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Previous studies have demonstrated residual complement-mediated deposits in repeat kidney biopsies of C3 glomerulopathies (C3G) (dense deposit disease (DDD) and C3 glomerulonephritis) following eculizumab treatment, despite some clinical improvement. With residual complement deposition, it is difficult to determine whether there is a reduced complement-mediated endothelial cell injury. We validated that myeloperoxidase (MPO) immunohistochemical staining identified glomerular endothelial cell injury in crescentic glomerulonephritis and C3G. We report that MPO staining in the glomerular endothelium of the post-treatment kidney biopsy was significantly reduced after 3 years of eculizumab treatment and clinical improvement in a 5-year-old boy with initial DDD and secondary crescent formation. We find that immunostaining for MPO is a useful method to compare glomerular endothelial injury in C3G following eculizumab treatment. This finding also supports the notion that eculizumab, a C5 blocker, may not mainly block C3 deposits in the glomeruli but significantly blocks final activation of the complement cascade, thus reducing glomerular endothelial cell injury.

The overlap syndromes of anti-neutrophil cytoplasmic antibodies (ANCA)-associated crescentic glomerulonephritis (AACGN) and variants of immune complex medicated glomerulopathy (ICMGN) have been reported. But very few have compared AACGN alone with the overlap syndromes (AACGN plus ICMGN). The aim of this retrospective study was to make that comparison, following serum creatinine (sCr) to determine whether the two groups (AACGN-only group versus overlap group) would behave differently over time. We identified 14 cases with dual diagnoses of AACGN and various ICMGN in the overlap group. Data were collected and compared with 15 randomly selected AACGN-only cases over the similar period of time. The overlap syndrome represented 0.35% of our overall biopsies (14/4049). All 14 patients were ANCA positive and had crescentic formation. The percentage of crescents in the biopsies ranged from 10 to 78%. ICMGN included the following: membranoproliferative glomerulonephritis, post-infectious glomerulonephritis, membranous glomerulopathies, idiopathic mesangial proliferative glomerulonephritis, lupus nephritis, and IgA nephropathy. With the exception one biopsy revealing lupus nephritis class III, most of the ICMGN were mild. When compared to the AACGN-only group, there were no significant differences in clinical and histologic indices including age, percent of crescents, and sCr (on biopsy days, and over the follow-up periods), although the numbers of follow-up cases were limited over time. Our findings suggest that AACGN was the dominant disease process in the majority of overlap syndromes between AACGN and ICMGN, similar to the clinical processes of AACGN-only disease, therefore, the AACGN in overlap syndrome cases should be the main target for clinical management.

Kidney injury molecule-1 (KIM-1) staining has been shown to be very useful in identifying acute proximal tubular injury, but its sensitivity, specificity and predicting values for the recovery of renal function after injury in renal biopsies have not been well established. In the first study, we randomly selected 184 renal biopsies from a wide age range of patients (children to elderly) with various renal diseases. KIM-1 staining scores were significantly correlated with serum creatinine (sCr) levels (P

To assess lead poisoning among a pediatric population in Gaza Strip, the Palestinian Authority.A total of 1705 questionnaires and blood samples were collected from children aged 2-6 years, by the finger stick capillary procedure, for the assessment of blood lead level (BLL), using the LeadCare kits. The samples were collected from children living close to lead processing units (hotspots) and far 100-500 m away (general population). Management of elevated BLL was achieved by gavage of chelating agent d-penicillamine at a dose of 30 mg kgDistribution of children in Gaza Strip by sampling process illustrated those 326 children (19.1%) living in lead processing units (hot spots) and 1379 children (80.9%) from location far away 100-500 m from host spot (general population). The mean BLL was 10.4 μg/dl. A total of 440 children (25.8%) were found to be having BLL ≥ 10 μg/dl while 1265 children (74.2%) have BLL 10 μg/dl. BLL 10 μg/dl was taken as a cut point due to CDC standards. The prevalence of BLL in hotspot areas in children who were exposed to lead and have BLL ≥ 10 μg/dl was 95.7% while in general population it was 9.3%. The difference between the study population was statistically significant (p 0.01). Statistical significant differences between the study populations were found among several independent variables of risk factors such as household location and exposure sources, and occupational exposure. Gavage of d-penicillamine significantly reduced BLL to the acceptable level (BLL 10 μg/dl).Childhood lead poisoning accounts for a substantial burden in Gaza Strip. Hotspots of lead-related industries are the high risk areas that contributing to high BLLs in children. d-Penicillamine was effective in the treatment of lead poisoning among children. Health education and treatment campaigns should be designed to minimize or prevent childhood lead poisoning in Gaza Strip.

