Search

Background: Hyperglycemia is frequent during steroid therapy and thus it is not uncommon during treatment of lymphoid malignancies. Steroid-induced diabetes (SID) can be complicated by an increased risk of infections, lower chemotherapy efficacy, and even increased mortality. Aim: To determine the prevalence of SID in patients with aggressive lymphoid malignancies during induction therapy and to analyze its impact on treatment outcomes. Methods: The study included 52 patients with lymphoid malignancies; 28 with acute lymphoblastic leukemia (ALL) and 24 with aggressive non-Hodgkin’s lymphomas (NHL). We studied the relation between the development of SID during induction therapy and the rates of complete remission (CR), complication and relapse and survival. Results: Steroid-induced diabetes occurred during induction therapy in 18/28 (64%) and 8/24 (33%) of patients with ALL and NHL, respectively. Older age, and elevated bilirubin level were significantly associated with the development of SID during induction therapy in ALL patients (p = 0.02 and 0.005, respectively), while only older age showed a significant association in NHL patients (p = 0.002). Compared with patients who did not develop SID, those with SID had significantly higher prevalence of febrile neutropenia in the ALL group (p = 0.001) and pneumonia in the NHL group (p = 0.009). Both ALL and NHL patients with SID were significantly less likely to achieve CR and had a significantly worse overall survival. Conclusion: The results of this study suggest that SID is frequent during induction therapy in patients with lymphoid malignancies and associated with more complications and worse treatment outcomes.

Background: Vitiligo is an acquired, multifactorial disorder of the skin and mucous membranes. An elevated homocysteine level has been described in vitiligo. Methylenetetrahydrofolate reductase (MTHFR) and cystathionine B synthase (CBS) are major determinants of the homocysteine metabolism. Objectives: Determine serum homocysteine levels in vitiligo patients as well as the association between MTHFR (C677T, A1298C) and CBSgene polymorphisms and susceptibility to vitiligo in a sample of those populations. Methods: Homocysteine levels were estimated by radioimmunoassay while MTHFR (C677T, A1298C) and CBSgene polymorphisms were detected by the polymerase chain reaction-restriction fragment length polymorphism technique in 100 vitiligo patients and 80 healthy controls. Results: The homocysteine level was significantly higher in vitiligo patients than controls (p = 0.000). Significant differences in the genotype and allele distributions of single nucleotide polymorphisms of the MTHFR (C677T, A1298C) with the mutant genotypes are more common in the controls than patients (p = 0.001, 0.029, respectively). CBS gene mutant genotypes and alleles are more common in vitiligo patients than controls (p = 0.002). Conclusion: CBSand MTHFRgene polymorphisms may play a major role in the genetic susceptibility to vitiligo.

Purpose: To compare the role of ultrasonography and MRI in the diagnosis of synovitis involving wrist and hand joints in Rheumatoid arthritis patients. Materials and methods: Fifty patients with rheumatoid arthritis involving the wrist were subjected to hand and wrist ultrasonography Doppler and MRI and the results are compared and correlated during the period from December 2015 to January 2017. Results: Ultrasound detected synovial hypertrophy (pannus) in 42 wrist joints while MRI detected it in 46. Power Doppler detected increased vascularity within 30 wrist joints (60%), MRI detected synovial enhancement within 38 (76%). Power Doppler detected synovial activity (vascularity) in MCP joints of 13 patients and MRI detected synovial activity (enhancement) in MCP joints of 9 patients. Ultrasound detected erosions in 35 wrist and 27 MCP joints and MRI detected erosions in 37 wrist and 25 MCP joints. Ultrasound detected tendinitis in 9 extensor tendons and MRI detected tendinitis in 8 tendons. Conclusion: We found a significant correlation between power Doppler ultrasonography and MRI in the detection of signs of inflammation and bone destruction in the wrist and hand joints in rheumatoid arthritis, which raise the potential importance of power Doppler study in the assessment and monitoring of disease activity as a reliable non-invasive method. Keywords: Rheumatoid artheritis, MRI, Ultrasonography

