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   Table of Contents - Current issue
Coverpage
May-August 2018
Volume 24 | Issue 2
Page Nos. 47-89

Online since Monday, February 11, 2019

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ORIGINAL ARTICLES  

Cyclooxygenase-2 and estrogen receptor-β as possible therapeutic targets in desmoid tumors p. 47
Rasha A Khairy
DOI:10.4103/kamj.kamj_1_18  
Background and aim Desmoid tumors are mainly treated by surgical excision and radiotherapy, but the failure to achieve complete response has given rise to the need for investigating the role of possible target therapy. The aim of this study was to evaluate the immunohistochemical detection of cyclooxygenase-2 (COX-2) and estrogen receptor-β (ERβ) in desmoid tumors and to assess their correlation with available clinicopathologic variables. Materials and methods A total of 17 desmoid tumor cases (11 abdominal, five extra-abdominal, and one intra-abdominal) were examined for immunohistochemical detection of COX-2 and ERβ using monoclonal antibodies. Toluidine blue staining was performed to confirm or exclude that COX-2 immunostained cells coincide with mast cells in co-localized sections. Correlation of results with available clinicopathologic variables was done and a P value less than 0.05 was considered significant. Results COX-2 was expressed in tumor cells in 92% of examined desmoid cases (16/17). Toluidine blue staining has shown that COX-2 immunostained cells do not coincide with the few metachromatically stained mast cells in co-localized sections. ERβ was expressed in 67.1% of tumor cells in desmoid cases (11/17); eight cases displayed high ERβ expression and three cases displayed low ERβ expression. No significant correlation was detected between ERβ or COX-2 immunohistochemical expression and patient’s age, sex, tumor size, site, margins status, and recurrence history (P>0.05). Conclusion This study confirmed the immunohistochemical expression of COX-2 and ERβ in tumor cells of the majority of studied desmoid cases. These results introduce COX-2 and ERβ as potential therapeutic targets in desmoid tumors. Further studies with a large sample size and follow-up are recommended to validate the current results.
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Does ascitic fluid lactoferrin has a role in the diagnosis and follow up of spontaneous bacterial peritonitis in hepatitis C virus cirrhotic patients p. 53
Soheir Abuelfadl, Ahmed A Heikl, Mahmoud M El-Nokeety, Laila A Rashed
DOI:10.4103/kamj.kamj_27_17  
Background Polymorphonuclear leukocyte (PMNL) count in the ascitic fluid (AF) is the gold standard method for the diagnosis of spontaneous bacterial peritonitis (SBP). Its measurement is routinely performed by traditional manual counting which is operator dependent and false-negative results may occur due to lysis of the leukocyte during transport. Aims The aims of the study were to assess the accuracy of AF lactoferrin and the best cutoff value for the diagnosis of SBP and also to compare its level before and after treatment to be used as a marker for follow up. Patients and methods The present study included 150 Egyptian patients with hepatitis C virus-related liver cirrhosis and ascites. The cases were divided into 100 patients with SBP and 50 patients with no SBP based on an elevated AF PMNL count of greater than or equal to 250 cells/mm3, ascitic samples were examined for PMNL count, culture, chemistry, and lactoferrin concentration in non-SBP patients and in SBP patients before and after systemic antibiotic treatment. Results AF lactoferrin concentration is significantly higher in SBP patients than in non-SBP patients with a cutoff value of 75.55 ng/ml, significantly higher in culture positive than in culture-negative SBP patients and its concentration is decreased significantly in SBP patients after systemic antibiotic therapy. Conclusion Elevated AF lactoferrin levels in cirrhotic patients are reliable for the diagnosis and follow up of SBP after systemic antibiotic therapy. The level of AF lactoferrin level is higher in resistant cases of SBP than the cases that respond to systemic antibiotic treatment.
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Mast cell, a new player in type 2 diabetes p. 59
Nehal Hamdy, Randa F Salam, Nagwa Abd EL-Ghaffar Mohamed