Introduction/Objective IgG4 related disease, a systemic autoimmune inflammatory disorders, can be identified by high% of IgG4 positive plasma cells, thus IgG4 staining in paraffin embedded tissue is widely available in the most of pathology labs. IgG4 staining has been found useful to identify primary MGN (PLA2R and/or THSD7A positive) by others and us. This study was to scrutinize the findings of primary vs secondary MGN needed for IgG4 staining as a screening tool in our renal pathology practice over pasts 5 years Methods/Case Report IgG4 staining in paraffin embedded tissue was performed in 45 primary MGN and 43 secondary MGN after the clinical history was reviewed and a possibility of primary MGN cannot be excluded. In addition, both groups of cases were also stained for PLA2R. Detail correlation with clinical history was analyzed. Results (if a Case Study enter NA) Totally 82 % (37/45) of primary MGN was found diffuse positive for IgG4 staining at 2+ intensity in the glomeruli. Seven out of eight remaining primary MGN cases with either negative or weak IgG4 stained MGN were found to have diffuse resolving features by electron microscopy but there was still positive PLA2R staining in the glomeruli. All secondary MGN were stained negatively for both IgG4 and PLA2R and we found that etiologies of the secondary MGN included membranous lupus nephritis, infection, GVHD, or variants of cancers. Conclusion Our data indicate that IgG4 staining along (without IgG1-3 staining) is a reliable screening tool to confirm the majority of primary MGN vs secondary MGN in paraffin embedded tissue. As both PLA2R+ and THSD7A+ primary MGN are both IgG4 related, the IgG4 staining may potentially represent a wider range of scope in identifying primary MGN. In addition, negative/weak IgG4 staining in PLA2R-positive MGN most likely represents a primary MGN with resolving features.

Electron microscopy (EM) has been mainly used for identifying ultrastructural abnormalities such as fusion of foot processes and immune complex deposits in glomeruli. However, electron microscopic findings in renal tubules can provide either diagnostic evidence (unique finding) or supportive evidence (additional finding) for final diagnosis. Here we present multiple situations that EM can be used for drawing conclusions of various drug-associated nephrotoxicity. Multiple cases with drug-induced nephrotoxicity are reviewed, including clinical history, EM findings, and serum creatinine (sCr) levels, prior to renal biopsy and during follow-up. Two cases with nephrotoxicity by aminoglycoside antibiotics showed acute tubular injury with EM findings of myeloid bodies, characterized by laminated dense materials in lysosomes in both proximal and distal tubular epithelium (diagnostic evidence). Five cases of vancomycin associated nephrotoxicity presented with acute tubular injury and vancomycin casts in distal tubules, characterized by central laminated casts in the lumina of distal tubules (supportive evidence). Vedolizumab, a humanized monoclonal antibody used in treating Crohn's disease, can cause T-cell dominant acute interstitial nephritis, with EM revealing lymphocytic infiltration into tubules as tubulitis (supportive evidence). Four of Seven cases (5/8) cases had renal functional recovery upon follow-up check for sCr. EM findings of characteristic changes in renal tubules can be particularly useful as either diagnostic or supportive evidence, in correlation with clinical history and etiologies of nephrotoxicity. Therefore, EM should not only focus on glomerular changes, but renal tubular changes as well.