Background Targeted therapy has revolutionized the management of Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL); however, relapse still occurs because of the presence of quiescent stem cells, termed leukemia propagating cells (LPCs). This study aimed to assess the phenotypic diversity of LPCs in adult patients with Ph+ B-Acute ALL (B-ALL) and to assess its prognostic impact. Methods Seventy adults with newly diagnosed Ph+ B-ALL were recruited at the Mansoura Oncology Center. Multiparameter flow cytometry studies of mononuclear blast cells for cluster of differentiation (CD)34, CD38, and CD58 were performed. Results Seventeen patients had blasts with the pattern of LPCs (CD34+CD38-CD58-), while 53 cases had other diverse phenotypic patterns. The rate of complete response was significantly lower in patients with the LPC phenotype (47% vs. 81%, P=0.006). The median time to achieve a complete response was prolonged in patients with the CD34+CD38-CD58- phenotype (48 vs. 32 days, P=0.016). The three-year overall survival was significantly lower in patients with the CD34+CD38-CD58- phenotype (37% vs. 55% respectively, P=0.028). Multivariate analysis showed that the CD34+CD38- CD58- phenotype was an independent risk factor for overall survival. Conclusion The presence of CD34+CD38-CD58- LPCs at diagnosis allows rapid identification of higher risk patients. Risk stratification of these patients is needed to further guide therapy and develop effective LPCs-targeted therapy to improve treatment outcome.

Objective To determine the accuracy of the posterior cervical angle (PCA) compared with the cervical length and the Bishop score in predicting the outcome of induction of labor (IOL). Methods The present prospective observational study included IOL candidates who had their PCA and cervical length assessed by transvaginal ultrasonography and the Bishop score at the Obstetrics and Gynecology Department, Kasr El-Aini Hospital, Cairo University, Cairo, Egypt, between April 1 and July 31, 2017. The accuracy of these tests in predicting successful IOL (defined as vaginal delivery) was compared. Results The analysis included 49 women with successful IOL and 21 women with unsuccessful IOL. The suggested cutoffs for the prediction of successful IOL were a PCA of more than 99.5°, a cervical length of less than 34 mm, and a Bishop score of more than five. The areas under the receiver operating characteristics curves for these three measures were not significantly different. However, a PCA of more than 99.5° had the best sensitivity (91.84%), specificity (90.48), positive predictive value (95.7%), negative predictive value (82.6%), positive likelihood ratio (9.64), and negative likelihood ratio (0.09) compared with the other two predictors. Conclusion A PCA of more than 99.5° yielded the best accuracy in predicting successful IOL compared with the cervical length and the Bishop score. ClinicalTrials.gov NCT03113227.

Background: rheumatoid arthritis can affect the lung in many ways including lung parenchymal affection (Interstitial lung disease), pleural inflammation, upper and lower airways affection and pulmonary vasculature. Aim of the work: this study aimed toestimate the prevalence of pulmonary manifestations in Egyptian RA patients. Patients and methods: this study included seventy patients with RA. All patients were subjected to detailed medical history taking, general examination including chest examination, local musculoskeletal examination, laboratory investigations including CBC, ESR, CRP titre, ALT, AST, BUN and creatinine, rheumatoid factor titer (RF), Anti-CCP antibodies titer, radiological investigations including chest X ray, HRCT and PFT. Results: pulmonary manifestations were prevalent in 50% of patients. Spirometric abnormalities were detected in 45.7%, while HRCT abnormalities were detected in 42.85%. HRCT severity score was correlated with age, tender joint count (TJC), swollen joint count (SJC) and ESR. There was a statistically significant negative correlation between HRCT and FVC, FEV1. There was no correlation regarding other parameters. Conclusion: pulmonary affection was prevalent in RA and can be detected by radiological and pulmonary functions. There was correlation with age, ESR and pulmonary functions

Background: The ankle is frequently injured in trauma, overuse syndrome and inflammatory processes. Different imaging modalities assess the ankle, including plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Purpose: Our objective is to assess the role of high resolution US as a valuable tool in the depiction of causes of ankle joint pain. Patients and methods: The study included 28 patients presented with ankle pain ranging in age from 17 to 60 years. They were examined by US and findings were correlated with MRI. Results: US was capable to detect various lesions (synovitis, arthritis, plantar fasciitis, tendon and ligamentous lesions). It had a sensitivity of 95.4%, a specificity of 83.3% and an overall accuracy of 92.8%. US had a limited value in detection of avascular necrosis (AVN), bone marrow oedema and fractures. Conclusion: US can be used as a first step diagnostic tool in cases of ankle pain. MRI should be spared to cases with negative or equivocal US findings. Keywords: High resolution ultrasound, Ankle joint pain, Tendons, Ligaments, Synovitis, Arthritis

