Alaa A Abd-Elsayed

Serum adiponectin and leptin as predictors of the presence and degree of coronary atherosclerosis.

BackgroundThe association of adipocyte-derived proteins, adiponectin and leptin, with the degree of coronary atherosclerosis has not been not been well elucidated. This study aimed to determine the relationship between serum adiponectin and leptin with the presence and degree of coronary atherosclerosis. MethodsSeventy patients and 20 matched controls were recruited. Angiographic evaluation of coronary atherosclerosis was carried out by assessing three atherosclerotic indices, severity (transverse disease), extent (longitudinal disease), and pattern (lesion complexity). ResultsThe independent predictors of atherosclerosis severity were larger waist/hip ratio, followed by higher low-density lipoprotein-cholesterol, low serum adiponectin level, older age, higher leptin level, current unstable angina, and finally previous myocardial infarction (MI). This model is a good one as indicated by the model-adjusted r2 (50%). For extent index, lower serum adiponectin level was by far the most important independent predictor, followed by higher low-density lipoprotein-cholesterol, older age, and previous MI, whereas higher serum leptin level was only a univariate predictor. The model-adjusted r2 was 65%. For pattern index, the independent predictors were previous MI, lower serum adiponectin level, larger waist/hip ratio, higher serum leptin level, older age, and higher fasting blood glucose level. The model-adjusted r2 was 62%. ConclusionBoth serum adiponectin and leptin might play an important pathogenic role not only in the occurrence but also in the severity, extent, and lesion complexity in coronary artery disease patients.

Successful treatment of kasabach-merritt syndrome with vincristine and surgery: a case report and review of literature

IntroductionHaemangiomas are vascular lesions resulting from abnormal proliferation of blood vessels. They are the most common pediatric neoplasm. Kasabach-Merritt syndrome is a rare type of vascular lesion with peculiar characteristics. The diagnosis is based upon three basic findings; enlarging haemangioma, thrombocytopenia and consumption coagulopathy.Case presentationA 5 month old boy was admitted to the Pediatrics department for the management of an abdominal wall mass. He was the first child of consanguineous parents, born in a private hospital following uncomplicated pregnancy and delivery. At birth a bluish birth mark 5 cm × 5 cm was noted below the umbilicus. Over the next five months, this birth mark increased in size and evolved into a swelling. As a result, the patient was admitted to Maternal and Child Health (MCH) unit for the management of this swelling.The clinical findings and imagining studies followed by laboratory investigations strongly suggested the diagnosis of Kasabach-Merritt syndrome.Vincristine was initiated after a trial of corticosteroids when the platelet count was 6000/cmm. One week after the start of vincristine the size of the lesion started to decrease. At the end of 6th week the lesion size decreased to half and the platelet count increased to 49,000/cmm. Vincristine was continued for another 2 weeks, no further improvement in lesion size or platelet count was observed. Vincristine was discontinued and the patient was shifted to the paediatric surgery department. A fresh platelet transfusion was given and the haemangioma was excised completely.The histopathological examination of the excised mass revealed a caverno-capillary haemangioma with infiltration into skeletal muscles.ConclusionSix weeks treatment with vincristine in a dose of 0.5 mg/kg/week followed by surgical excision may be the best management in selected cases of Kasabach-Merritt syndrome.

Patient reported and anatomical outcomes after surgery for pelvic organ prolapse

Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair.

Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic Hepatitis C virus infection.

Background/Aim: Both nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C virus (HCV) infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C (CHC) (necroinflammation and fibrosis) and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. Patients and Methods: Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. Results: Our study included 92 male patients. Their mean ± SD age and aspartate aminotransferase (AST) level were 42 ± 7.7 years (range 20-56) and 68 ± 41.7 U/L (range 16-214), respectively. The mean insulin level and insulin resistance index were 15.6 ± 18.3 mIU/mL (range 5.1-137.4) and 5.9 ± 15.2 (range 0.9-136.2), respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age ≥40 years, and steatosis. Conclusions: Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age.