DOI:10.4103/kamj.kamj_18_18  
Background Mast cells plays critical role in inflammatory diseases, including cardiovascular and metabolic diseases and their associated complications. These cells exert their physiological and pathological activities by releasing granules containing histamine, cytokines, chemokines, and proteases, including mast cell-specific chymases and tryptases Aim of our study is to detect the role of mast cell in diabetic obese and its correlation to different diabetic complications Method 70 Type 2 diabetic obese patients attending the Diabetes and Endocrinology clinic in Kasr El Ani hospital compared to 15 healthy controls All patients were subjected to: Full medical history, complete physical examination, Anthropometric measurements (BMI, waist circumference) fasting glucose(assessed after 8 hours fasting) –A1C – serum cholesterol –triglycerides-LDL-HDL(assessed after 12 hours fasting) Tryptase level Results Statistical significant difference between patients and control regarding BMI, glucose,cholesterol, HDL, LDL,tryptase (p<0.001) ,triglycerides(p=0.001) Tryptase statistically correlated with BMI,fastingglucose,A1C,triglycerides(p=0.014,r=0.031)/(p=0.012,r=0.297)/(p<0.001,r=0.862),(p=0.039,r=0.247) Higher mean level of tryptase in patients with diabetic complications mainly in retinopathy (32.32 ng/ml) Conclusion Tryptase participate in the pathogenesis of diabetes mellitus and its complication targeting mast cells as novel therapy for diabetes requires further investigations
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High-mobility group box 1, early activity marker in lupus nephritis p. 65
Aysha I Badawi, Hanan H Fouad, Randa F Salam, Amira M Bassam, Sahar A Ahmed
DOI:10.4103/1687-4625.251936  
Objectives Systemic lupus erythematosus is an autoimmune disease characterized by the involvement of multiple organ systems. High-mobility group box 1 (HMGB1) is a nuclear nonhistone protein secreted by many cells during activation or cell death. We aim to study the potential pathogenetic role of HMGB1 in lupus and whether urinary, serum, and renal biopsy levels reflect renal inflammation and correlate with disease activity. Patients and methods In a case–control study, 61 systemic lupus patients and 18 healthy volunteers were divided into four groups. Group 1 included 21 patients with lupus nephritis (LN). Group 2 included 21 patients with lupus activity without nephritis. Group 3 included 19 patients without activity. Group 4 included 18 healthy volunteers who were age and sex matched. Participants were subjected to assessment of history, physical examination, activity scoring using SLE disease activity index (SLEDAI), and laboratory investigations including plasma and urinary levels of HMGB1 by enzyme-linked immunosorbent assay. Study of the HMGB1 immunohistochemical expression pattern in renal biopsy was carried out in group 1. Results Plasma and urinary HMGB1 levels and the renal tissue extranuclear expression (cytoplasmic and extracellular) pattern of HMGB1 were significantly increased in patients with active LN compared with the other groups (P<0.001), and were significantly correlated with SLEDAI, suggesting active release of HMGB1. Plasma and urinary levels in patients without active LN were also significantly higher compared with the control group (P<0.001). Conclusion HMGB1 plays an important role in the pathogenesis of LN and reflects disease activity. Thus, HMGB1 can be utilized as a biomarker for renal disease activity in patients with lupus and the therapeutic value of HMGB1-blocking agents must be investigated.
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Role of color doppler ultrasound for assessment of arteriovenous fistula dysfunction in hemodialysis patients p. 72
Omar Abdelaziz, Mirna Adel Fahmy, Sahier O El-Khashab
DOI:10.4103/kamj.kamj_2_18  
