Myelolipoma After Infliximab Treatment for Crohn's Disease.

A 20-year-old woman with Crohn's disease receiving infliximab therapy presented to the emergency department with lower extremity swelling secondary to compression of the common iliac vein. On magnetic resonance imaging, an enlarging pelvic mass was identified. The pathology of the mass was consistent with myelolipoma. We believe this is the first case of myelolipoma in a patient on immunosuppression with infliximab.

Skeletal muscle secretome in Duchenne muscular dystrophy: a pivotal anti-inflammatory role of adiponectin.

BACKGROUND: Persistent inflammation exacerbates the progression of Duchenne muscular dystrophy (DMD). The hormone, adiponectin (ApN), which is decreased in the metabolic syndrome, exhibits anti-inflammatory properties on skeletal muscle and alleviates the dystrophic phenotype of mdx mice. Here, we investigate whether ApN retains its anti-inflammatory action in myotubes obtained from DMD patients. We unravel the underlying mechanisms by studying the secretome and the early events of ApN. METHODS: Primary cultures of myotubes from DMD and control patients were treated or not by ApN after an inflammatory challenge. Myokines secreted in medium were identified by cytokine antibody-arrays and ELISAs. The early events of ApN signaling were assessed by abrogating selected genes. RESULTS: ApN retained its anti-inflammatory properties in both dystrophic and control myotubes. Profiling of secretory products revealed that ApN downregulated the secretion of two pro-inflammatory factors (TNFα and IL-17A), one soluble receptor (sTNFRII), and one chemokine (CCL28) in DMD myotubes, while upregulating IL-6 that exerts some anti-inflammatory effects. These changes were explained by pretranslational mechanisms. Earlier events of the ApN cascade involved AdipoR1, the main receptor for muscle, and the AMPK-SIRT1-PGC-1α axis leading, besides alteration of the myokine profile, to the upregulation of utrophin A (a dystrophin analog). CONCLUSION: ApN retains its beneficial properties in dystrophic muscles by activating the AdipoR1-AMPK-SIRT1-PGC-1α pathway, thereby inducing a shift in the secretion of downstream myokines toward a less inflammatory profile while upregulating utrophin. ApN, the early events of the cascade and downstream myokines may be therapeutic targets for the management of DMD.

First report of pediatric hematopoietic stem cell transplantation activities in the eastern mediterranean region from 1984 to 2011: on behalf of the pediatric cancer working committee of the eastern mediterranean blood and marrow transplantation group.

To describe the hematopoietic stem cell transplantation (HSCT) activities for children in the Eastern Mediterranean (EM) region, data on transplants performed for children less than 18 years of age between 1984 and 2011 in eight EM countries (Egypt, Iran, Jordan, Lebanon, Oman, Pakistan, Saudi Arabia and Tunisia) were collected. A total of 5187 transplants were performed, of which 4513 (87%) were allogeneic and 674 (13%) were autologous. Overall, the indications for transplantation were malignant diseases in 1736 (38.5%) and non-malignant in 2777 (61.5%) patients. A myeloablative conditioning regimen was used in 88% of the allografts. Bone marrow (BM) was the most frequent source of stem cells (56.2%), although an increasing use of PBSC was observed in the last decade. The stem cell source of autologous HSCT has shifted over time from BM to PBSC, and 80.9% of autologous HSCTs were from PBSCs. The donors for allogeneic transplants were matched-related in 94.5% of the cases, and unrelated transplants, mainly cord blood (99%) in 239 (5.5%) cases. This is the first report to describe the pediatric HSCT activities in EM countries. Non-malignant disorders are the main indication for allogeneic transplantation. Frequency of alternate donor transplantation is low.

Exploring the Clinicopathological Parameters Affecting the Outcome in Egyptian Patients with Multiple Myeloma.

