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Background & objectives: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters. Patients and methods: The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sub-inguinal micro-varicocelectomy using a surgical microscope HB surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP. Results: Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p= 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p=0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p=0.009). Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p= 0.013, p= 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p=0.001, p=004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT. Conclusion: 17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy.

Abstract Background Diabetic nephropathy (DN) is one of the major causes of ESKD, and its complications are characterized by proteinuria, decreased glomerular filtration, and renal fibrosis resulting in the deterioration of renal functions, so early detection of nephropathy is essential to slow down and prevent the progression of the disease. Fatty acid-binding protein 4 (FABP4) is expressed in renal proximal tubule cells and released in response to hypoxia caused by decreased peritubular capillary blood flow, so serum FABP 4 is one of the promising biomarkers for early prediction of diabetic nephropathy in patients with type 2 diabetes. Methods This was a case–control study that included 120 patients with type-2 diabetes mellitus selected from Kasr Alainy Hospital, Cairo University Hospital, who were divided into 2 groups: the first group comprised 60 diabetic patients divided into 3 sub-groups according to their urinary albumin/creatinine ratio (normo-, micro-, and macroalbuminuria). The second group included 60 apparently healthy individuals. All patients were subjected to history, clinical examination, laboratory investigations, and serum FABP4 by ELISA. Results There was a significant increase in serum FABP4 in the macroalbuminuria group, followed by the microalbuminuria group, then the normoalbuminuria group, in comparison to the normal control group. There was a significant positive correlation between serum FABP 4 level and the duration of diabetes and HBA1c. There was a significantly negative correlation between serum FABP4 and serum albumin in the macroalbuminuria group. Receiver operating characteristic curve analysis found that serum FABP 4 discriminate micro- and macroalbuminuric patients with diabetes from controls with 96.6% and 98.3% diagnostic specificity and 100% diagnostic sensitivity respectively. Conclusion Serum FABP 4 can be used as a biomarker for the early detection of diabetic nephropathy.

Interleukin-18 (IL-18) is a pro-inflammatory cytokine that rises approximately 24–48 h before a diagnosis of acute kidney injury (AKI). Kidney injury molecule-1 (KIM-1) is one of the most promising early biomarkers. It participates in the process of both kidney injury and healing, although the precise mechanism of the restoration of tubular integrity after injury still remains unclear. The renal resistive index (RRI) is used for evaluating changes in intrarenal perfusion occurring in renal parenchyma diseases. The study included 80 critically ill patients with sepsis, divided into 40 patients who developed AKI and 40 patients without AKI. All patients were evaluated through their history, clinical examination, laboratory investigations of serum IL-18 and KIM-1, and the RRI. Serum IL 18, serum KIM-1, and the RRI were significantly higher in critically ill patients with sepsis and AKI. Receiver operating characteristic analysis for detecting AKI 1 day after admission showed that the area under the curve (AUC) for serum IL-18 was 86.1%, the AUC for serum KIM-1 was 86%, and the AUC for the RRI was 88%, demonstrating statistical significance for the diagnosis of AKI within the next 24 h. Serum IL-18, KIM-1, and the RRI represent early predictors of AKI in critically ill septic patients.

Abstract Background Renal tubulointerstitial fibrosis is a structural marker and prominent pathological characteristic of chronic progressive kidney disease, fibroblast growth factor-2 (FGF2) is a key fibrogenic cytokine that is likely to be involved in the pathogenesis of renal fibrosis, kidney injury molecule-1 (KIM-1) is one of the most promising, early biomarkers of renal disease, either acute or chronic, due to its translatability between preclinical and clinical trials. It is believed that this molecule participates in the process of both kidney injury and healing. Methods We prospectively enrolled a cohort study of eighty adult patients who had glomerular diseases (with glomerular filtration rate (GFR) > 30 ml/min/m2); serum level of FGF-2 and KIM-1 was measured at the same time of renal biopsy and was correlated with the degree of interstitial renal fibrosis. Results We found a significant positive correlation between FGF-2 and KIM-1 and the degree of interstitial renal fibrosis, albumin, and creatinine (P≤ 0.001), and a negative significant correlation with GFR and proteinuria. there is a positive significant correlation between serum KIM-1 and FGF-2 and hypertension with a significant P value (

Background: Congenital adrenal hyperplasia (CAH) is a monogenic disorder caused by genetic diversity in the CYP21A2 gene, with 21-hydroxylase deficiency (21-OHD) as the most common type. Early sex assignment and early diagnosis of different genetic variations with a proper technique are important to reduce mortality and morbidity. Proper early sex identification reduces emotional, social, and psychological stress.Aim: Detection of a spectrum of aberrations in the CYP21A2 gene, including copy number variations, gene conversion, chimeric genes, and point variations.Methods: The CYP21A2 gene was screened using MLPA assay in 112 unrelated Egyptian children with 21-OHD CAH (33 males and 79 females).Results: In the studied group, 79.5% were diagnosed within the first month of life. 46.8% of the genetic females were misdiagnosed as males. Among the copy number variation results, large deletions in 15.4% and three types of chimeric genes in 9% (CH-1, CH-7, and CAH-X CH-1) were detected. Regarding gene dosage, one copy of CYP21A2 was found in 5 cases (4.5%), three copies were detected in 7 cases (6.3%), and one case (0.9%) showed four copies. Eight common genetic variants were identified, I2G, large deletions, large gene conversion (LGC), I172N, F306 + T, -113 SNP, 8bp Del, and exon 6 cluster (V237E and M239K) with an allelic frequency of 32.62%, 15.45%, 7.30%, 3.00%, 2.58%, 2.15%, 0.86%, and 0.86%, respectively.Conclusion: High prevalence of copy number variations highlights the added value of using MLPA in routine laboratory diagnosis of CAH patients.

