Characterization and Cytotoxicity Analysis of a Ciprofloxacin Loaded Chitosan/Bioglass Scaffold on Cultured Human Periodontal Ligament Stem Cells: a Preliminary Report.

AIM: The aim of this study was to analyze the cytotoxicity of ciprofloxacin (CIP) loaded on chitosan bioactive glass scaffold on human periodontal ligament stem cells (PLSCs) in vitro. MATERIALS AND METHODS: PLSCs obtained from human third molars, cultures treated with medium containing 15 x 15 mm chitosan/bioactive glass scaffolds without/with different concentration 0, 5, 10, and 20 % of CIP. A total of 15 x 10^3 cells were plated in 6 well plates. The attached cells of each group were harvested from the plates after 1, 4 and 8 days of culture to detect the viability of cells. The cell number was determined using a hemocytometer and the trypan blue dye-exclusion assay. Data was analyzed using normality using Shapiro-Wilk test. Comparisons between groups were made using One-way ANOVA complemented by Tukey's test. RESULTS: When comparing the proliferation rate of cells in the four groups, no statistically significant difference was found (P = 0.633). With regards to cell viability, no statistical difference was found between the 0, 5, and 10 % CIP concentrations, while the 20 % CIP concentration demonstrated the least viability with a high statistically significant difference (P = 0.003). CONCLUSION: Twenty percentages CIP demonstrated the least proliferation rate and viability.

Bacterial meningitis surveillance in the Eastern Mediterranean region, 2005-2010: successes and challenges of a regional network.

OBJECTIVE: To describe epidemiology of bacterial meningitis in the World Health Organization Eastern Mediterranean Region countries and assist in introduction of new bacterial vaccines. STUDY DESIGN: A laboratory-based sentinel surveillance was established in 2004, and up to 10 countries joined the network until 2010. Personnel at participating hospitals and national public health laboratories received training in surveillance and laboratory methods and used standard clinical and laboratory-confirmed case definitions. RESULTS: Over 22,000 suspected cases of meningitis were reported among children ≤5 years old and >6600 among children >5 years old. In children ≤5 years old, 921 of 13,125 probable cases (7.0%) were culture-confirmed. The most commonly isolated pathogens were S pneumoniae (27% of confirmed cases), N meningitidis (22%), and H influenzae (10%). Among culture-confirmed case-patients with known outcome, case-fatality rate was 7.0% and 12.2% among children ≤5 years old and those >5 years old, respectively. Declining numbers of Haemophilus influenzae type b meningitis cases within 2 years post-Haemophilus influenzae type b conjugate vaccine introduction were observed in Pakistan. CONCLUSIONS: Bacterial meningitis continues to cause significant morbidity and mortality in the Eastern Mediterranean Region. Surveillance networks for bacterial meningitis ensure that all sites are using standardized methodologies. Surveillance data are useful to monitor impact of various interventions including vaccines, but maintaining data quality requires consistent reporting and regular technical support.

End-stage renal disease among living-kidney donors: single-center experience.

OBJECTIVES: Renal transplant from living donors is widely accepted as a highly effective treatment for end-stage renal disease. Donors undergo a major operation with considerable perioperative risks of morbidity and mortality. Living with a single kidney also confers long-term risks. This study sought the incidence and causes of end-stage renal disease among living kidney donors. MATERIALS AND METHODS: This study included all donors who had reached end-stage renal disease among 2000 consecutive living-kidney donors. All operations and follow-up were performed in a single center. We studied the onset of renal disease, cause of end-stage renal disease, date of replacement therapy, and outcome. We also revised the donor's medical records related to their corresponding recipients. RESULTS: Of 2000 living donors, 8 developed end-stage renal disease; 6 were men (mean age, 30.87 ± 5.84 years. Renal failure occurred 5 to 27 years after donation. Renal transplant was done in 1 donor. Medical complications were proteinuria (6 patients), hypertension (7 patients), diabetes (3 patients), gout (3 patients), ischemic heart disease (5 patients), and hepatitis viral infection (4 patients). The causes of end-stage renal disease were diabetic nephropathy in 3 patients. Other possible causes included toxic nephropathy, chronic pyelonephritis, and preeclampsia. CONCLUSIONS: Living kidney donation is safe, and development of renal failure after donation is caused by the same causes as in the general population.

Does posttransplant anemia at 6 months affect long-term outcome of live-donor kidney transplantation? A single-center experience.

BACKGROUND/AIMS: Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia at 6 months of transplantation in patients under different protocols of immunosuppression, and to determine the impact of anemia on long-term patient and graft survival. METHODS: We included 832 renal transplant recipients who were categorized at 6 months according to hemoglobin (Hb) level into two groups: the first group, with Hb >13 g/dl in males and >12 g/dl in females (group I, 385 cases); and the second group, with Hb <13 g/dl in males and <12 g/dl in females (group II, 447 cases). We compared the two groups regarding posttransplant complications as well as patient and graft survival. RESULTS: Although there was no significant difference between the two groups regarding acute rejection episodes, chronic allograft nephropathy was significantly higher in the anemic group. Other posttransplant medical complications were comparable in both groups. Graft survival was significantly higher in the nonanemic group. However, no difference in patient survival was detected. CONCLUSION: From this study, we can conclude that prevalence of PTA is high, especially in females and those receiving calcineurine inhibitors (CNI) and mycophenolate mofetil (MMF), and that it was associated with poorer graft outcome but with no effect on patient survival.

