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AIM To review the incidence of graft loss and acute rejection among renal transplant recipients with early reduction of immunosuppression for BK viremia. METHODS We performed a retrospective analysis of consecutive de-novo kidney-only transplants from January 2009 to December 2012 to evaluate the incidence of Polyoma-virus associated nephropathy (PyVAN). Recipient plasma was screened for BKV DNA via quantitative polymerase chain reaction (PCR) at months 1, 3, 6, 9 and 12 post-transplant and on worsening graft function. Immunosuppression was reduced at ≥ 3-log copies/mL. Those with viremia of ≥ 4-log copies/mL (presumptive PyVAN) underwent renal transplant biopsy. Presumptive PyVAN (PP) and definitive PyVAN (DP; biopsy-proven) were treated by immunosuppression reduction (IR) only. RESULTS Among 319 kidney transplant recipients, the median age was 53 years (range 19-83), 65.8% were male, and 58.9% were white. Biopsy-proven acute rejection was found in 18.5% within 0-168 wk. Death-censored graft loss occurred in 5.3% (n = 17) and graft loss attributable to PyVAN was 0.6% (n = 2). Forty-seven patients were diagnosed with PP (14.7%) and 18 (5.6%) with DP. Graft loss among participants with PyVAN (8.5%) and those without (4.8%) was not significantly different. Deceased donor kidney transplantation (OR = 2.3, 95%CI = 1.1-4.6) and AR (OR = 2.3, 95%CI = 1.2-4.7) were associated with PyVAN in the multivariate analysis. BK viremia between 3 and 4-log copies/mL occurred in 27 patients, all of whom underwent IR. Of these, 16 (59%) never developed PyVAN while 11 (41%) developed PyVAN (4 DP, 7 PP) within a range of 11-39 wk. CONCLUSION Instituting an early reduction of immunosuppression, in the absence of adjunctive antivirals, is effective at preventing PyVAN and may be associated with a lower incidence of graft-loss without a reciprocal increase in the incidence of acute rejection.

BACKGROUND: To our knowledge, the correlation between ultrasonographic enthesopathy and severity in psoriatic arthritis (PsA) has been done before. However, the correlation between ultrasonography of enthesopathy and the Psoriatic Arthritis Disease Activity Score (PASDAS) have not been done.AIM: To compare the results of ultrasonographic enthesopathy of foot and PASDAS in PsA.MATERIALS AND METHODS: A total of 65 PsA patients were involved and divided into two groups. The first group of 35 active PsA and the second group of 30 ages and sex matched inactive PsA as a control group were recruited in this study. Both groups were evaluated by examination, radiological findings and ultrasonography.RESULTS: Of 70 entheses in 35 active PsA patients, the most entheseal abnormalities were tender plantar fascia (18.5%), tender Achilles tendon (37.8%). PASDAS was a direct highly significant correlated with plantar fascia and Achilles tendon thickness in in active PsA (r = 0.823 and r = 0.796, p < 0.001 respectively).CONCLUSION: Musculoskeletal US is an accurate and low-cost method for assessment of enthesopathy with significant correlation to disease activities in psoriatic arthritis.

Objective To evaluate the role of transarterial chemoembolization “TACE”, radiofrequency ablation “RFA” and combination of both techniques in management of hepatocellular carcinoma “HCC”. Patients and methods: This study was carried out at Al-Azhar University Hospital (New Damietta) during the period from May 2013 to June 2015. It included forty patients were included in this study (27 males and 13 females), with age ranged from 43 to 68 year (mean age 51 year). They were divided into three groups after laboratory and radiological assessment: group 1 treated with TACE, group 2 treated with RFA and group 3 treated with combined therapy. The response was evaluated by triphasic MDCT, alpha-fetoprotein as well as clinical follow-up and classified as complete and partial response, and the overall survival was recorded. Results: There were no major complications detected. At 3 month follow-up, there was complete response “CR” in 32 patients (80%), and partial response “PR” in 8 patients (20%). At 6 months, there was complete response in 34 patients (85%), and partial response in 3 patients (7.5%). At 12 months, there was complete response in 33 patients (82.5%), and partial response in one patient (2.5%). It is proved that complete response with high percentage achieved by combined therapy than either by TACE or by RFA (100%, 88.46% and 75% respectively), with the overall survival was 85%. Conclusion: The study showed that combined therapy achieved better results regarding complete response and overall survival rate than RF or TACE alone.