Background and objective Arteriovenous fistulas (AVFs) are the vascular access of choice for hemodialysis with a lower incidence of complications and longer survival than prosthetic grafts or central venous catheters. Our aim was to evaluate the role of color Doppler ultrasound (CDUS) in the detection and characterization of complications of AVF dialysis access. Materials and methods During a 9-month duration, we prospectively evaluated 25 patients with clinically suspected AVF complications using CDUS examination of the upper limbs. There were 11 (44%) males and 14 (56%) females, ranging in age from 8 to 70 years. All patients were examined after reconstruction of AVF for the assessment of vascular access complications. Doppler indices were measured in the afferent arteries, at the site of anastomosis, and the draining veins. Results All 25 patients had shunt complications. Venous thrombosis was the highest among all complication (n=12, 48%), followed by stenosis (n=11, 44%), aneurysm and pseudoaneurysmal formation (n=5, 20%), and infection (n=1, 4%). Four patients had more than one complication. Sixteen (64%) patients had complicated fistulas requiring further intervention, either surgical management [reconstruction of new fistula (n=3), ligation (n=1), graft (n=1), and superficialization (n=2)] or radiological intervention [percutaneous transluminal angioplasty (n=5), thrombectomy (n=2), and percutaneous transluminal angioplasty and thrombectomy (n=2)]. Conclusion CDUS is a noninvasive diagnostic tool for early detection and localization of complications of AVFs that allows detection of possible causes of vascular access malfunction.
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Ultrasonic wave’s influence on the changes of the number of bacteria in the infected root canal p. 79
Ri Myong-Un, Ri Myong-Gil, Ju Gyong-Il, Yun Son-Yong, Ri Gyong-Sok, Kim Chang-Song
DOI:10.4103/kamj.kamj_24_18  
Background We have focused on the making an attempt toward making ultrasonic scaler available for the endodontic treatment and assess the changes in the bacterial numbers in the infected root canal when using it. Materials and methods An ultrasonic root canal irrigator was used. A sterilized paper point was inserted in the root canal of the tooth that had been clinically diagnosed as having necrosis of the pulp. After a few minutes, it was suspended in the transport culture medium of 1 ml. This suspension was diluted 10 times and inoculated in the thioglycolate agar medium to calculate the number of alive bacteria. Results Ultrasonic irrigation leads to the remarkable reduction in the number of bacteria in the infected root canal, and bactericidal rate was 99.88% and treatment efficacy was 95.6% when combined with canal irrigants. Conclusion Ultrasonic wave showed remarkable irrigation effect and higher antibacterial rate when combined with various irrigants; however, it alone cannot kill 100% of bacteria in the infected root canal.
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Prediction of clinical outcome in patients with nonvariceal gastrointestinal bleeding using Forrest classification and Rockall score p. 83
Nam Hun Jong, Hye Song Kim, Chol Jin Han
DOI:10.4103/kamj.kamj_20_18  
Background Predicting outcome of upper gastrointestinal bleeding has significant importance to reduce mortality, duration of hospital stay, and medical cost. Objective The aim was to investigate the predictive value of Forrest classification and Rockall score in assessing rebleeding rate and mortality rate in patients with nonvariceal gastrointestinal bleeding (NVUGIB). Patients and methods A total of 518 patients with NVUGIB from January 2013 to July 2017 were enrolled in this retrospective study. Logistic regression analysis was used to assess the association between these scores and clinical outcome. Results Forrest classification is significantly associated with rebleeding, whereas Rockall score is closely associated with mortality. The risks of rebleeding in patients with Forrest Ia-b [odds ratio (OR): 39.2; 95% confidence interval (CI):19.2–79.8], FIIa (OR: 29.7; 95% CI:13.5–65.4), and FIIb (OR: 6.5; 95% CI: 3.0–14.1) were significantly increasing compared with FIII. The risks of mortality in patients with Rockall score 4–6 (OR: 9.4; 4.1–21.6), 7–11 (OR: 101.5; 50.2–205.3), were significantly increasing compared with the group with Rockall score less than 4. Conclusion Forrest classification can be used as a predictor for rebleeding and Rockall score can be used as a predictor for mortality in patients with NVUGIB.
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ERRATUM Top

Erratum: Studying the correlation between transforming growth factor β1 and chitinase-3-like-1 in assessment of bronchial asthma severity p. 89

DOI:10.4103/1687-4625.251934  
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