Safety and benefits of large-volume liposuction: a single center experience

Background Liposuction is a surgical technique to remove excess fat deposits from specific areas of the body. Purpose of this study is to determine how far large volume liposuction is safe and effective. Methodology From July 2003 to December 2005, 60 female patients had liposuction of different areas of the body as waist, hips, buttocks, thighs, and knees. Their mean age was 30.6 ± 15.4 years old. A standard liposuction technique was done by using a tumescent infiltration formula. The average amount of infusate was 3000 cc, with an average aspirate amount of 6000 cc. Pre-operative anthropometric measurements as weight, height, body mass index, areas to be liposuctioned in addition to pre-operative hematological investigations as complete blood picture, blood sugar, liver function tests, blood urea, serum creatinine, and serum cholesterol were done. Results The results were evaluated with preoperative and postoperative photographs. Postoperative anthropometric measurements and hematological investigations were done at 6th week, and 4th month after surgery. The rate of complications was low and relatively minor in nature. No major complications were presented. Minor complications have occurred as skin irregularities (20%), Seroma (15%), Garment pressure sore (10%), Cutaneous hyper-pigmentation (5%). Conclusion Large-volume liposuction can be performed safely and it can produce desirable morphological and hematological changes.

Prune belly syndrome in an Egyptian infant with Down syndrome: A case report

IntroductionPrune belly syndrome is a rare congenital anomaly of uncertain aetiology almost exclusive to males. The association between prune belly syndrome and Down syndrome is very rare.Case presentationA 4-month-old Egyptian boy was admitted to our institute for management of acute bronchiolitis. He was born at full term by normal vaginal delivery. His mother, a 42-year-Egyptian villager with six other children, had no antenatal or prenatal care. On examination, the boy was found to be hypotonic. In addition to features of Down syndrome, karyotyping confirmed the diagnosis of trisomy 21. Ultrasound examination of the abdomen showed bilateral gross hydronephrosis with megaureter. Micturating cystourethrography showed grade V vesicoureteric reflux bilaterally with no urethral obstruction. Serum creatinine concentration was 90 μmol/litre, serum sodium was 132 mmol/litre and serum potassium was 5.9 mmol/litre.ConclusionWe report an Egyptian infant with Down syndrome and prune belly syndrome. The incidence of this association is unknown. Routine antenatal ultrasonography will help in discovering renal anomalies which can be followed postnatally. Postnatal detection of prune belly syndrome necessitates full radiological investigation to detect any renal anomalies. Early diagnosis of this syndrome and determining its optimal treatment are very important in helping to avoid its fatal course.

Single puncture percutaneous nephrolithomy for management of complex renal stones

BackgroundThe purpose of this report is to assess the safety and efficacy of single lower pole access for multiple and branched renal calculi. A prospective non randomized clinical study included 26 patients with complex renal stones (9 patients had branched renal stones and the other 17 had multiple renal stones) in the period from May 2003 to May 2004. Mean patient age was 42 years ± 13.2 (range 18 to 67 years). All patients underwent percutaneous nephrolithotomy (PCNL) via a single lower calyceal puncture. Small stones were intactly extracted by a range of stone graspers while large stones (smallest diameter more than 1 cm) were disintegrated using either the pneumatic EMS Swiss lithoclast or Holmium YAG laser. Flexible nephroscope was used for stones inaccessible by the rigid instruments.FindingsOverall stone-free rate was 74.8%. Patients with residual stones were managed by one session of shock wave lithotripsy (SWL). Mean operative time was (80 minutes ± 27.4) for branched stones and (49.1 minutes ± 15.9) for multiple stones. No significant blood loss reported. Perforation of pelvicalyceal system occurred in 2 patients (11.5%) with no serious sequelae. Only 1 patient developed secondary hemorrhage which necessitated blood transfusion and selective angio-embolization.ConclusionIn our hands, the efficacy and safety of single lower calyceal puncture PCNL in management of complex renal stones are comparable to those of the general procedure stated in literature.