BACKGROUND: Recent studies suggest that unhealthy food practices and lack of exercise are the main cause of the progressive increase in the obesity prevalence. AIM: We aim to assess the prevalence of obesity among school students and its relationship to dietary and physical habits. METHODS: A cross-sectional study from 18 intermediate and high schools located in Taif, Saudi Arabia, between April 2014 and June 2015. We excluded any student with a psychological disease or chronic diseases. We calculated the body mass index (BMI) of students by measuring their height and weight. Dietary, physical, sleep habits, and socioeconomic status were assessed. RESULTS: A total of 2943 students participated with a mean age of 15.4 ± 1.7 years. The majority of these were boys and attending government schools with a mean BMI 22.7 ± 8.6 kg/m2. Overall, 13.6% were overweight and 12.8% were obese. One-third of students report a sedentary lifestyle. Compared to girls, boys were more likely to have lower BMI (p < 0.001), be overweight (p < 0.001), exercise for >300 min/week (p < 0.001), own electronic devices other than smartphone (p < 0.001), use the electronic devices 300 min/week (p < 0.001), and walk to and from school at least once weekly (p < 0.001). CONCLUSION: A quarter of the students were either overweight or obese. Girls were more likely to be obese with less favorable socioeconomic, media consumption, dietary, and physical profiles.

Background: Tuberculosis and cryptococcosis co-infection usually occurs in immunocompromised patients with impaired cell-mediated immunity. Here, we report a case of disseminated tuberculosis with co-existing pulmonary cryptococcosis in a non-HIV patient. However, there is a history of preceding exposure to anti-tumor necrosis agents.

Background: The primary aim was to assess the prevalence of overweight and obesity among the participants and its relationship to obesity awareness. Methods: A cross-sectional study that included intermediate and high schools students was conducted between April 2014 and June 2015. Anthropometric measurements were obtained by the researchers and body mass index (BMI) was calculated. We used the obesity risk knowledge (ORK-10) scale to assess obesity awareness. Participants who answered ≥ 5 out of 10 questions correctly were considered to be aware. Result: A total of 528 students were enrolled (mean age, 15.58 years). The mean BMI was 22.37 kg/m 2 , and 27.6% were either overweight or obese. The mean ORK-10 score was 3.15 and 25.4% were considered to be aware. Compared to those who were non-aware, participants in the aware group were more likely to be older (P < 0.001), male (P < 0.001), attend high school (P < 0.001), eat dinner with their families (P = 0.021), eat fruit at least daily (P = 0.027), and consider obesity to be a disease (P < 0.001). Conclusion: Only 25.4% of students who participated were considered to be aware about obesity. Those who were aware were more likely to be older male high school students. J Clin Med Res. 2017;9(6):520-524 doi: https://doi.org/10.14740/jocmr2987w

Background Hospital-acquired and ventilator-associated pneumonia (HAP/VAP; nosocomial pneumonia) due to Gram-negative pathogens are associated with significant morbidity and mortality; treatment options for multidrug-resistant infections are limited. The pivotal phase III REPROVE trial evaluated the efficacy of ceftazidime-avibactam (CAZ-AVI) vs meropenem in the treatment of patients with HAP/VAP. Study results for prespecified analyses per US Food and Drug Administration–recommended trial end points are reported here. Methods Hospitalized adults with HAP/VAP proven or suspected to be caused by a Gram-negative pathogen were randomized 1:1 to receive CAZ-AVI or meropenem for 7 to 14 days. The primary outcome was 28-day all-cause mortality in the intent-to-treat (ITT) population. Secondary outcomes included clinical cure at test of cure (TOC) in the ITT and microbiological ITT (micro-ITT) populations, and safety and tolerability throughout the study. Results hundred seventy randomized patients received treatment and were included in the ITT population (CAZ-AVI, n = 436; meropenem, n = 434). CAZ-AVI was noninferior to meropenem for the primary end point (28-day all-cause mortality; ITT) based on the prespecified 10% noninferiority margin (CAZ-AVI, 9.6%; meropenem, 8.3%; difference, 1.5%; 95% confidence interval [CI], –2.4% to 5.3%) and for the clinical cure end point in the ITT population based on a prespecified –10% noninferiority margin (CAZ-AVI, 67.2%; meropenem, 69.1%; difference, −1.9%; 95% CI, –8.1% to 4.3%). Clinical cure rates at TOC for patients infected with CAZ-nonsusceptible pathogens were similar (CAZ-AVI, 75.5%; meropenem, 71.2%; micro-ITT). Safety data were consistent with established safety profiles for both agents. Conclusions CAZ-AVI provides an important new treatment option for HAP/VAP due to Gram-negative pathogens, including CAZ-nonsusceptible strains.