Recognition of BCR/ABL translocation is obligatory in precursor B cell precursor acute lymphoblastic leukemia (BCP-ALL) patients at diagnosis for categorization of patients. The risk stratification of BCP-ALL especially those negative for Philadelphia chromosome is an area of research. The prognostic impact of CD20 expression in childhood BCP-ALL remains controversial. In pediatric patients with BCP-ALL, some studies have demonstrated that CD20 overexpression correlates with bad overall survival, but some others suggest a better outcome. This study aimed to evaluate the efficacy of CD20 expression as a biological marker in BCP-ALL. For 104 children with newly diagnosed BCP-ALL included in this study, CD20 expression was evaluated by flow cytometry. CD20 was positively expressed in 40 (38.5%) of cases. The CD20positive subgroup had significantly shorter overall survival and disease free survival as compared to the CD20negative one (P = 0.018

Purpose The use of antithrombotic therapy may increase morbidity and mortality in patients with infective endocarditis (IE). This study evaluated the use of oral anticoagulant and antiplatelet agents on the development of embolic complications and bleeding episodes within 30 days of IE diagnosis. Methods This pilot study was a retrospective medical record review of patients receiving treatment for IE between July 1, 2012, and July 31, 2017. The 2 study arms were patients receiving long-term anticoagulant/antiplatelet therapy versus patients not receiving therapy at the time of IE. Patients were eligible for inclusion if they had definite IE per modified Duke criteria and received at least 48 h of antibiotic therapy. The primary and secondary outcomes evaluated the incidence of embolic phenomenon and bleeding events in each group, respectively. Findings Of 129 patients with IE, 34 met the eligibility criteria, with 20 patients on receiving anticoagulant/antiplatelet therapy and 14 patients not receiving anticoagulant/antiplatelet therapy. The median age was 63 years, with 50% male patients. Staphylococcus aureus was the infecting pathogen in 41% of patients. Embolic events occurred in 30% of patients receiving anticoagulant/antiplatelet therapy versus 7.1% of those not receiving therapy. No patients in the anticoagulant/antiplatelet therapy arm experienced a bleeding event, whereas 7.1% of those in the comparator arm did. Implications This retrospective pilot study indicates that patients with IE receiving anticoagulant/antiplatelet agents may be at an increased risk for embolic episodes versus those who are not. Larger, prospective studies are necessary to find a definitive correlation.

Background and aim for the work: Bone marrow failure (BMF) is the inability of the bone marrow to produce an adequate number of peripheral blood cells. BMF included inherited and acquired conditions. The telomerase complex maintains telomere length (TL) in embryonic cells and in few adult cell types such as germ cells, stem cells, T lymphocytes, and monocytes. All the other adult cells, including blood cells, show a progressive reduction in telomere length, which correlates with the age and rate of cell proliferation. Our study aims to evaluate the utility of Real-Time Quantitative-Polymerase Chain Reaction (RQ-PCR) in measuring the relative telomere length and to investigate its correlation with the clinicopathological data of the Egyptian BMF patients. Materials and methods: The study included 3 groups: a group of inherited BMF (25 patients), a group of acquired BMF (10 patients) and a third healthy control group (15 cases). The relative telomere length (RTL) is evaluated for them using RQ-PCR. Results: We have found a significant difference in RTL between all BMF patients and healthy controls (P value= 0.001), there was a significant difference in RTL between inherited BMF patients and its age-matched controls (P value=0.009), also a significant difference between acquired BMF patients and its age-matched controls (P value= 0.034). However, there was no significant difference between inherited and acquired BMF patients (P value= 0.479). On the other hand, we find an association between RTL and lymphocyte count (P value= 0.032) in inherited BMF patients. While another association observed with RTL and red blood cell count (RBCs) in acquired BMF patients (P value= 0.048). There was no significant correlation with RTL and the overall survival or prognosis of those patients. Conclusion: We conclude that the telomere lengths are significantly altered in Egyptian BMF patients, either whether inherited or acquired compared to the control group, with some hematological changes.