Neonates born very preterm (before 32 weeks’ gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.

Importance Preterm infants must establish regular respirations at delivery. Sustained inflations may establish lung volume faster than short inflations. Objective To determine whether a ventilation strategy including sustained inflations, compared with standard intermittent positive pressure ventilation, reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks’ postmenstrual age without harm in extremely preterm infants. Design, Setting, and Participants Unmasked, randomized clinical trial (August 2014 to September 2017, with follow-up to February 15, 2018) conducted in 18 neonatal intensive care units in 9 countries. Preterm infants 23 to 26 weeks’ gestational age requiring resuscitation with inadequate respiratory effort or bradycardia were enrolled. Planned enrollment was 600 infants. The trial was stopped after enrolling 426 infants, following a prespecified review of adverse outcomes. Interventions The experimental intervention was up to 2 sustained inflations at maximal peak pressure of 25 cm H2O for 15 seconds using a T-piece and mask (n = 215); standard resuscitation was intermittent positive pressure ventilation (n = 211). Main Outcome and Measures The primary outcome was the rate of BPD or death at 36 weeks’ postmenstrual age. There were 27 prespecified secondary efficacy outcomes and 7 safety outcomes, including death at less than 48 hours. Results Among 460 infants randomized (mean [SD] gestational age, 25.30 [0.97] weeks; 50.2% female), 426 infants (92.6%) completed the trial. In the sustained inflation group, 137 infants (63.7%) died or survived with BPD vs 125 infants (59.2%) in the standard resuscitation group (adjusted risk difference [aRD], 4.7% [95% CI, −3.8% to 13.1%];P = .29). Death at less than 48 hours of age occurred in 16 infants (7.4%) in the sustained inflation group vs 3 infants (1.4%) in the standard resuscitation group (aRD, 5.6% [95% CI, 2.1% to 9.1%];P = .002). Blinded adjudication detected an imbalance of rates of early death possibly attributable to resuscitation (sustained inflation: 11/16; standard resuscitation: 1/3). Of 27 secondary efficacy outcomes assessed by 36 weeks’ postmenstrual age, 26 showed no significant difference between groups. Conclusions and Relevance Among extremely preterm infants requiring resuscitation at birth, a ventilation strategy involving 2 sustained inflations, compared with standard intermittent positive pressure ventilation, did not reduce the risk of BPD or death at 36 weeks’ postmenstrual age. These findings do not support the use of ventilation with sustained inflations among extremely preterm infants, although early termination of the trial limits definitive conclusions. Trial Registration clinicaltrials.gov Identifier:NCT02139800

A 63-year-old man with HIV (human immunodeficiency virus) infection and end-stage renal disease, treated with lanthanum carbonate phosphate binder for 4 years, presented with anemia and an upper gastrointestinal bleed. Upper endoscopy revealed a nodular hyperplastic epithelium, with an endoscopic ultrasound confirming hyperechoic material within the nodules. Light microscopy showed collections of histiocytes and multinucleated giant cells containing brown granular cytoplasmic material and extracellular crystalline material, a finding confirmed by electron microscopy. Similar pathologic findings associated with lanthanum exposure have been described recently. In our patient, lanthanum carbonate treatment was withdrawn and gastrointestinal bleeding has since ceased. The patient was exposed to a high amount of lanthanum over a long period, which may explain his adverse reaction. However, other contributing factors, such as competing medications or comorbid conditions, also may have increased his sensitivity to the drug.