Pattern of eye casualty clinic cases

Introduction/Background The purpose of the eye casualty clinic (ECC) is to manage patients with ocular emergencies, however a large number of patients attended the eye casualty clinic did not have an acute problem and could have been treated by their General Practitioner (GP) or referred to the eye outpatient clinic. Aim To identify the number of patients attending the ECC every day and their route of referral and to estimate the number of patients who could have be seen and managed by a competent ophthalmic nurse practitioner. Methods A retrospective analysis was conducted using the notes and history of all patients who attended the eye casualty clinic at the Princess Margaret Hospital in Swindon during two weeks in March 2006. Results The average daily attendance was 21 patients who were seen between morning and afternoon sessions in the Eye Casualty Clinic.112 (54%) patients were female. The median patient age was 50 years with an age range of 1 to 91 years. 68 (34.2%) patients attended as self referrals without GP letters as our eye casualty clinic is open to the general public from 9.00 a.m. to 5.00 p.m. A & E referred 28 (14.1%) patients of which only 3 had a General Practitioner (GP) letter and only 1 patient had a walk-in centre letter. There was insufficient information to assess whether 14 patients could have been managed by a nurse; of the remaining 195 visits, 50 (25.6%) patients could have been managed by an Ophthalmic Nurse Practitioner and 145 (74.4%) patients could not have been managed by an Ophthalmic Nurse Practitioner. Conclusion The workload of the eye casualty doctors could be decreased by 38.6% if defined categories of patients were managed by the ophthalmic nurse practitioner, appropriate referrals were directed to the General Clinic and casualty patients were not followed up inappropriately.

Necrotizing fasciitis with toxic shock syndrome in a child: a case report and review of literature

IntroductionNecrotizing fasciitis was described as early as the fifth century BC. It showed an increased incidence worldwide in the past several years.Case presentationAn 8-year-old Arabian boy was referred for admission as a case of cellulitis of the left thigh. Ten days prior to admission he had a cat scratch to his left thigh and the parents did not seek medical advice at that time. The child was again examined by orthopedic surgeon and a diagnosis of cellulites was made at that time.Physical examination on admission revealed a very toxic appearing weak child with cold extremities and poor peripheral perfusion.Examination of the left thigh revealed extensive swelling, induration and edema with dusky skin, blistering and bleb formation, in addition to an area of gangrenous skin. Laboratory investigation revealed white blood cell count of 22,400 × 109 with toxic granulation on peripheral blood smear.The child was admitted to the pediatric intensive care unit and dopamine and dobutamine infusions were started after volume expansion. Penicillin and clindamycin also were started in addition to multiple transfusions of fresh frozen plasma. Surgical debridement of all necrotic tissues and drainage of involved fascia planes via extensive fasciotomy were done for our patient after stabilization of his vital signs and improvement of his general condition.Blood cultures grew group A streptococcus, as did wound swab culture.The child showed great improvements in his clinical condition after the 3rd day of antibiotics and supportive treatment and the wound healed normally and antibiotics were administered for 21 days.ConclusionNecrotizing fasciitis in children is a frequently misdiagnosed condition; early identification of the necrotizing process can improve the outcome of this life-threatening disease. Surgical debridement and antibiotics were the most important therapeutic measures.

The first case of isolated facial cutanenous leishmaniasis in a Down syndrome infant: a case report and review of the literature

BackgroundCutaneous leishmaniasis can be caused by several Leishmania species and is transmitted to human beings and animals by sand flies, Down syndrome is known to cause immunodeficiency that might lead to increase the susceptibility to infection with Leishmania.Up to our knowledge this is the first case of isolated facial cutaneous leshmaniasis in association with Down syndrome.Case presentationA 2 month old Saudi Arabian male infant was admitted in the pediatric ward of maternity and childrens hospital, Buraidah, Kingdom of Saudi Arabia for the management of multiple ulcers on his face, two ulcers were big and were surrounded by edema, causing severe disfigurement. This disfigurement caused difficulty in recognizing the facial feature of Down syndrome. The presence of hypotonia, microcephaly, low set ears, bilateral simian creases and wide separation between big toe and other toes directed us to request karyotyping. The result of karyotyping confirmed the diagnosis of Down syndrome.ConclusionChildren with Down syndrome are immunodeficient, they have been reported to have a complex of immunological alterations which might lead to increased susceptibility to infection.