Onychomycosis is the most common nail disorder, accounting for up to 50% of all nail problems and about 30% of cutaneous fungal infections. Treatment of onychomycosis is expensive. It requires long term therapy with an oral antifungal medication with potential side effects. Therefore, a proper diagnosis of infection is needed. Aim of the study: This study aimed to compare real time PCR using novel primers targeting the pan-dermatophyte-specific sequence of the chitin synthase 1 gene (CHS1) with nested PCR targeting the same gene, KOH microscopy, direct microscopy in relation to culture for diagnosis of clinically suspected onychomycosis. Subjects and methods: This study was conducted during the period from April 2013 through May 2014. Eighty patients attending Outpatient Dermatology and Andrology clinic at Benha University Hospital were included in this study. They were 30 females and 50 males with suspected clinical diagnosis of onychomycosis. Their ages ranged from 22 to 77 years. Thirty eight of them were living in rural areas, while the other 42 came from urban areas. Nail scrapings were collected and examined by the following: direct KOH microscopic examination, culture, nested PCR using double sets of primers and finally real time PCR. Results: As regards direct microscopy by KOH examination, 66 (82.50%) cases were positive, while 14 (17.5%) were negative. Culture was positive only in 38 (47.5%) of nail samples revealing different fungi. Dermatophytes were isolated from 30 (37.5%) cases; most of them were Trichophyton mentagrophytes, and in 8 cases the only isolated non-dermatophytic organism was Aspergillus Niger spp. (10.00%). Nested PCR was positive in 52 (65.00%) of nail samples while real time PCR was positive in 58 (72.5%) of nail samples. Conclusion: Real-time PCR followed by melting-point analysis, gives a diagnostic tool that has a higher sensitivity (93.3%) and is faster than nested PCR (73.3%) and other conventional methods. Keywords: Onychomycosis; Dermatophytes; Nested PCR; Real time PCR

Cellular transferrin receptor 1 (CD71) has been identified as a proliferation marker. Inferior outcome with higher expression was observed in many solid tumors. This study objected to assess the expression of CD71 in patients with acute leukemia and to address its prognostic significance and relations to clinicopathologic features. The study included 34 acute myeloid leukemia (AML) and 64 acute lymphoblastic leukemia (ALL) newly diagnosed cases from Mansoura Oncology Center. CD71 was analyzed on blast cells by flow cytometry. CD71 expression was significantly elevated in both AML and ALL. Antigen expression apparently increased in T-ALL, while in AML there was a trend toward a gradual increase of antigen expression in relation to maturation evidence of myeloid subtypes. CD71 expression correlated positively with total leukocyte count in ALL cases and negatively with platelet count in AML cases. In ALL, higher CD71 expression was associated with higher relapse rate and was an independent prognostic factor of overall survival (HR 1.8; 95 % CI 1.2–4.1). In conclusion, CD71 is overexpressed in acute leukemia; it predicts adverse clinical outcome in ALL. In addition, CD71 antagonism could be a possible therapeutic target in acute leukemia.

Background: Extended-spectrum beta-lactamases (ESBLs) are rapidly evolving group of beta-lactamase enzymes commonly produced by the Gram negative bacteria. Objectives: This work aimed to detect the bacterial pathogens that cause urinary tract infection and to detect ESBL producing bacteria among them in Pediatric Department at Benha University Hospital. Methodology: This study was conducted on 118 children patients suffering from UTI collected from Outpatient and Inpatient of pediatric department at Benha University during the period from January 2015 to the end of July 2015. They were 77 girls and 41 boys and their ages ranged from 1 to 13 years.118 Urine samples were subjected to isolation and identification of causative organisms, screened for ESBL production by the pattern of antimicrobial susceptibilities. Phenotypic identification for ESBL production was confirmed by double disc diffusion test, bla SHV and bla CTX-M genes in ESBL, producing isolates were detected by using multiplex PCR. Results: This study showed that the most common cause of children UTI was E.coli (55.1%) followed by klebsiella pneumoniae (21.2%). Thirty seven (31.4%) of 118 bacterial isolates that tested by double disc confirmatory test were ESBL positive. Among the ESBL producing bacteria, 16 out of 37 (43.24%) have CTX-m and SHV genes together while 3 out of 37 (8.1%) have SHV gene only. Conclusion: Our findings showed that majority of ESBL isolates were positive for both CTXm and SHV genes (43.24%) but SHV gene alone was positive only in (8.1%) of isolates, So studies should be done in different regions of Egypt to find the common ESBL genes present in that geographical area for epidemiological purposes. Also ESBL producing isolates have been increasingly recognized in hospitals in Egypt and are associated with multiple drug resistance. Thus, ESBL producing organisms should be identified quickly so that appropriate antibiotic usage and infection control measures can be implemented.