Background/Aims: Substance abuse is a global health problem with harmful consequences for the individual, family and society. This study explored the personal factors contributing to substance abuse from the perspective of Jordanian clients and its implications for occupational therapy. Methods: An exploratory qualitative study was conducted using a questionnaire with nine open-ended questions to explore participants' experience of their illness and recovery. Inductive content analysis was used to analyse data. Results: Participants were 146 Jordanian substance abuse clients (142 male) with a mean age of 28 years. Five main themes emerged: fears; personal traits; helpers; speaking out; the best solution. Conclusions: Occupational therapists might design client-centred interventions for substance abuse where they consider the perspectives of clients with regard to the personal traits that contribute to their recovery. Occupational therapy services that take an interdisciplinary team approach are recommended for clients diagnosed with substance abuse.

To examine the relation between body mass index (BMI) and the academic performance of students from Taif city, Kingdom of Saudi Arabia (KSA) using the grade point average (GPA). Method: A cross-sectional study that includes students from intermediate and high schools located in Taif city, KSA between April 2014 and June 2015. Height and weight were measured and BMI calculated. Related risk factors including dietary habits, activity, parent's education, sleeping pattern, and smoking were recorded. Result: A total of 14 schools included 424 students. 24.5% were either overweight or obese. The mean age was 15.44 year, 74.8% of the students were male, 53.8% were high school students, and 83.7% attended public schools. The mean overall GPA was 82.44% and the mean GPA for science subjects was 70.91%. No statically significant difference in the BMI was found between those who achieved greater than 90% of the overall grade compared with those who achieved less than 90%. Post hoc 1-way-analysis of variance showed that obese students were performing worse in physics than normal weight peers (p=0.049). Students who achieved greater than 90% overall grade are more likely to attend private school (p less than 0.05), live with their parents (p=0.013), having educated parents (p=0.037), getting optimal sleep (p less than 0.05), and they rarely eat their food outside their home (p less than 0.05). Conclusion: There was no correlation between the BMI and school performance, except in physics results where obese students perform worse than normal-weight students.

It was believed that fluid flow and the laminar to turbulent transition delay were more easily controlled on smooth surfaces until the discovery of the grooved shark skin surface that changed the whole idea of how smooth the surface should be to have high flow in submerged surfaces. Riblets have gained renewed interest in academic fields of study and in industry due to several advantages in manipulating the turbulence boundary layer. Drag reduction using small, longitudinally grooved surface provides up to 10 % lower energy consumption in several applications. This review provides an overview of the mechanism of drag reduction with riblets, the different geometries and types, and the latest developments in drag reduction riblet technology.

Researchers have investigated whether customers would be willing to pay more for mass customised products and also whether they would wait to receive them. But surprisingly, these two issues have not been examined simultaneously. We describe a study where we use conjoint analysis, a market research technique, to examine the customer trade-off between price, delivery waiting time and type of customisation in the walking stick market in Australia. Our approach should be relatively easily repeatable in other mass customisation markets.

Introduction: Surgical ligation is used in the treatment of painful varicocele. We conducted this retrospective study to establish the effectiveness of varicocele ligation for the treatment of pain and to examine the factors that might predict outcomes. Patients and Methods: Eighty-three patients underwent varicocele ligation for pain during the study period. Review of medical records and postal questionnaires were used to document patient age, grade and location of varicocele, duration and quality of pain, surgical approach, complications and the resolution of pain. Results: Follow-up was available for 68 (82%) patients. In 76.5% patients there was marked or complete resolution of pain and 14 had partial resolution. Only 9% patients had persistent pain and 1.5% patient reported worsening pain. The quality of pain, dull ache or dragging, was the only factor that correlated with the resolution of pain following surgery. Conclusions: Surgical ligation is an effective treatment for the painful varicocele. The quality of pain at presentation may predict outcomes in selected patients.