Postkidney transplant malignancy in Egypt has a unique pattern: a three-decade experience.

The pattern of posttransplant malignancy varies among transplant units. We report on our single-center experience. Between 1976 and 2007, 1866 kidney transplantations were carried out (1390 males and 476 females, mean age 29.84+/-10.47 years). Recipients who developed posttransplant malignancy were evaluated (74 patients, 3.97%). Furthermore, their data were compared with those of the malignancy-free recipients (1792 patients). Kaposi sarcoma was the commonest type (36.8%) and had the shortest transplant-to-malignancy period (mean 2.84 years). The lesions were only cutaneous in 75% of cases. Skin cancers were the fourth among posttransplant malignancies (9.2%) and 85.7% of cases were basal cell carcinoma. In our series, age and prior blood transfusion were identified as independent risk factors for the development of posttransplant malignancy. In conclusion, the prevalence and type of posttransplant malignancy vary because of many factors including environmental and genetic factors. In our series, Kaposi sarcoma was the commonest type and, therefore, needs further evaluation.

Nomogram that predicts graft survival probability following living-donor kidney transplant.

OBJECTIVES: The goal of this project was to develop a nomogram that predicts the probability of graft survival at 5 years. MATERIALS AND METHODS: From our dataset, 1,581 patients were used to construct a nomogram (modeling group), the remaining 319 patients (testing group) were used for its validation. Initially, the modeling group variables were correlated with graft survival by univariate analysis. Significant factors were subjected to a multivariate analysis using a Cox regression model. The results formed the basis of our nomogram construction. Internal validation was done first by discrimination using the concordance index. Second, the calibration was assessed graphically. And finally, for external validation, the nomogram was used to predict graft survival using the testing group. The predicted probability(s) was compared with the actual survival estimates. RESULTS: Validation of the nomogram yielded a concordance index of 0.77, and the observed correspondence between predicted and actual outcomes suggested a high level of calibration. Nomogram predictions of the testing group revealed no differences in the means of predicted and observed graft survival at 5 years, with a high correlation coefficient and accepted predictive accuracy (concordance index, 0.72). CONCLUSIONS: We developed a well-validated and reasonably precise nomogram for predicting 5-year graft survival.

An investigation to assess the potential of CD25highCD4+ T cells to regulate responses to donor alloantigens in clinically stable renal transplant recipients.

Regulatory T cells are enriched within CD25(high)CD4(+) leukocytes, however their role in renal transplant recipients with stable function vs. recipients with biopsy-proven chronic allograft dysfunction remains unclear. We therefore studied the number, phenotype, and function of CD25(high)CD4(+) cells in the peripheral blood of 30 renal transplant recipients of living-related grafts, comprising 15 rejection-free recipients with stable graft function (Group A) and 15 with biopsy-proven chronic graft dysfunction (Group B). A higher absolute number of CD25(high)CD4(+) cells were present in the peripheral blood of rejection-free recipients (Group A) vs. those recipients with chronic graft dysfunction (Group B) (P = 0.019); but there was no significant difference with healthy volunteers (P = 0.084). In carboxyfluorescein diacetate succinimidyl ester-mixed leukocyte culture assays, depletion of CD25(high)CD4(+) revealed active regulation in 11 (74%) of 15 rejection-free recipient samples (Group A) in response to donor- but not third party-leukocytes, whereas no regulatory activity was observed in any samples from recipients with chronic graft dysfunction (Group B). In conclusion, these data provide evidence for the presence of an increased number of CD25(high)CD4(+) T cells with donor-specific regulatory activity in the peripheral blood of renal transplant recipients with stable graft function compared with recipients with chronic graft dysfunction.

Comparison of sirolimus with low-dose tacrolimus versus sirolimus-based calcineurin inhibitor-free regimen in live donor renal transplantation.

UNLABELLED: Between May 2001 and January 2003, 132 live donor renal allotransplant recipients were included in a prospective, randomized controlled trial where they were divided into two groups. All patients received steroids and basiliximab induction therapy. For maintenance immunosuppression, tacrolimus and sirolimus were used in group A. In group B, mycophenolate mofetil (MMF) and sirolimus were utilized. Patients were followed up for a minimum of 24 months. One-year patient and graft survival rates were not significantly different between group A (96.9%, 92.3%) and group B (100%, 98.4%), respectively. However, the incidence of biopsy-proven acute rejection was less in group B but the difference was not statistically significant (13.5% vs. 18.5% in group A). Statistically significant better renal function was encountered among group B patients at two years post-transplantation as measured by serum creatinine (1.25 vs. 1.43 mg/dl; P = 0.017) and calculated glomerular filtration rate (GFR) (94.9 vs. 79.6 ml/min; P = 0.005). One year protocol biopsies showed insignificant differences relative to chronic allograft damage index (CADI) between either group (Group A: 2.41 vs. Group B: 2.69; P = 0.436). CONCLUSION: Similar outcome was noted among patients in whom calcineurin inhibitors were not included in their immunosuppressive regimen. The long term impact of this observation on graft survival and function needs longer follow up.