Background: Chlamydia trachomatis (C. trachomatis )is the most prevalent sexually transmitted pathogen worldwide. It is common among sexually active young women. Objectives: Evaluate the sensitivity and specificity of tissue culture followed by antigen detection by immunoflurescencein comparison with nested PCR for diagnosis of genital C. trachomatis infection. Methodology: This study was carried out on 50 women, among those attending the Gynecology Outpatient Clinics of Benha University Hospital during the period from May 2014 to March 2015. The participants suffer from symptoms suggestive of genital C. trachomatis infection , their ages ranged from 20 to 39 years old (mean ± SD =29.80±4.647) .Two endocervical swabs were taken from each patient. One used for cytological examination, and the other used for tissue culture detected by, immunoflurescence as well as nested PCR. Results: The result of tissue culture detected by direct immunoflurecence revealed that out of 50 patient, 24 (48%) were positive for C.trachomatis and 26 (52%) were negative .Result of nested PCR revealed that out of 50 patient, 34 (68%) were positive and 24 (32%) were negative . The result of cytological examination revealed that out of 50 patient, 17 (34%) were positive and 33 (66%) were negative. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPP) of tissue culture for detection of C.trachomatis were 70.6%, 100%, 100% and 61.5% respectively. Roc curve of tissue culture revealed that it is considered to be a good test compared to PCR in diagnosis of genital C.trachomatis. Conclusion: The tissue culture as detected by immunoflurescence is a good test in relation to nested PCR in diagnosis of genital C.trachomatis

This work aimed to compare nested PCR using novel primers targeting the pan-dermatophyte-specific sequence of the chitin synthase 1 gene (CHS1) with KOH microscopy and culture isolation for diagnosis of clinically suspected onychomycosis. This study was conducted during the period from December, 2012 to October 2013. Forty patients attending Outpatient Dermatology and Andrology Clinic in Benha University Hospital. This study was done on forty patients 15 cases were female and the other 25 cases were males with abnormal nails .Their ages ranged from 22 to 77 years. As many as 19 patients were living in rural areas, while 21 patients came from urban areas. Nail scrapings were collected and examined using direct KOH microscopic examination, culture and PCR using double sets of primers. As regard direct microscopy by KOH examination; 33 (82.50%) cases were positive, while 7 (17.5%) were negative. Culture was positive only in 19(47.5%) of nail samples revealing different fungi. Dermatophytes were isolated from 15(37.5%) cases; most of them were T. mentagrophytes. And in 4 cases the only isolated non dermatophytic organism was Aspergillus Niger spp. (10.00%). Nested PCR was positive in 26 (65.00%) nail samples. Conclusion: It is concluded that nested PCR targeting the CHS1 gene may be considered the gold standard for detection of dermatophytes in patients with onychomycosis and can aid the clinician in initiating prompt and appropriate antifungal therapy.PCR is a very powerful tool for microbiology and clinical mycology. It can detect very small amounts of nucleic acids. This technique may also play an important role in large-scale studies and in the management of problematic cases of onychopathies.

Motor neuron disease (MND) is a neurological disorder that attacks and destroys the motor neurons. This causes the messages from the brain to stop reaching muscles which leads to weakness and difficulties in doing the normal activities. Musculoskeletal diseases (MSDs) or Myopathy are as bad as motor neuron diseases, as it causes weakness of the muscles. The correctness of disease diagnosis, rehabilitation, and interactional control depend on the high accuracy of the model employed to track muscle activity disorder. In this paper, a new model is introduced for muscle activity disorder tracking through analyzing of Electromyogram signals (EMG). The proposed model integrates wavelet packet transform with candidate selection of Motor unit action potential (MUAP) for efficient feature extraction. A multi-class disorder discrimination of EMG signals is designed for various disorders identification such as Myopathy and Amyotrophic Lateral Sclerosis (ALS). Experiments have been conducted on large dataset of EMG signals to demonstrate the performance and robustness of the proposed model in terms of sensitivity, accuracy, and specificity. The proposed model outperforms existing models. Experimental results indicate up to 2% improvement in terms of Specificity, up to 7.53% improvement in terms of sensitivity in case of binary classification, and up to 5.76 % improvement in terms of accuracy in case of multi-classification.

There is a perception that socioeconomically disadvantaged patients tend to sue their doctors more frequently. As a result, some physicians may be reluctant to treat poor patients or treat such patients differently from other patient groups in terms of medical care provided.We (1) examined existing literature to refute the notion that poor patients are inclined to sue doctors more than other patients, (2) explored unconscious bias as an explanation as to why the perception of the poor being more litigious may exist despite evidence to the contrary, and (3) assessed the role of culturally competent awareness and knowledge in confronting physician bias.We reviewed medical and social literature to identify studies that have examined differences in litigation rates and related medical malpractice claims among socioeconomically disadvantaged patients versus other groups of patients.Contrary to popular perception, existing studies show poor patients, in fact, tend to sue physicians less often. This may be related to a relative lack of access to legal resources and the nature of the contingency fee system in medical malpractice claims.Misperceptions such as the one examined in this article that assume a relationship between patient poverty and medical malpractice litigation may arise from unconscious physician bias and other social variables. Cultural competency can be helpful in mitigating such bias, improving medical care, and addressing the risk of medical malpractice claims.