The detection and prevention of lead toxicity and poisoning among children have been a major international public health priority. The distribution and severity of lead toxicity are determined largely by lead in gasoline emissions, proximity to environmental sources, point sources, hot spots, and episodic exposures, sometimes from food sources (Richter 1992). Infants and children are more vulnerable to lead exposure because of more rapid airway and gastrointestinal absorption, hand-to-mouth activities, and increased susceptibility of the developing brain to the neurotoxic effects of lead (Grigg 2004; Needleman 2004). High exposures produce acute poisoning, with abdominal pain, constipation, anemia, irritability, bone and joint pain, and convulsions. Lead exposure has been linked to increased risk for diverse health outcomes, including infertility and cancer (Lustberg and Silbergeld 2002; Silbergeld 2003). Today, the major concerns regarding childhood lead exposures are the health risks associated with exposures once considered “normal.” These low-level exposures produce subtle and not readily detectable neurobehavioral effects on personality, intellectual development, behavior, and achievement (Delville 1999; Mendelsohn et al. 1998). New data suggest that a safe threshold without adverse neurobehavioral effect is lower than the U.S. Centers for Disease Control and Prevention threshold of 10 μg/dL for intervention, and that in fact a safe level may not be detectable (Canfield et al. 2003; Chiodo et al. 2004). In the Middle East today, the major reported point sources of lead exposure are industrial sources, including smelters, battery factories, and radiator repair shops; flour from traditional stone mills; and the occasional burning of wastes (El Sharif et al. 2000; Hershko et al. 1989). Leaded gasoline remains the major source of environmental lead pollution, and > 300,000 tons of leaded gasoline are sold annually in Israel and the Palestinian Authority (Israel Ministry of Infrastructure 2004). Children of lead-exposed workers are at high risk for lead poisoning (Friedman et al. 2005). Exposure and elevated blood lead (PbB) levels in children also comes from the use of traditional cosmetic kohl (kahal) among women and young girls (Nir 1992; Parry 1991). Isolated cases of lead poisoning from the use of dental powders such as Saoott and Cebagin, which can contain as much as 51% lead, have been reported (Abdullah 1984). Information has not been readily available on “background” community-wide sources, notably from gasoline and general air pollution by lead and from high-risk spots in crowded areas. Past work in Israel suggested nontrivial risks from lead exposure in urban areas at levels once considered safe (Richter et al. 1980, 1986). Results of previous studies on childhood lead exposure in the Palestinian Authority, Jordan, and Israel are summarized in Table 1. Table 1 Previous studies on lead exposure in the Palestinian Authority, Jordan, and Israel. Investigation of an episode of familial lead poisoning led to the discovery that the source was flour contaminated by lead from metal fittings of the axle on the stone grinding wheel, not only in the index village but also in many others (Hershko et al. 1989). A similar episode later occurred in eight children of a family that owned a flour mill in Hebron (El Sharif et al. 2000). We report the results of the childhood lead poisoning prevention study (1996–2000) in Israel, Jordan, and the Palestinian Authority supported by U.S. Agency for International Development (USAID)/Middle East Regional Cooperation–Centers for Disease Control and Prevention (West Bank and Gaza). The objectives of the study were a) to assess the distribution of PbB levels; b) to search for sources of exposure to lead among children in Israel, Jordan, Gaza, and the West Bank, including so-called “hot spots”; c) to assess the utility and practicality of screening, case finding, source identification, and prevention, using a new state-of-the art method for fingerstick (FS) measurement of PbB; d) to determine whether there is a need for routine surveillance and screening in each of the four regions; e) to determine whether reduction in use of leaded gasoline and total emissions resulted in reduction in PbB in children in the region; and f ) to promote appropriate interventions. The outbreak of political conflict and violence in September 2000 disrupted progress toward the last objective. The four regions differ substantially from one another in terms of standard indices of development, socioeconomic status, and public health (Table 2). However, three of the four regions—Israel, West Bank, and Gaza—share a common source of fuel, and access to water in all four regions is closely interrelated. Lead emissions from stationary and mobile sources are also transported across boundaries as air pollution (Silbergeld 1995). Because socioeconomic status is often a predictor for lead exposure among children, we expected to find variations in PbB levels among the different regions. The advent of the LeadCare FS method offered new possibilities for cost-effective and efficient field investigations. Table 2 Statistical information for Jordan, West Bank and Gaza, and Israel.