Myopia is the most common ocular disorder causing visual impairment worldwide. It is a public health issue in many parts of the world. Compared with Caucasian or other ethnicities, its prevalence in Asians, especially Japanese, Koreans, and Chinese, is much higher. Environmental and genetic factors play important roles in myopia development. Myopia is a multifactorial disease. Time spent outdoors, amount of near work, and educational level influence myopia onset and progression. Recent advances in modern technology and molecular biology including linkage analyses, candidate gene analysis, genome-wide association studies (GWAS), whole-exome sequencing (WES), and next-generation sequencing (NGS) have led to mapping and identifying many myopia-associated gene loci and variants. Understanding the genetic basis may help in myopia prediction and prevention. This review is to summarize recent major findings in myopia genetics with a focus in Asian populations.

BACKGROUND: To our knowledge, the importance of US findings, pain (brief pain inventory (BPI)) and disability in osteoarthritic knee (OA) pain patients remain uncertain. AIM: The objectives are to evaluate the correlation of US findings, pain (brief pain inventory (BPI)) and disability in OA pain patients. MATERIALS AND METHODS: Eighty - three patients with OA knee were divided into two groups. The first group was OA as symptomatic knee group and the second group was an asymptomatic control group. The maximum sagittal height of synovial fluid in 12 scans at 0, 30, 60 and 90 degrees flexion knee in 3 major recesses were measured. RESULTS: There were a significant positive correlation between BPI Pain severity index, or BPI function interference index and a maximum height of effusion at 30-degree flexion angle in a supra-patellar recess in painful symptomatic knees. But, there was a significant negative correlation between BPI Pain severity index, and BPI function interference index and cartilage thickness in painful symptomatic knees. CONCLUSION: The increase of maximum height of synovial effusion at different angles of knee and decrease of cartilage thickness associated with pain and disability in OA pain patients and are being predictors for pain severity and disability in OA pain patients.

BACKGROUND: Gait disorders or postural instability has been done before. However, lack of reviews has addressed the relation between gait and postural stability in Parkinson's disease (PD).AIM: The aim was to evaluate the relation between gait parameters and postural stability in early and late stages of PD.MATERIALS AND METHODS: The forty-one idiopathic PD patients were divided into two groups into a group (A) considered as early PD and group (B) considered as late ambulant PD. They were evaluated for postural stability by computerised dynamic posturography (CDP) device and gait analysis using an 8 m-camera Vicon 612 data capturing system set.RESULTS: There was a statistically significant improvement of composite equilibrium score, the composite latency of motor response, walking speed and cadence after treatment as compared to before training (p < 0.05) in early PD. However, in the late PD, there was a non-significant change of previous parameters after treatment as compared to before training (p > 0.05).There was a significant correlation between UPDRS motor part score, walking speed and composite equilibrium score after training in early PD (p > 0.05).CONCLUSIONS: Both gait analysis and CDP are important quantitative assessment tools of gait and posture instability.

BACKGROUND: Diabetic peripheral neuropathy (DPN) often has reduced stability during standing conditions.AIM: To compare balance control in diabetic patients and normal subjects using computerized dynamic posturography and to assess effect of visual feedback-based balance training in DPN.MATERIALS AND METHODS: A total of 57 patients of type 2 diabetes mellitus and 30 age-matched normal control subjects were recruited. The sensory organization test was done before and after the training program.RESULTS: There was a significant decrease of mean (± SD) of composite equilibrium score and somatosensory ratio score between subgroups of DPN and control healthy group (p < 0.05). There was a significant increase of mean (± SD) of composite equilibrium score and the somatosensory ratio score after treatment as compared to results before training (p < 0.05) in mild DPN. Moreover, there were a significant correlation between composite equilibrium score and disease duration before training in the severe DPN (r = 0.368, p < 0.05). CONCLUSIONS: Computerized dynamic posturography is an important quantitative tool in the assessment of posture instability and allows for early disclosure of the failure of the postural control system. Visual feedback-based balance training was shown to be a promising method for fall prevention among early diabetes mellitus with peripheral neuropathy.