Acute leukemia (AL) displays characteristic patterns of antigen expression, which facilitate their identification and proper classification. The purpose of this study is to evaluate the diagnostic usefulness of commonly used immune-markers for immunophenotyping of AL and to define the best immune-markers to be used for proper diagnosis and classification of AL. Besides, to recognize the frequency of different AL subtypes and the antigen expression profile in our Egyptian patients. We retrospectively analyzed the immunophenotypic data of 164 de novo AL patients from our institution during 2009 and 2010. Among these patients, 68.9% were classified as acute myeloblastic leukemia (AML) while 31.1% classified as acute lymphoblastic leukemia (ALL). The commonest FAB subtype in AML group was AML-M4/5 (34.5%) which may differ from most published data. As regard ALL, there were 74.5% with B-ALL and 25.5% with T-ALL. It was found that combined use of HLADR and CD34 was much more helpful in distinguishing APL from non-APL AML than either of these antigens alone. It was found that cCD79a and CD19 were the most sensitive marker for B-ALL while cCD3, CD7 and CD5 were the most sensitive antigens for T-ALL. Our analysis of AL phenotypes proved that employed antibody panels are adequate for proper diagnosis and classification of AL. Flowcytometry was found to be especially useful in the identification of AML-M0 and differentiation of APL from non-APL AML. Immunophenotyping results and FAB classification of our AL patients were comparable to internationally published studies apart from predominance of AML-M4/5 and more frequent APL.

THE ANNUAL INCIDENCE OF PULMONARY EMBOLISM (PE) EXCEEDS 1 PER 1000 IN THE UNITED STATES, WITH AN ASSOCIATED MORTALITY OF UP TO 40%.1 PE is thought to account for 5% to 10% of deaths in hospitalized patients.2,3 If untreated, approximately one third of those who survive an initial PE die of a future embolic episode. Although risk factors for the development of PE are well established, up to 30% of cases have no identifiable cause.4 Moreover, risk-factor assessment may have important implications for both prevention and treatment of PE.5 Obstructive sleep apnea (OSA) is characterized by episodes of recurrent upper airway obstruction during sleep, leading to repetitive sleep disruption, with or without concomitant oxygen desaturation.6 Recent studies estimate that OSA affects up to 25% of the adult population in the United States.7,8 OSA is increasingly recognized as a risk factor for cardiovascular disease.9–12 Some of the proposed mechanisms whereby OSA contributes to cardiovascular complications include hemodynamic alterations,13 sympathetic nervous system activation,14 oxidative stress,15 systemic inflammation,16 hypercoagulability,10 and vascular endothelial dysfunction.17 These same pathophysiologic derangements are prothrombotic and could promote the development of venous thromboembolic disease. Several previous case reports and uncontrolled cohort studies have suggested a possible association between OSA and PE.18–23 We hypothesized that patients with PE might have an increased prevalence of OSA. We performed a prospective cross-sectional study to determine the prevalence of snoring and the risk of having OSA in patients suspected of having an acute PE.

Mutation in IDH1 gene was suggested to be associated with bad prognosis in cytogenetically normal AML (CN-AML). However, there are conflicting data about its prognostic impact. Besides, its prevalence and prognostic significance in Egyptian patients still not fully stated. We aimed to assess the prevalence of IDH1R132 mutation in Egyptian CN-AML patients, its correlation with FAB subtypes, and clinical outcome of those patients. Sequencing of amplified IDH1 gene exon four from 50 patients was performed to detect codon R132 point mutation. High prevalence of IDH1 mutation was detected in our patients (9/50, 18 %). Mutated IDH1R132 was associated with older age and higher platelets count (p = 0.04 and 0.01 respectively). The most common FAB subtype associated with mutated IDH1R132 was AML-M2 followed by M4. In multivariate analysis, IDH1R132 mutation was found as independent prognostic variable. It was significantly associated with lower CR and shorter OS (p = 0.06 and 0.009 respectively).

