Hanan H. Hagar

Folic acid and vitamin B12 supplementation attenuates isoprenaline-induced myocardial infarction in experimental hyperhomocysteinemic rats

Hyperhomocysteinemia (Hhcy) is an independent risk factor for cardiovascular disease. Oxidative stress may contribute to the deleterious effects of homocysteine (Hcy). The aim of the present study is to study the effect of folic acid and Vitamin B(12) supplementation on isoprenaline (ISO)-induced myocardial infarction (MI) in hyperhomocysteinemic rats. Hhcy was induced by daily intake of methionine (1 g kg(-1) body weight) in the drinking water for 4 weeks. MI was then produced by a single subcutaneous injection of ISO (300 mg kg(-1), s.c.). Electrocardiographic parameters, heart rate, ST segment, and blood pressure as well as serum marker enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH) were measured. Lipid peroxidation measured as malondialdehyde (MDA) and reduced glutathione (GSH) concentrations in heart tissue were estimated as indices of oxidative stress. Hhcy resulted in significant blood pressure reduction, ST segment elevation and increase in heart rate and serum CK and LDH levels. Cardiac MDA was significantly increased, while GSH was decreased in Hhcy group compared to the normal control group. All the measured parameters were greatly exaggerated in Hhcy rats treated with ISO in comparison with Hhcy rats alone. Administration of folic acid (10 mg kg(-1), orally via gavage) and Vitamin B(12) (500 microg kg(-1), i.m.) concurrently for 4 weeks during the induction of Hhcy markedly reduced the increase in heart rate, ST segment elevation and blood pressure reduction as well as the increase in serum CK and LDH levels. Cardiac MDA content was decreased while cardiac GSH was elevated in the treated group compared to Hhcy + ISO group. Moreover, the severe cardiac histopathological changes observed in Hhcy + ISO group were attenuated by folic acid and Vitamin B(12). These results suggest that Hhcy aggravates MI via oxidative stress mechanisms and that lowering Hcy level with folic acid and Vitamin B(12) can ameliorate the detrimental effects of Hhcy and may reduce the risk of MI.

Focal and segmental glomerulosclerosis in murine models: a histological and ultrastructural characterization with immunohistochemistry correlation of glomerular CD44 and WT1 expression

ABSTRACT Aim: Focal segmental glomerulosclerosis (FSGS) is a common progressive chronic renal disease. Podocyte injury and loss are the postulated pivotal events that trigger FSGS. In this study, the authors aim to examine the evolution of FSGS in murine models histologically, ultrastructurally and immunohistochemically with special emphasis on podocytes and parietal epithelial cells (PECs). Material and methods: FSGS resembling primary FSGS in humans was initiated in Wistar rats using intravenous Adriamycin injections. Blood and urine analysis were performed at 0, 8, and 12 weeks. Both the control kidneys and the test kidneys were harvested at 8 and 12 weeks, examined histologically and ultrastructurally and the findings correlated with the glomerular expression of immunostains specific for podocytes (WT-1) and for activated PECs (CD44). Results: FSGS developed in both 8 and 12 weeks test groups showing progressive proteinuria, podocytopathy and segmental glomerular scarring. There was a decrease in the glomerular expression of WT-1 with a concurrent increase in the glomerular expression of CD44, indicating podocyte loss with synchronous increase in activated PECs. The evolving FSGS correlated negatively with podocytes and positively with activated PECs. Conclusion: Our study shows that with podocyte injury there is podocyte effacement and loss, proteinuria, glomerular segmental adhesion and scarring, all culminating in FSGS. In addition, there is activation, hyperplasia and hypertrophy of PECs. This demonstrates that both podocyte loss and PEC activation promote FSGS. Our findings are consistent with recent investigations. More studies are required to further understand the role of these cells in the evolution of FSGS and subsequently introduce new targeted treatment modalities.

The Impact of Diabetes on Acute Post-Infectious Glomerulonephritis in Rats: An Experimental Study with Literature Review

Background: The concurrence of diabetes and nephritogenic infections may have a tremendous impact on the kidney. The approach to the two concurrent diseases is based on histological, immunofluorescence findings and most importantly on ultrastructural features. In this experiment our aim was to compare the pattern of injury seen in the kidney in animals with induced post-infectious glomerulonephritis with and without associated diabetes. nMethods: We divided 48 Wistar species rats into four groups comprising twelve rats each. Group I is the normal control, group II includes the rats with induced diabetes, group III are the rats with acute post-infectious glomerulonephritis (APIG), while group IV includes the rats with induced diabetes and APIG. Streptozocin was used to induce diabetes in groups II and IV while neutral phosphatase toxin (NPTase) of Staphylococcus strain was used in groups III and IV. Groups III and IV were sacrificed three and ten days after infection. Routine, immunofluorescence and ultrastructural stains and studies were performed on the kidneys of all rats. Serum urea and creatinine and urinary protein were estimated in all groups. nResults: Out of the forty-eight rats initially included in the study, only twenty-four survived the experiment: three in Group I, five in Group II, five in Group III and eleven in Group IV. The most relevant and distinguishing findings in cases of APIG with associated diabetes are the earlier and more prominent infiltration by polymorphonuclear cells, the stronger positivity for IgG and the earlier and more extensive presence of dense deposits which were confirmed by the electron microscopy study. nConclusions: This experiment ascertains the adverse effects of diabetes in cases of acute post-infectious glomerulonephritis, in terms of onset and severity of the disease. The necessity of a better control of the glucose level may not only decrease the incidence of acute post-infectious glomerulonephritis but may also contribute to the development of a milder form of the disease.