The present research was conducted to determine the effects of parity, calving season and stage of lactation on the somatic cell count (SCC) in Anatolian water buffaloes reared different herd conditions. In total, 2,736 SCC readings from 456 Anatolian water buffaloes were analyzed. Data were evaluated by the stage of lactation (early, mid, and late), calving season, and parity with the SPSS package program. Significant effects of calving season, parity, and stage of lactation on SCC were observed (Pis less than 0.05). The average SCC was 90,701±6,372 cells/ml. The results indicated that the SCC of buffaloes were in accordance with, even considerably lower than, the limits indicated in the related regulations of the Turkish Food Codex and those of the European Union Commission. Further studies are necessary to investigate the development of the appropriate threshold values under the conditions of Turkey.

Newborn Transition The transition from intrauterine to extrauterine life that occurs at the time of birth requires timely anatomic and physiologic adjustments to achieve the conversion from placental gas exchange to pulmonary respiration. This transition is brought about by initiation of air breathing and cessation of the placental circulation. Air breathing initiates marked relaxation of pulmonary vascular resistance, with considerable increase in pulmonary blood flow and increased return of now-well-oxygenated blood to the left atrium and left ventricle, as well as increased left ventricular output. Removal of the low-resistance placental circuit will increase systemic vascular resistance and blood pressure and reduce right-to-left shunting across the ductus arteriosus. The systemic organs must equally and quickly adjust to the dramatic increase in blood pressure and oxygen exposure. Similarly, intrauterine thermostability must be replaced by neonatal thermoregulation with its inherent increase in oxygen consumption. Approximately 85% of babies born at term will initiate spontaneous respirations within 10 to 30 seconds of birth, an additional 10% will respond during drying and stimulation, approximately 3% will initiate respirations after positive-pressure ventilation (PPV), 2% will be intubated to support respiratory function, and 0.1% will require chest compressions and/or epinephrine to achieve this transition.1–3 Although the vast majority of newborn infants do not require intervention to make these transitional changes, the large number of births worldwide means that many infants require some assistance to achieve cardiorespiratory stability each year. Newly born infants who are breathing or crying and have good tone immediately after birth must be dried and kept warm so as to avoid hypothermia. These actions can be provided with the baby lying on the mother’s chest and should not require separation of mother and baby. This does not preclude the need for clinical assessment of the baby. …

Hypertension is present in ∼90% of patients in late-stage CKD. There are scarce data focusing on the transition period between CKD Stages 4 and 5 (end-stage kidney disease) as it relates to hypertension evaluation and management. Here, we propose that a combination of the principles used in the management of patients with CKD Stages 4 and 5 be applied to patients in this transition. These include the use of out-of-office blood pressure (BP) monitoring (eg, home BP), avoidance of excessively tight BP goals, emphasis of sodium restriction, preferential use of blockers of the renin-angiotensin system and diuretics, and consideration of the use of beta blockers.

Chemotherapy agents are indispensable in the treatment of malignant diseases. However, they have adverse drug effects including nephrotoxicity that can contribute significantly to morbidity and mortality in patients with cancer. The potential for nephrotoxicity depends on a particular drug’s mechanism of action, the kidney microenvironment, and patient characteristics such as presence of other comorbidities, hemodynamic status, age, and less likely, gender of the patient. Intrinsic renal injury is the most common type of nephrotoxicity, and some agents can cause site-specific injury in the nephron, affecting the tubules, vasculature, glomeruli, the interstitium, or a combination of these sites. A classic example of site specificity is the proclivity of anti-vascular endothelial growth factor (VEGF) agents to cause glomerular endothelial damage. Thus, these result in distinct clinical syndromes such as: (1) acute tubular necrosis, (2) tubulopathies, (3) crystal nephropathy, (4) vascular injury (thromobotic microangiopathy), and (5) glomerular disease. Management of chemotherapy-induced nephrotoxicity includes preventive and treatment measures. Preserving kidney function is of paramount importance for allowing patients to continue chemotherapy safely and effectively. Thus, strategies for prevention, early detection, and proper management of nephrotoxicity associated with chemotherapy agents will be reviewed in this chapter

