in MCNS than other histological groups (P = 0.0518). ABRBC was age-dependent (r = -0.399, P < 0.02). These findings provide further indirect evidence of the relative roles of charge and size selective filters in glomerular basement membrane (GBM) in renal diseases, and suggest that depletion of anionic charge may be a major cause of proteinuria in MCNS.

Cellular immune mechanisms may be involved in the pathogenesis of tubulointerstitial nephritis associated with several forms of primary glomerulonephritis. This study aims to characterize the mononuclear leukocytes infiltrating the interstitium in patients with primary membranoproliferative glomerulonephritis (MPGN) and correlates the degree and nature of the infiltrate with renal function. Cellular identification using monoclonal antibodies to leukocyte cell-surface antigens was conducted on renal biopsy specimens from 17 patients with type I primary MPGN (group 1) and 10 controls with various forms of nonproliferative glomerulonephritis (group 2). The majority (14) of the 17 patients in group 1 were black South Africans. Renal function was assessed at the time of renal biopsy. Patients with MPGN had a significant increase in the number of interstitial total leukocytes (LCA), T lymphocytes (T), and B lymphocytes (B) compared with controls. Although the interstitial monocyte (KP(1)) count was also increased in MPGN patients, the difference was not significant. Recorded numbers of cells per square millimeter in group 1 versus group 2 are as follows: LCA, 1306 +/- 1254 versus 138 +/- 91 (P0.001); T, 638 +/- 547 versus 42 +/- 60 (P.0.01); B, 161 +/- 165 versus 57 +/- 50 (P=0.02); and KP(1), 125 +/- 153 versus 54 +/- 59 (P=0.17). As noted in previous studies, the T lymphocyte was the dominant cell, comprising 48.8% of the total count. However, the combined number of T lymphocytes, B lymphocytes, and monocytes accounted for only 70.6% of the total leukocytic interstitial count, implying that the majority of the remaining 29.4% of the cells were mononuclear leukocytes that did not express the antigens we stained for. There was a moderate correlation between the number of interstitial total leukocytes, and impairment of renal function as measured by both the serum creatinine (r = 0.43) and creatinine clearance (r = -0.41). This correlation also existed for the individual cells comprising the infiltrate and was strongest for T lymphocytes (r = 0.63) followed by monocytes (r =0.46) and B lymphocytes (r = 0.41). In conclusion, we have demonstrated a significant mononuclear leukocytic interstitial infiltrate in our patients with type I MPGN and a correlation between all cells of this infiltrate with impaired renal function. This correlation was strongest for the most frequently observed cell, the T lymphocyte.

This study compares our experiences of the incidence and etiology of acute renal failure in pregnancy (ARF-P) in patients requiring hemodialysis, a decade after a previous publication from our institution. A retrospective analysis of the hospital records of 42 patients with a diagnosis of ARF-P during a 3-year period from 1990 to 1992 was undertaken [16% of the total number of acute renal failure (ARF) patients needing hemodialysis]. The incidence of ARF-P (expressed relative to all cases of acute renal failure requiring hemodialysis) decreased from 24.6% (1978) to 16% (1992: p = 0.03). Preeclampsia-eclampsia (PE:E) replaced septic abortion as the principal cause of ARF-P. In those patients with PE:E, thrombocytopenia (platelet count < 150 x 10(9)/L) occurred in all, while 33% developed the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Ingestion of herbal toxins was noted mostly in patients with septic abortion. Maternal mortality was 5% and was due to multiorgan failure complicating septic abortion. The perinatal mortality of 55% occurred in women with early gestation, thrombocytopenia, and high serum creatinine levels. Acute renal failure in pregnancy continues to present a challenge in South Africa, a developing country. There were significantly more obstetric than gynecological causes in 1992 (p = 0.0003). This could be attributed to the steady decline in septic abortion since 1978. The main contributor to obstetric-related causes was PE:E. Greater emphasis should therefore be placed on detecting hypertension at antenatal visits.(ABSTRACT TRUNCATED AT 250 WORDS)