BACKGROUND: Multiple myeloma (MM) is a plasma-cell neoplasm in which the interplay of several clinical, pathological and genetic parameters affects the patient's prognosis and response to treatment and survival. AIM: The aim of this study was to evaluate the different clinicopathological parameters of MM patients in correlation with response to therapy, progressionfree survival (PFS) and overall survival (OS). METHODS: This retrospective study was performed on 60 MM patients diagnosed at NCI, Cairo University from January 2005 to December 2008. The patients were evaluated for different clinicopathological parameters which were correlated to their response to treatment, OS and PFS. RESULTS: Sixty patients were followed up for a median period of 21 months wherein about 90% received 1st line treatment: 34 VAD, 17 MP and 3 dexamethasone. Six patients (10%) were referred for BSC. CR was achieved by 15%, 11.7% achieved good PR, 6.7% achieved PR, 22.1% have stable disease, 35% experienced disease progression. ECOG PS-I patients have 39 months median survival compared to 12 months for patients with PS ECOG-II (P 0.005). Patients with multiple skeletal lesions (≥3) have median OS of 19 months (P 0.03). Patients who presented with plasmacytoma have better OS than those without (38 months versus 14 months) (P<0.05). Patients <60 years old have a better median OS compared to patients <60 years (37 months versus 12 months) (P 0.001). OS was 39 months in female patients versus 14 months in male patients (P0.025). Median OS was 9 months for patients with comorbidities versus 27 months for those without (P0.01), 39 months for patients with non-detected paraproteinuria versus 18 months for those with paraproteinuria (P 0.045), 18 months for stage II disease versus 12 months for stage III disease (P0.001), 12 months for patients with elevated serum LDH versus 39 months for those with normal levels (P 0.001), 27 months for patients with normal serum creatinine level versus 13 months for those with elevated levels (>1.4 mg/dl) (P 0.005), 27 months for patients with normal serum calcium levels versus 10 months for those with hypercalcemia (P 0.03). CONCLUSION: Besides FISH-guided molecular cytogenetic classification of myeloma abnormality, a specific risk-stratification model based upon the patient's age, sex, performance status, lytic bone lesions, plasma cells labeling index, serum creatinine, calcium, LDH, B2M and paraproteins in serum and urine, can depict the response to treatment, OS and PFS of patients with MM.

Effect of phosphorus supplementation on weight gain and waist circumference of overweight/obese adults: a randomized clinical trial.

BACKGROUND: Phosphorus status is inversely correlated with body weight; however, the effect of phosphorus supplementation on body weight in a controlled design has not been studied. METHODS: This is a double-blind, randomized, placebo-controlled trial of 63 adults aged 18-45 years with a body mass index (BMI) of ⩾25 kg m(-2) and normal kidney function at the American University of Beirut. Participants were randomly assigned to the placebo or phosphorus group where daily placebo or phosphorus supplements were ingested with three main meals (breakfast, lunch and dinner) for a period of 12 weeks. Primary outcomes were changes in anthropometric measures, blood metabolites (including lipid profile, glucose and insulin) and subjective appetite scores. The trial is registered with Clinical Trial.gov, NCT02329990. RESULTS: Body weight was significantly lower in the phosphorus group when compared with the placebo group (-0.65 kg (95% confidence interval (CI) -1.69 to 0.40) vs 1.13 kg (95% CI 0.19 to 2.06), P=0.01). Similarly, BMI and waist circumference were significantly lower in the phosphorus group when compared with the placebo group (-0.24 kg m(-2) (95% CI -0.59 to 0.12) vs 0.42 kg m(-2) (95% CI 0.05 to 0.78), P=0.01; -3.62 cm (95% CI-4.90 to -2.33) vs 0.38 cm ( 95% CI-0.44 to 1.20), P<0.001; respectively). Several parameters of subjective appetite scores were decreased in the phosphorus-supplemented group. CONCLUSIONS: Phosphorus supplementation for 12 weeks significantly decreases body weight, BMI, waist circumference and subjective appetite scores. These findings support a promising role of the mineral phosphorus in the prevention and management of obesity, especially abdominal adiposity. The exact mechanisms of action and longer-term effects still need to be elucidated.

The impact of trisomy 12, retinoblastoma gene and P53 in prognosis of B-cell chronic lymphocytic leukemia.

PURPOSE: Routine cytogenetic analysis frequently fails to identify an abnormal clone in B-cell lymphocytic leukaemia (B-CLL) due to poor response to mitogen stimulation. Fluorescence in situ hybridization (FISH) suggest that chromosomal abnormalities occur more frequently, most commonly trisomy 12, retinoblastoma gene deletion (Rb1 gene) and P53 gene deletion. PATIENTS AND METHODS: 30 patients with B-CLL were enrolled in the trial from two centers in Cairo, Egypt during the period May 2000 to January 2002. Karyotyping and FISH assessment for possible chromosomal abnormalities (trisomy 12, Rb1 gene and P53 gene) were done at initial diagnosis. Results of cytogenetic abnormalities were correlated with clinical picture and survival. RESULTS: The median age was 57.4 years (range 40-75). Karyotyping technique showed that no metaphase could be detected in 30%, metaphase with normal karyotyping was observed in 63% and cytogenetic abnormalities were detected in two cases (one trisomy 12 and one deletion in chromosome 13). FISH examination of interphase and metaphase nuclei revealed cytogenetic abnormalities in 15 cases (50%), trisomy 12 in 9 (30%), Rb1 gene deletion in 5 (17%) and P53 gene deletion in 3. At diagnosis, patients with trisomy 12 were significantly associated with advanced stage and absolute lymphocyte count of >or=30,000/mm(3). Univariate analysis showed that absolute lymphocyte count >or=30,000/mm(3) (p=0.004) and trisomy 12 (p=0.024) were associated with poor progression free survival. CONCLUSION: Interphase and metaphase FISH studies improve the cytogenetic diagnosis of chromosomal abnormalities in B-CLL. Lymphocytosis and trisomy 12 may be a good indicator of poor prognosis.

Formulation and hypoglycemic activity of pioglitazone-cyclodextrin inclusion complexes.

Pioglitazone is a thiazolidinedione derivative used for the treatment of type 2 diabetes. The drug's poor aqueous solubility and slow dissolution rate are the main causes of its limited therapeutic action in some cases. The aim of the present study is to formulate a more soluble product of pioglitazone at physiological pH. The potential interaction of pioglitazone with cyclodextrins and water-soluble polymers was investigated to enhance the drug's bioavailability and improve its efficacy. The interaction of pioglitazone with ß-cyclodextrin, HP-ß-cyclodextrin, and dimethyl-ß- cyclodextrin was evaluated by spectrophotometric and solubility methods. Both methods revealed the formation of 1:1 inclusion complexes. The phase solubility diagram of pioglitazone-cyclodextrin systems with or without water-soluble polymers was classified as the AL type. The solubilization strength of cyclodextrins and the apparent stability constant of systems increased upon addition of water-soluble polymers. Inclusion complexes of pioglitazone in cyclodextrins with or without watersoluble polymers were prepared by the kneading method. Binary systems were characterized and confirmed by IR spectroscopy, X-ray diffractometry, and thermogravimetric analysis. The dissolution rates of pioglitazone, pioglitazone-cyclodextrin physical mixtures, pioglitazone-cyclodextrin complexes, and ternary systems containing watersoluble polymers were determined using a USP dissolution tester; results revealed enhanced dissolution properties of cyclodextrin complexes compared to drug and physical mixtures, and all of the ternary systems displayed higher dissolution efficiency than corresponding binary systems. The permeation of pioglitazone and pioglitazonecyclodextrin complexes through a cellulose membrane with and without water-soluble polymers (PVP and HPMC) present increased and the release pattern follows the kinetics of a Higuchi equation. Assessment of the hypoglycemic effect of the free drug and its cyclodextrin complexes in normal rats via measurement of blood glucose levels (BGL) after administration of a single oral dose revealed that the hypoglycemic effect of pioglitazone-cyclodextrin complexes was greater than that of the free drug and that a pioglitazone-DM ß-cyclodextrin complex had the greatest effect. In conclusion, the physicochemical and biological properties of pioglitazone improved as a result of complexation with cyclodextrins, and the improvement of physicochemical properties was more prominent after water-soluble polymers were associated with pioglitazone-cyclodextrin systems.

Toxicity of the Red Sea pufferfish Pleuranacanthus sceleratus "El-Karad".

The pufferfish Pleuranacanthus sceleratus (El-Karad) represents serious public health problems, because of its responsibility for many incidents in Egypt, especially in the Suez Gulf. In the present study, samples of this fish were collected monthly and the toxins were extracted from gonads, liver, digestive tract, muscles, and skin, then purified and identified using TLC and electrophoresis. The alkaline hydrolyzates of these toxins were also detected using UV absorption and GC-mass spectra of their trimethylsilyl derivatives.

Neuropsychiatric syndromes and occupational exposure to zinc phosphide in Egypt.

Eighty-six workers exposed to zinc phosphide (Zn3P2) pesticide were studied for evidence of neuropsychiatric manifestations. They were evaluated clinically, by electroencephalography (EEG), and, in some cases, by electromyography (EMG). All were males (mean age, 35.8 years; mean duration of exposure to zinc phosphide, 11.3 years). Most presented with one (or more) neuropsychiatric symptom(s), including fear of poisoning, anxiety, impotence, and easy fatigue. About half showed evidence of neuropsychiatric signs, including hyperreflexia, polyneuropathy, lumber radiculopathy, and cervical myelopathy, as well as anxious mood, impaired attention, and psychomotor stimulation. EEG recordings showed abnormal findings in 17.4% of the subjects. The mean age in that group was 39.1 years; mean duration of exposure to Zn3P2 was 15.1 years. EMG studies showed evidence of partial denervation of the anterior tibial group of muscles and flexor digiti minimi in 2 of the 30 workers (6.7%) who underwent EMG examination. Serum levels of zinc (Zn) and cadmium (Ca) were significantly higher in exposed workers than in controls (P < 0.005). Serum copper (Cu), iron (Fe), phosphorus (P), and magnesium (Mg) were significantly lower in exposed workers than in controls. Electrophoretic pattern of globulin showed that gammaglobulin fraction was significantly increased (P < 0.005); alpha2 and beta-globulin were decreased (P < 0.005) in exposed workers. Lipoprotein pattern showed that the total lipids, B-lipoprotein, and B/alpha ratio were significantly increased (P < 0.005) in exposed workers; the alpha1 lipoprotein was decreased. Triglycerides and cholesterol were significantly increased (P < 0.001), and phospholipids and phospholipid/cholesterol ratio were significantly decreased (P < 0.005) in exposed workers compared to controls. The study findings indicated that exposure to Zn3P2 not only caused mild acute and subacute liver cell damage, but also affected renal function and perhaps B-cells of the pancreas. A total of 68.6% of the exposed workers had chest symptoms; only 24.4% presented with chest or cardiac signs. Ventilatory functions were abnormal in 70% of the exposed workers; abnormal ECG findings were present in 12.8%.