Objective To determine the effectiveness of diclofenac potassium combined with 2% lidocaine gel in reducing the pain of intrauterine device (IUD) insertion. Study design We randomized 90 parous women requesting copper T380A IUD insertion in a 1:1 ratio to active or placebo treatment. Active treatment included administration of two 50-mg diclofenac potassium tablets 1 h before IUD insertion, application of 3 mL of 2% lidocaine gel on the anterior cervical lip 3 min before IUD insertion and placement of a cotton swab soaked in 2% lidocaine gel in the cervical canal 3 min before IUD insertion. Women in the placebo group received placebo tablets and gel. Participants assessed pain intensity using a 10-cm visual analog scale (VAS). We considered a 2-cm difference in VAS pain score between both groups during IUD insertion to be a clinically significant difference. Results Subjects receiving active treatment, as compared to placebo, experienced less pain during tenaculum placement (1.66 ± 0.85 vs. 2.33 ± 1.19, p = .003) and IUD insertion (3.14 ± 0.92 vs. 3.94 ± 1.3, p = .001). Women who delivered only by cesarean section had higher pain scores with IUD insertion compared with women with previous vaginal deliveries (4.41 ± 1.24 vs. 3.29 ± 1.05, p = .001). Conclusion Diclofenac potassium combined with 2% lidocaine gel slightly reduced pain scores during tenaculum application and copper IUD insertion in parous women; however, the reduction in pain scores lacked clinical significance. Implications Although we found a statistically significant lowering of pain scores with pretreatment with diclofenac potassium and lidocaine gel in parous women having copper IUD placement, the reduction is not clinically relevant. These findings may be more relevant for nulliparous women who experience more pain than parous women with IUD insertion and support studies of diclofenac potassium and lidocaine gel in this population.

Cytogenetic analysis has detected an accumulation of genetic lesions in oral cancers. Numerical changes in chromosome 17 might be associated with an up-regulation of p53 gene, and could contribute to critical events in carcinogenesis. The aim of this study was to reveal possible correlations between the numerical aberrations of chromosome 17, deletion or amplification of the P53 gene and histological grading in patients with oral squamous cell carcinoma (OSCC). This study was performed retrospectively on anonymous forty paraffin embedded specimens diagnosed with a primary OSCC. Sections were prepared for p53 immunohistochemical staining and FISH technique evaluation. All studied cases showed a positive nuclear staining with different indices for the p53 protein. Furthermore, statistical analysis showed a significant difference between all histological types of OSCC. In term of P53 immunoreactivity well differentiated OSCC showed the highest, whereas poorly differentiated showed weakest. Regarding chromosome 17 aberrations and p53 gene mutations, Spearman correlation test revealed a statistical significant positive correlation between chromosome 17 abnormalities and p53 gene mutations as well as with the immunohistochemical expression of p53 proteins. Moreover, the positive association between p53 gene mutations and the expression of p53 protein was statistically significant. In the light of the previous findings, we concluded that numerical aberrations of chromosome 17 and p53 gene mutations as well as expression of p53 protein have enormous influence on various cellular processes including differentiation and carcinogenesis. Such knowledge provides an easy and simplified approach to prognosis predilection for OSCC. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2015_232 .

Musculoskeletal medicine targets both cartilage regeneration and healing of soft tissues. Articular cartilage repair and regeneration is primarily considered to be due to its poor regenerative properties. Cartilage defects due to joint injury, aging, or osteoarthritis have low self-repair ability thus they are most often irreversible as well as being a major cause of joint pain and chronic disability. Unfortunately, current methods do not seamlessly restore hyaline cartilage and may lead to the formation of fibro- or continue hypertrophic cartilage. Deficiency of efficient modalities of therapy has invited research to combine stem cells, scaffold materials and environmental factors through tissue engineering. Articular cartilage tissue engineering aims to repair, regenerate, and hence improve the function of injured or diseased cartilage. This holds great potential and has evoked intense interest in improving cartilage therapy. Platelet-rich plasma (PRP) and/or stem cells may be influential for tissue repair as well as cartilage regenerative processes. A great promise to advance current cartilage therapies toward achieving a consistently successful modality has been held for addressing cartilage afflictions. The use of stem cells, novel biologically inspired scaffolds and, emerging nanotechnology may be the best way to reach this objective via tissue engineering. A current and emergent approach in the field of cartilage tissue engineering is explained in this review for specific application. In the future, the development of new strategies using stem cells seeded in scaffolds and the culture medium supplemented with growth factors could improve the quality of the newly formed cartilage.

Objective. Several studies with contradictory results from different cultures about association of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in schizophrenia and bipolar disorders. Little is known about this association in Arab culture and Egypt. So the present study aimed to assess the association of MTHFR C677T polymorphism in bipolar disorder (BD) and schizophrenia in comparison to control group. The association between MTHFR C677T polymorphism and the age at onset in schizophrenia or BD was also studied.Methods. Polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) were used to examine the genotype and allele frequencies of MTHFR C677T polymorphism in 149 healthy subjects and 134 bipolar and 103 schizophrenia patients.Results. In BD and schizophrenia, there was a higher prevalence of MTHFR C677T polymorphism than healthy subjects. Earlier age at onset was found in patients with BD, carrying one copy of the T allele or CT genotypes but not in patients with schizophrenia.Conclusion. The present findings suggest that the MTHFR C677T polymorphisms are likely to be associated with the risk of developing BD and schizophrenia and influence the age at onset of BD but not the age at onset of schizophrenia.