Comparative Study between Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Ulcerative Colitis Induced Experimentally in Rats

Eosinophilic oesophagitis (EoE) is characterized by upper gastrointestinal symptoms and of more than 15 or 20 eosinophils in the esophageal epithelium. Lack of awareness to EoE among some gastroenterologists made the disease under recognized. Patients with eosinophilia oesophagitis should be referred to both an allergist and gastroenterologist for optimal management, which may include dietary modifications, pharmacologic agents, ingested fluticasone and its role in EoE will be discussed in this study. This study was conducted at faculty of medicine, Alexandria University, internal medicine, tropical medicine department, and gastroenterology and endoscopy unit. The study was conducted on twenty patients who were complaining from recurrent dysphagia and done upper GIT endoscopy and diagnosed histopathologically as E0E. The 20 patients were randomly assigned to receive either placebo (n = 10) or swallowed fluticasone (n = 10). Patients received two puffs four times a day, with 200 micrograms per puff. Treatment lasted four weeks and follow up extended up to 8 months. The fluticasone was delivered via a metered-dose inhaler without the spacer. After 4 weeks treatment, Clinical symptoms and histological changes were evaluated. Histologic improvement in the form of full histological remission was seen in seven patients in the fluticasone group compared with one patient who achieved remission in the placebo group. In conclusion, the study highlights the problems of diagnosis and lack of awareness and understanding of the etiology and pathogenesis of the disease. The use of ingested fluticasone showed improvement of symptoms, and histological pattern.H B virus (HBV) infection is a global epidemic with estimated mortality 0.5-1.2 million deaths a year. Long-term goal of treatment on patients with chronic hepatitis B infection (CHB) is to reduce cirrhosis, hepatocellular carcinoma, and ultimately improve survival.The decision on initiating viral therapy can be complex because not all the patients with CHB derive significant clinical benefits from current medical therapies. Elevated HBV DNA level is a strong independent risk predictor of liver-related disease outcomes. Up to date, many studies have demonstrated improved clinical outcomes with successful viral suppression in CHB patients.Hepatic disease activity, assessed by histology and less accurately by alanine aminotransferase (ALT), is another major decision-making factor on initiating anti-viral therapy in patients with CHB. As in immune tolerance phase of CHB, characterized by high HBV DNA level, normal ALT, and no/minimal hepatic inflammation, disease progression is negligible.Treatment on these patients is therefore unlikely to alter long-term clinical outcomes. However, close monitoring of ALT level is highly recommended during immune tolerant phase astransition to immune clearance phase may occur. Anti-viral therapy is often required during immune clearance phase due to rapid disease progression.In patients with low HBV DNA and normal ALT, as seen in inactive carrier, medical therapy is typically not beneficial in long-term out comes due to minimal risk of developing hepatic complications.Introduction: ESWL has become the preferred tool in the Urologist’s armamentarium for treatment of urinary calculi in appropriate cases because it is simple, effective and minimally invasive technique. Efficacy of ESWL besides other factors also depends on cooperation of the patient throughout the procedure. Several different techniques along with analgesic drugs have been used for ESWL procedure including general, regional and local anesthesia as well as monitored anesthesia care. The aim of our study was to compare safety and efficacy of performing ESWL under intravenous (IV) anesthesia as compared to local anesthesia.T Sonography of the Stomach & Duodenum can reveal following diseases. Gastritis & Duodenitis. Acid Gastritis. An Ulcer, whether it is superficial, deep with risk of impending perforation, Perforated, Sealed perforation, Chronic Ulcer & Post-Healing fibrosis & stricture. Polyps & Diverticulum. Benign intra-mural tumours. Intra-mural haematoma. Duodenal outlet obstruction due to Annular Pancreas. Gastro-Duodenal Ascariasis. Pancreatic or Biliary Stents. Foreign Body. Necrotizing GastroDuodenitis. Tuberculosis. Lesions of Ampulla of Vater like prolapsed, benign & infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature. Enlargement of the involved segment seen. Shouldering effect at the ends of stricture is most common feature. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-Ampullary malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy.