Control and treatment of type 2 diabetes in private patients in the Egyptian "DIACONTROL study".

OBJECTIVE: This study aims to identify the characteristics of Egyptian patients suffering from type 2 diabetes mellitus (T2DM), determine disease control rates, and gain insights into clinical treatments. PATIENTS AND METHODS: A total of 2,516 patients with T2DM were recruited from 244 private clinics across Egypt in a one-month period from May to June 2017. Data collected from patients included glycemic control parameters of glycosylated hemoglobin, fasting plasma glucose, and postprandial glucose. Additional information gathered included patients' weight, age, level of physical activity, smoking habits, presence of comorbidities, type of treatment received for type 2 diabetes, number and severity of hypoglycemic events, as well as treatment modification by the physician in the last visit. The type of statistics used for the analysis is descriptive statistics and regression model. RESULTS: Only 18.4% of participating patients achieved the target level of glycosylated hemoglobin of 7% or below. The mean age of these patients was 54±11.2 years, and the mean duration since the first diagnosis was 6.6±6.4 years. A total of 33.4% of all patients had no known comorbidity, while the rest had one or more known and treated comorbidities. A total of 76% of patients received sulfonylurea either as monotherapy or in combination with other treatments. In addition, no treatment modifications or adjustments were provided for 32% of the study participants who did not reach their glycemic control target. CONCLUSIONS: In Egypt, there is a low rate of glycemic control among private patients and a high prevalence of comorbid conditions. This is likely to cause a significant health burden to people with T2DM, the healthcare system, and the economy due to a loss in productivity. This study presented an argument for better-managed measures to improve glycemic control in the population, such as patient education to increase patient awareness and adherence to treatment protocols as well as improved adherence to guidelines by clinicians.

Orchiepididymitis in the context of multisystem inflammatory syndrome in a child with Covid-19 from Syria: a very rare presentation for SARS-Cov-19 in children.

The coronavirus disease 2019 (COVID-19) is still striking the global population affecting all age groups. So far, many clinical features associated with COVID-19 illness remain under-identified, especially atypical manifestations. It is essential to characterize associated rare symptoms to better recognize complications. As severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes Multisystem Inflammatory Syndrome in children (MIS-C) in severe infection manifesting as a generalized inflammatory reaction and immune response in many body systems, potential involvement of the male urogenital tract by SARS-CoV-2 should be considered. Herein, we report a case of a pediatric patient with orchiepididymitis associated with COVID-19 infection, emphasizing the importance of considering other manifestations such as genital involvement of MIS-C in children with COVID-19 and highlighting the need to monitor the genitourinary function after infection. Therefore, andrological consultation is necessary to evaluate fertility as a long-term follow-up, especially as the effects of SARS-CoV-2 on male reproductive function are still to be thoroughly researched.

Seroprevalence of hepatitis E virus in dromedary camels, Bedouins, Muslim Arabs and Jews in Israel, 2009-2017.

Hepatitis E virus (HEV) is an emerging cause of viral hepatitis worldwide. Recently, HEV-7 has been shown to infect camels and humans. We studied HEV seroprevalence in dromedary camels and among Bedouins, Arabs (Muslims, none-Bedouins) and Jews and assessed factors associated with anti-HEV seropositivity. Serum samples from dromedary camels (n = 86) were used to determine camel anti-HEV IgG and HEV RNA positivity. Human samples collected between 2009 and 2016 from >20 years old Bedouins (n = 305), non-Bedouin Arabs (n = 320) and Jews (n = 195), were randomly selected using an age-stratified sampling design. Human HEV IgG levels were determined using Wantai IgG ELISA assay. Of the samples obtained from camels, 68.6% were anti-HEV positive. Among the human populations, Bedouins and non-Bedouin Arabs had a significantly higher prevalence of HEV antibodies (21.6% and 15.0%, respectively) compared with the Jewish population (3.1%). Seropositivity increased significantly with age in all human populations, reaching 47.6% and 34.8% among ⩾40 years old, in Bedouins and non-Bedouin Arabs, respectively. The high seropositivity in camels and in ⩾40 years old Bedouins and non-Bedouin Arabs suggests that HEV is endemic in Israel. The low HEV seroprevalence in Jews could be attributed to higher socio-economic status.

Multiple Injuries to the Lower Urinary Tract: Two Cases and Comparison with the EAU Guidelines.

Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.

Postoperative Urinary Leakage Following Partial Nephrectomy for Renal Mass: Risk Factors and a Proposed Algorithm for the Diagnosis and Management.