Abstract Background Beside common risk factors for stroke such as diabetes and hypertension, single-nucleotide variants occurring within micro RNA genes have been identified as susceptibility loci for ischemic stroke risk. Objectives Investigate the possible association of two variants in pre miRNA sequences, rs11614913 within miR-196a2 C > T and rs2292832 within miR-149 T > C, with ischemic stroke. Subjects and methods One hundred ischemic stroke patients and 100 age and sex-matched controls having > 1 risk factor for atherosclerosis were enrolled in a case-control study. Degree of atherosclerosis was assessed using ultrasonography. Micro RNA variants were assessed by real-time PCR TaqMan probe assay. Results The TT genotype and T allele frequencies of miR-196a2 C > T were protective against ischemic stroke (OR 0.168, P 0.001; OR 0.482, P < 0.001 respectively). While among miR-149 T > C variants, CC genotype was associated with increased risk by threefold (OR 3.061, P 0.005) and C allele was associated with about 1.9 fold risk of stroke (OR 1.909, P 0.002). Haplotypes analysis revealed miR-196a2T/-149 T allele combination was significantly lower among stroke patients than the controls (P < 0.001) with a protective effect (OR 0.196, 95% CI 0.083-0.466). Conclusion A decrease in the incidence of ischemic stroke is associated with miR-196a2 TT genotype and T allele and increases in the likelihood risk of ischemic stroke are associated with CC genotype and C allele within miR-149, and the two miRNAs under study are closely associated with vascular damage responses.

Introduction Albuminuria is commonly used to predict the onset and to follow the progression of diabetic nephropathy (DN), but it lacks both sensitivity and specificity in early stages. Aim We assessed urinary cyclophilin A (CypA) as a biomarker for the diagnosis of DN in Egyptian patients with type 2 diabetes. Patients and methods The study was conducted on 150 Egyptian participants aged 30–65 years; 125 (58 male individuals and 67 female individuals) patients with type 2 diabetes mellitus (diabetes duration>5 years) in different stages of DN and 25 age-matched and sex-matched healthy control participants comprised the study cohort. Estimated glomerular filtration rate and urine albumin/creatinine ratio (ACR) were assessed in all participants. Urinary CypA was measured in the morning specimen. Results Urinary CypA was significantly higher in patients with stage 2 DN, as compared with stage 1 patients (P=0.02) and the control group (P=0.017), with no significant change in urine ACR between stages 1 and 2 (P=0.809). Urinary CypA also showed a steady rise in DN stages 3, 4 and 5 (P

Background: Tumor cells have numerous immune surveillance escape mechanisms as well as means of resistance to apoptosis. This study tried to clarify one of these mechanisms in bladder cancer with the hope of being able to develop targeted therapy that will sensitize the tumor cells to immune-mediated apoptosis., Methods: In this study, electron microscopic examination and expression of TGF-beta-1 protein and TGF-beta-R-1 receptor using immunoelectronmicroscopic and immunocytochemical techniques were investigated in urine and peripheral blood mononuclear cells (PBMNCs). Samples were obtained from 5 healthy controls (Group 1) and 60 study patients who were classified according to the cytopathologic examination of their urine into 2 main subgroups: chronic cystitis (bilharzial and nonbilharzial, Group 2, n = 15) and bladder cancer (transitional cell carcinoma and squamous cell carcinoma, Group 3, n = 45)., Results: Examination of PBMNCs by immunoelectronmicroscopic and immunocytochemical techniques showed a significant increase in the percentage of positive cases expressing both TGF-beta-1 protein and TGF-beta-R-1 receptors in bladder cancer in comparison with the control (P < .01 and P < .05, respectively) and with chronic cystitis (P < .05). By electron microscopic examination, 42 out of 45 bladder cancer cases (93.3%) revealed remarkable apoptotic changes represented by cell shrinkage, surface blebs, nuclear chromatin condensation, and vacuolated cytoplasm. Urine examination by immunoelectronmicroscopic and immunocytochemical techniques revealed a statistically significant decrease in the percentage of positive cases expressing TGF-beta-R1 receptor in bladder cancer in comparison with either chronic cystitis cases or controls (P < .01), while TGF-beta-1 protein was significantly increased (P < .01). By electron microscopic examination, exfoliated necrotic malignant epithelial (urothelial) cells and many inflammatory cells were detected., Conclusions: This work helps researchers and clinicians to better understand one of the escape mechanisms in bladder cancer that may facilitate the reverse of tumor escape from the immune system. It also draws attention to TGF-beta-1 protein and TGF-beta-R1 receptor; TGF-beta-1 protein can be used as an attractive target for anticancer therapy, and the absence of TGF-beta-R1 can be considered a marker for malignant transformation of urothelial cells in bladder cancer.