Aim: To investigate entheseal abnormalities by using Leeds Enthesitis Index (LEI) score in Psoriatic arthritis (PsA). Also, to find the correlation of LEI score and parameters of the activities of the cutaneous disease at baseline and after 6 months of treatment in PsA. Furthermore, to find correlation between LEI score and C-reactive protein (CRP) and Psoriasis Area and Severity Index (PASI) score as well as acute phase reactants. Materials and Methods : A total of thirty-nine patients with PsA and thirty-five age and sex matched healthy subjects were recruited. Clinical and laboratory assessment of disease activity included LEI score, PASI score, erythrocyte sedimentation rate (ESR) and CRP and were measured at baseline and after 6 months of treatment. Results: Enthesopathy showed a significant prevalence among PsA of 20.5%. We found a highly significant decreased in LEI score, PASI score, ESR and CRP at baseline compared to results after 6 months of treatment in PsA. A significant correlation between PASI score and LEI score was found. Also, PASI score was significant correlated with ESR and CRP in PsA. Conclusion: Enthesopathy showed a significant prevalence among PsA. The good potential parameters for PsA were LEI score, PASI score, ESR and CRP in PsA. Also, they may be the predictive value of changes induced by biological treatment in PsA.

Aim: To compare limits of stability (LOS) between stroke patients and control group and to evaluate the effects of balance training program on hemiplegic stroke patients.Setting: Balance clinic, physical medicine and rehabilitation hospital, Kuwait.Materials and Methods: A total of 36 ambulatory hemiplegic stroke patients and 34 age-matched healthy individuals as control group were recruited in this study. All patients and healthy individuals were evaluated by the LOS test.Results: There were a significant increased RT (sec), a significant decreased MVL (deg/sec), a significant decreased EPE (%), a significant decreased MXE (%) and a significant decreased directional control(DCL) (%) in stroke patients compared to control group (p < 0.01). Moreover, a significant decreased RT, a significant increased MVL (deg/sec), a significant increased EPE (%) and a significant increased MXE(%) after training compared to results before training in stroke patients (p < 0.01). However, no significant difference of DCL (%) after training compared to results before training in stroke patients (p >0.05). Conclusion: There were significantly worse in parameters of LOS test in stroke patients. Moreover, significant enhancement of some parameters of LOS test after training in stroke patients was found.

The effects of sub-acute exposure (7 days) to aflatoxins and the potential protective effects of Lactobacillus rhamnosus GG ATCC53013 (LGG) were studied in male Albino mice. Four experimental groups were used, each comprising 30 mice; control group, LGG-treated group (1 × 1010 CFU), AFs-treated group (0.7 mg/kg b.w.), and a group given LGG two hours before AFs intoxication. The malondialdehyde (MDA), glutathione (GSH) levels and superoxide dismutase (SOD) activity were measured in liver and kidney tissues. Chromosomal aberrations in bone marrow and in spermatocytes, as well as mitotic and meiotic activities were performed to assess the genotoxicity; besides sperm parameters were evaluated. Results showed that AFs significantly elevated the tissue levels of MDA, whereas the levels of GSH as well as SOD activity were significantly decreased in liver and kidney. AFs increased significantly the frequencies of structural and numerical chromosome aberrations in bone marrow and spermatocytes. In addition, mitotic and meiotic activities of somatic and germ cells were declined significantly. Also, AFs caused a high significant reduction in cauda epididymal sperm count, sperm motility and significant increase sperm abnormalities, as compared to control. Mice received LGG before AFs gavage, showed a significant amelioration in oxidative status in both liver and kidney, by increasing the contents of GSH and SOD activity. Cytogenetic analyses revealed that LGG administration before AFs gavage significantly reduced frequencies chromosomal aberrations in bone marrow and spermatocytes, and recovered mitotic and meiotic activities as well. Moreover, gavage LGG before AFs intoxication caused significant recovery in all sperm parameters studied. In conclusion, LGG was found to be safe and successful agent counteracting the oxidative stress and protected against the genotoxicity induced by AFs, in addition to reduction in spermatotoxic alterations.