OBJECTIVES: To evaluate the current incidence, risk factors, management, and long-term follow-up of urinary leakage following partial nephrectomy, in order to propose an algorithm for diagnosis and evaluation of postoperative urinary leakage. MATERIALS AND METHODS: The study included 752 patients who underwent elective partial nephrectomies for renal masses between the years 1988 and 2013. Patients' demographics, clinico-pathologic variables, and operative details were collected retrospectively. The associations between urinary leakage and patients' variables were assessed by univariate and multivariate analyses. RESULTS: Of the 752 patients, 21 (2.8%) experienced urinary leakage; 4 of the 21 patients with urinary leakage had spontaneous resolution, 1 patient underwent nephrectomy, and 16 patients were treated by retrograde ureteral stents insertion. One of them necessitated insertion of an additional percutaneous nephrostomy and another one deserved concomitant percutaneous drainage of a perirenal urinoma. The average period of time that elapsed from the operation until the insertion of stent was 8.5 ± 4.5 days. Stents were removed 68 ± 20.5 days postoperatively. None of the patients had either persistent or repeated leakage. On univariate analysis, hilar renal masses (p < 0.04) and higher preoperative creatinine levels (p < 0.01) were found to be associated with higher rates of urinary leakage. None of these variables was significant on a multivariate analysis. Review of the urinary leakage rate over time revealed it has been constantly decreasing over time, from 4% in early cases to 1.3% among the most recent ones. CONCLUSION: None of the preoperative variables that were examined in this study was significantly associated with increased risk of urinary leakage. However, cumulative surgical experience was associated with lower rates of urinary leakage, suggesting that the decrease in its incidence is related to the improved surgical skills, rather than to differences in tumors' or patients' characteristics.

Caseous lymphadenitis in small ruminants in Egypt. Clinical, epidemiological and prophylactic aspects.

OBJECTIVE: The aim of this study was to investigate the distribution of caseous lymphadenitis (CLA) among small ruminants in Egypt, identify risk factors associated with its occurrence and to analyze the efficacy of the vaccine for control of CLA. MATERIAL AND METHODS: A total of 1206 sheep and 351 goats were examined clinically for CLA. The prevalence and the risk factors of CLA in small ruminant flocks were estimated and identified. Efficacy of the commercial vaccine Case-Bac (Colorado Serum Company, USA) was determined in a field study trial conducted on 15 CLA-free lambs. Follow-up of vaccination immune response was carried out using indirect ELISA. RESULTS: Prevalence of superficial CLA was 6.7%. Clinically, CLA appeared as abscesses in superficial lymph nodes mostly of the head and neck. On the basis of a multivariate analysis which accounted for clustering at herd level, sheep were at risk of getting superficial CLA 3.5 times more than goats (p < 0.0001). Animals of fixed flocks were at risk of getting the superficial CLA 2 times more than animals in fixed-mobile flocks (p < 0.038). Serological follow-up indicated protective antibody titers for 6 months. In vaccinated animals clinical cases were not observed while they occurred among non-vaccinated sheep. DISCUSSION: Prevalence of CLA varied among studied flocks even between those of the same breeding system due to complex and overlapping factors associated with each flock like introduction or culling rate of animals, care of shepherds or owners to deal with opened abscesses in addition to the average age of the animals within each flock. Breeding systems have observable effects on occurrence of CLA: infected sheep can transmit the infection to a large number of animals in a short period under the conditions of close contact and reduced air flow in covered sheds. CONCLUSION AND CLINICAL RELEVANCE: Infected small ruminants in fixed flocks represent a risk factor for CLA for healthy ones. The vaccine used in the study provides an effective protection against new infections. So mass vaccination of small ruminants against CLA in Egypt has to be considered to minimize the disease prevalence.

Molecular phylogeny of equine herpesvirus 1 isolates from onager, zebra and Thomson's gazelle.

Viruses related to equine herpesvirus type 1 (EHV-1) were isolated from an aborted fetus of an onager (Equus hemionus) in 1984, an aborted fetus of Grevy's zebra (Equus grevyi) in 1984 and a Thomson's gazelle (Gazella thomsoni) with nonsuppurative encephalitis in 1996, all in the USA. The mother of the onager fetus and the gazelle were kept near plains zebras (Equus burchelli). In phylogenetic trees based on the nucleotide sequences of the genes for glycoproteins B (gB), I (gI), and E (gE), and teguments including ORF8 (UL51), ORF15 (UL45), and ORF68 (US2), the onager, Grevy's zebra and gazelle isolates formed a genetic group that was different from several horse EHV-1 isolates. Within this group, the onager and gazelle isolates were closely related, while the Grevy's zebra isolate was distantly related to these two isolates. The epizootiological origin of the viruses is discussed.

Enhanced stress reactivity in nitric oxide synthase type 2 mutant mice: findings in support of astrocytic nitrosative modulation of behavior.