We report the case of an 8-month-old female infant presenting with bilateral, diffusely enlarged kidneys. A diagnosis of bilateral, universal nephroblastomatosis was made on tissue biopsies from both kidneys after correlation with the radiological findings. As far as we know, this is the oldest patient reported with this diagnosis in the English literature (they are usually younger than 4 months). The patient was treated with chemotherapy with very good response and almost 1 year later she is showing no signs of recurrence of her disease.

OBJECTIVE To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS Patients across specialities with a urethral catheter in situ for ≥ 48 h and ≤ 7 days were recruited at the time of catheter removal. Patients were excluded if they had had recent genitourinary surgery or were on antibiotics. Eligible patients were randomly assigned to a 48-h course of either ciprofloxacin or placebo tablets starting 2 h before catheter removal. A catheter specimen of urine was obtained before the start of the trial medication. The follow-up was at 7 and 14 days after catheter removal, with a questionnaire for UTI symptoms, and a mid-stream urine sample was taken. RESULTS Forty-eight patients were recruited and had a complete follow-up (25 received ciprofloxacin and 23 placebo). Of the ciprofloxacin group, four patients (16%) had a UTI at the follow-up after catheter removal, and two were symptomatic. The UTI in two patients (including one of those symptomatic) was newly developed after catheter removal; the other two UTIs were a result of failure to resolve a catheter-associated UTI. All these UTIs in the ciprofloxacin group were resistant to ciprofloxacin. Of the placebo group, three patients (13%) had a UTI at the follow-up after removal, and one patient was symptomatic. The UTI, newly developed after catheter removal, was resistant to ciprofloxacin. The other two patients were asymptomatic; their UTIs were a result of failure to resolve a catheter-associated UTI, and one was resistant to ciprofloxacin. CONCLUSIONS The risk of UTI (both symptomatic and asymptomatic) after removing a urethral catheter is real, even in absence of catheter-associated UTI before removal. UTIs occurring after removing a short-term urinary catheter had a high rate of resistance to ciprofloxacin. There was no detectable significant benefit in using prophylactic ciprofloxacin to reduce the UTI rate after catheter removal.

One third of non-Hodgkin lymphomas are extranodal, however it is uncommon for the lower urinary tract to be involved. We present an unusual case of a low-grade primary lymphoma affecting the prostate, which responded well to radical radiotherapy.

In the UK, 10 000 new cases of bladder cancer are reported per annum. Earlier diagnosis and better care have improved survival rates, but the incidence is still rising. This article updates the current understanding of bladder cancer diagnosis and management.

We report an interesting case of testicular seminoma in a 57-year-old man who had received treatment for a pulmonary extra-gonadal seminoma 22 years previously. This case indicates that patients with extra-gonadal germ-cell tumours should either be followed up for life or, if discharged, should be informed of the potential risk of developing testicular tumour in the future and advised of the need for regular self-testicular examination.

Primary lymphoma of the bladder is a rare non-epithelial bladder tumour. It is usually non-Hodgkin’s lymphoma with mucosa-associated lymphoid tissue (MALT) lymphoma being its predominant subtype. Most of the literature has been limited to individual sporadic case reports. We present 2 cases of the MALT-type primary lymphoma of the urinary bladder which were treated in our unit. Both patients were females with a history of recurrent urinary tract infections. They were treated successfully with chemotherapy alone. We also present a review of the literature emphasising the clinical presentation, the morphological and immunophenotypic features and the various treatment modalities of this rarely seen bladder pathology.