Bovine farcy: a clinico-pathological study of the disease and its aetiological agent.

An extensive survey for bovine farcy covering 14,192 animals was conducted in the Sudan. The incidence of the disease was 31.9 per cent in Western Sudan which is regarded as an endemic area. Animals were examined clinically and at post-mortem. The lesions involved the prescapular, femoral, parotid, retropharyngeal, submaxillary, inguinal and mediastinal lymph nodes. Some animals had farcy lesions in the udder and some developed the pulmonary form of the disease. The disease is slow, but progressive in nature and was more prevalent among adult cattle than calves. Mycobacterium farcinogenes was found to be the cause of bovine farcy in the Sudan. The morphological and biochemical characteristics, and the mycolic acid content of the isolated strains were found to be identical to the reference strains of M. farcinogenes and were quite different from reference strains of Nocardia farcinica from which they were easily distinguished by the presence of alpha-mycolate, alpha'-mycolate and epoxymycolate in M. farcinogenes. Hydrolysis of mycolic acids with tetrabutylammonium hydroxide and the precipitation with toluene and acetonitrile gave good results comparable with acid methonalysis and alkaline hydrolysis. Precipitin lines were detected in the sera of some farcy-infected cattle. Histopathological examination of farcy lesions revealed a severe granulomatous reaction characterized by lymphocyte, macrophage, epithelioid and giant cell infiltration as well as marked fibrous proliferation. These changes were indicative of a progressive disease of the delayed tuberculin hypersensitivity type.

First report of infectious necrotic hepatitis (black disease) among Nubian goats in Sudan.

In a flock of 425 female and male Nubian goats in the Khartoum Province, an outbreak of a disease causing sudden death of 18 apparently healthy goats occurred (11 females and 7 males, 3-6 years old). Adult Fasciola gigantica were found in the livers of all goats and in seven of them Cysticercus tenuicollis cysts. These organs showed necrotic and severe histopathological changes. Clostridium novyi type B was isolated from necrotic areas of all livers and found to be highly pathogenic and toxigenic to laboratory animals. The disease was diagnosed as infectious necrotic hepatitis (black disease). Faecal examination revealed the presence of F. gigantica eggs. Lymnaea natalensis snails were found to be prevalent in the water canals. As the Khartoum Province is regarded as an endemic area for black disease, routine vaccination is highly recommended for its control in goats and sheep.

Cutaneous habronemiasis in horses and domestic donkeys (Equus asinus asinus).

Cutaneous habronemiasis in 15 horses and 5 donkeys is described. The lesions were distributed in many parts of the body involving the medial canthus, shoulder and pectoral regions, knee and fetlock joints, abdominal wall and prepuce. Some animals had more than one lesion. The lesions were ulcerative and filled with soft light red granulation tissue. When curretted, the deeper layers revealed a dense fibrous tissue with calcified foci. Close examination of the lesions showed that the superficial layer of this dense fibrous tissue contained small caseated and necrotic foci. The same features prevailed in lesions involving the muscular areas, but the deeper layers consisted of a dense granuloma with no evidence of cicatrization. Curretted material digested in potassium hydroxide revealed fragments of larvae of the nematode suggestive of Draschia or Habronema. The histopathological changes were severe and comprised: necrotic foci in a dense fibrous stroma infiltrated with eosinophils, macrophages and few giant cells. Sections of the larvae surrounded by eosinophils were encountered in lesions of the muscular areas. Curretting and excision of the lesion were effective and produced complete healing of the wound by scar tissue formation.

Studies on gangrenous mastitis in goats.

One hundred and fifty goats were diagnosed as having proven gangrenous mastitis. The disease was categorized into early, intermediate and late stages. Gangrenous mastitis in goats is typified by a sudden onset, dark hyperemia, and edema with progressive discoloration of the distal part of the udder. The disease affected lactating goats but not the dry ones. Coagulase positive Staphylococcus aureus was isolated from 60% of composite and half milk samples obtained from the diseased goats. The histopathological changes mainly comprised proliferation of connective tissue, thrombosis and necrosis involving a group of lobules. Treatment of the early and intermediate stages of the disease was successful through the administration of systemic and intramammary terramycin together with diuretics and topical antiseptic cream. The late stage of the disease was successfully treated only through surgery.