Alterations of nitric oxide (NO) metabolism in the brain have been associated with modifications of stress-related behavior in animal models. It has been generally assumed that these behavioral changes are due to the neuronal nitrosative activity. On the other hand, glial NO production has been demonstrated mainly as a slow reaction to brain insults through the activity of an inducible nitric oxide synthase (NOS) isoform (NOS2). Recently we uncovered increased NOS activity in astrocytes of mice with a NOS2 mutation. Interestingly, these mice revealed a behavioral phenotype suggestive of increased susceptibility to stress. In the present study we investigated the responses of these mutants to stress by exposing them to predator scent. Seven days later, mutant mice exhibited significantly higher anxiety-like behavior in the elevated-plus maze, increased acoustic startle responses, and higher plasma corticosterone levels compared with their controls. Systemic administration of a NOS inhibitor prior to the stress exposure reversed these stress-related effects without affecting controls' behavior. These findings are in agreement with previous studies showing an association between increased NO levels and enhanced anxiety-like responses. In addition, mutant mice performed better in the Morris water maze prior to stress exposure, but the two animal groups performed alike in an object-recognition test. Taken together, our results suggest the involvement of astrocytic-derived NO in modulating behavior.

Comparative properties of excitatory and inhibitory inter-laminar neocortical axons.

In recent years it has become increasingly clear that variations in voltage-gated channels, as well as highly diverse geometrical properties, shape the way axons conduct action potentials to their terminals. Numerous cell types in the mammalian neocortex form a dense network of connections, and the properties of their axons may have an effect on the processing performed by this network. We studied the conduction properties of local, inter-laminar axons emanating from regular-spiking (RS) pyramidal neurons and Martinotti type inhibitory neurons (MCs) in layer 5 of the mouse barrel neocortex by comparing the patterns of their antidromic activation from layer 1. Both types of axons had similarly slow conduction velocities ( approximately 0.3 m/s), compatible with thin unmyelinated fibers. In addition, in both types of neurons, subthreshold changes of the somatic membrane potential affected the stimulus threshold for evoking an antidromic spike in layer 1, a distance of 600-800 microm. However, the axons differed considerably in their antidromic activation profiles. 1) The antidromic latency in RS neurons was highly consistent while some MCs display considerable activation-latency jitter; 2) RS neurons displayed a steeper increase in excitability to repeated 40 Hz stimulation; 3) RS neurons displayed a sharp, step-like antidromic activation threshold to both somatic voltage and stimulus intensity, while MCs displayed a gradual recruitment pattern. Morphological differences in the branching pattern of the two types of neurons may account for some of these distinctions. These results suggest differences among excitatory and inhibitory neocortical neurons in the computational tasks of their local axons.

Study of erythrocyte shape changes in schistosomiasis.

The aim of this work was to study the red cell morphology in different stages of schistosomiasis. Patients were divided into three groups according to the stage of the disease. For each patient, complete clinical examination, liver function tests, renal function tests, complete blood picture, scanning electron microscopy for erythrocytes (SEM) and abdominal ultrasonography were done. Abnormal morphologic changes of a total discoid flat cells of 70.14%, margin changes of 12.34% and 3.55% of cup forms were found. To our knowledge, these marked changes were not reported in any other disease. No statistical differences were found between red cell shape changes and stage of liver disease. There was a positive correlation between portal vein diameter and percentage of flat discoid forms and a negative correlation between surface changes and clinical stage of liver disease. These changes are known to be accompanied by reduction of red cell deformability and impaired capillary flow.

In vitro effects of somatostatin on red cell filterability measured by three methods.

Somatostatin is an ubiqutary neuropeptide and hormone which has been reported to exert hemodynamic effects and to bind to receptors on the red cell membrane. We investigated its effects on red cell deformability by three filtration methods: (a) filtration of red cells resuspended at hematocrit 8% in Tris-Albumin-Glucose buffer under atmospheric pressure; (b) filtration of red cells resuspended at hematocrit on native plasma at 8% hematocrit under a negative pressure of 5 cm of water; (c) filtrability of whole blood under a negative pressure of 20 cm of water. Aprotinin (Antagosan*) was added to the different suspensions in order to avoid rapid destruction of somatostatin. Increased quantities of somatostatin (from 1 pg/ml to 1 microgram/ml) were obtained by adding natural somatostatin (Modustatin*) to the media, before they were incubated at 37 C for 30 minutes. In 11 samples from healthy subjects, somatostatin was shown to increase red cell flow rate in technique (c) (+ 118%, p less than 0.05) and to reduce red cell rigidity index in technique (b) (- 71%, p less than 0.025) whereas a nonsignificant similar tendency (- 56%) was observed with technique (a). Similar results (p less than 0.05) are observed when adding somatostatin to blood of diabetics. These in vitro data suggest that somatostatin, like other previously studied hormones, may modify red cell deformability.