This article highlights studies revealing disparities in joint and bone health among racial groups in the United States, and offers explanations for the disparities based on education and access to care. It describes the difficulties orthopedists (physicians who specialize in joint and bone health) have when they try to educate and motivate patients to address and prevent orthopedic health problems. We argue that the most promising strategies for addressing the disparities involve improving the cultural competency of health care providers and increasing the health literacy of individuals who must ultimately take charge of their health. In addition, we present arguments for interpreting and applying state tort law in a way that that will encourage health providers and community member to participate in health literacy education and motivational counseling.

Pseudoachalasia is a condition in which clinical and manometric signs of idiopathic achalasia are mimicked by another abnormality, most often a malignancy. An underlying malignancy should be recognized early to prevent delay in appropriate treatment. The aim of our study was to identify characteristics that suggest potential pseudoachalasia caused by malignancy and warrant additional investigation. Methods: All patients newly diagnosed with achalasia by manometry between January 2000 and November 2014 were included. Patients who were afterwards found to have an underlying malignancy were classified as having pseudoachalasia. Clinical (symptoms and Eckardt score), manometric, endoscopic and radiological findings were reviewed and compared between pseudoachalasia versus achalasia. Results: In total 270 patients with achalasia were included (148 male, median age 51 (38-63) (median (IQR)). Malignant pseudoachalasia was diagnosed in 16 patients (5.9%, 12 male) and caused by esophageal adenocarcinoma (n=5), esophageal squamous cell carcinoma (n=3), gastric adenocarcinoma (n=5), pancreatic adenocarcinoma (n=2) or paraneoplastic syndrome by mediastinal lymphoma (n=1). The underlying malignancy was found at EUS (19%), second or third endoscopy with biopsies (25%), CT scan (31%) or during a treatment session (25%; 2x Heller myotomy, 2x pneumodilation). In 3/16 of the patients a CT scan after achalasia treatment, performed because of quick recurrence of symptoms, eventually showed the malignancy. Patients with pseudoachalasia were older at time of diagnosis (66 (53-72) vs 51 (38-63), p .05). Manometries in both groups showed aperistalsis and dysrelaxation of the LES, with no difference in LES pressure (32 (21-35) mmHg vs 25 (18-34) mmHg, p >.05). In 91% of patients with pseudoachalasia a barium esophagogram was performed and in 77% it was typical of achalasia, showing stasis and/or luminal dilation, compared to 93% in achalasia (p >.05). In 56% of endoscopies in pseudoachalasia the LES was difficult or even impossible to pass, compared to 23% in the achalasia group (p 60 years with a clinical history

Patients with Diffuse Large B-Cell Lymphoma (DLBCL) and Follicular Lymphomas (FL) exhibit marked variability in survival, the international prognostic index (IPI) predicts the cure with chemotherapy as IPI is a well established predictor of outcome in DLBCL and FL. Biological prognostic markers including expression on of BCL2, BCL6, CD5, CD10, and HLA-DR have been described as IPI independent prognostic factors. The purpose of this study is to high light how these biomarkers might be incorporated into current risk – adjustment models for prognosis. Biological parameters were evaluated by flowcytometric immunophenotyping of 96 patients with DLBCL and FL. In our study, Superior overall survival (OS) was associated with high expression of HLA-DR in DLBCL either do novo or on top of FL (p < 0.001 for both group), and with low expression of CD 5 and BCL2 in de novo DLBCL (p < 0.001 for both ) independently of the IPI. On the other hand Inferior overall survival was established with high expression of BCL6 in DLBCL. However Inferior progression free survival (PFS) was independently correlated with high expression of BCL2 (p = 0.007 and 0.018 ) and lower expression of HLA-DR ( p=0.003 and 0.03 ) in both de novo DLBCL and on top of follicular, but not in FL and with high expression of CD10 in de novo DLBCL only ( p In 96 patients with DLBCL and FL treated with risk adapted therapy, low HLA-DR expression is associated with poor outcome in DLBCL either de novo or on top of follicular but not in a FL group. the time is right to begin to consider how these biomarkers should be incorporated into current prognostic models to move beyond the clinically based IPI.