CLINICAL AND IMMUNOLOGICAL PROFILE OF NEWLY DIAGNOSED DIABETIC PATIENTS IN A COHORT OF YOUNG ADULTS OF NATIONAL HEPATITIS C VIRUS SURVEY IN EGYPT.

T2DM (Type 2 diabetes mellitus) is considered a disease that affects old age group. Recently, it has become common in children, adolescents and adults. Aim of the work - to highlight the challenges in differentiating T1DM (type1 diabetes mellitus) from T2DM (type2 diabetes mellitus) in early onset diabetes in youth depending on clinical and laboratory characteristics. Our cross-sectional study was performed on 200 newly diagnosed diabetic patients aged (18-30) years. All patients were subjected to detailed medical history and full clinical examination. Laboratory investigations included FBS, 2hPP, HbA1C, fasting C peptide and GADA. About 59% (118) of our patients were T2DM while (82) 41% were T1DM. T1DM was more dominant than T2DM in age group less than 25 years (T1DM 79% versus T2DM 21%, P<0.001), while T2DM was more than T1DM in age group more than 25 years (T2DM 93% versus T1DM 17%, P<0.001). GADA was detected in 73.2% of T1DM patient and it was high titer while GADA was detected in only 8% of T2DM with low titer, in addition GADA positive patients were significantly younger than negative patients, age (20.9±2.5 years vs. 26.4±3.5 years respectively) (P <0.001). About 8% of phenotypically type 2 diabetic youth had GADA positive antibodies which did not confer impact on c peptide level or glycemic control yet type 1 diabetics who were GADA negative had a better glycemic control.

Clinical and electromyographic assessment of facial nerve function after temporomandibular joint surgery.

The aim of this study was to evaluate the factors that may cause alterations in facial nerve function during temporomandibular joint (TMJ) surgeries. Forty-six patients were included (66 joints) between the years 2000 and 2007. Study patients were those undergoing various surgical procedures for the treatment of TMJ disorders. Patients who had made an incomplete recovery from a facial nerve injury resulting from a previous operation and patients who presented with facial palsy after a previous TMJ surgery were excluded. The facial nerve function of all patients was evaluated at different time intervals using a facial nerve grading system, motor unit action potentials of the frontalis and orbicularis oculi muscles, and a facial nerve latency test. Various degrees of facial nerve affliction were initially noticed in 71% of the study cases (47 of 66 joints). Statistical analyses (χ(2) goodness-of-fit) revealed that several factors could lead to facial nerve injury following TMJ surgery, including the design of the skin incision, prior surgeries, type of surgery, and duration of surgery. Facial nerve injury during TMJ surgery is multifactorial. Electromyographic studies are non-invasive and valuable diagnostic and prognostic tools for assessing facial nerve function.

Cathepsin B activity has a crucial role in the developmental competence of bovine cumulus-oocyte complexes exposed to heat shock during in vitro maturation.

Cathepsin B was found to be correlated inversely with the quality of bovine oocytes and embryos. The aims of this study were to evaluate i) the relationship between heat shock during in vitro maturation (IVM) of bovine cumulus-oocyte complexes (COCs) and cathepsin B activity in relation to apoptosis and ii) the effect of supplementation of cathepsin B inhibitor (E-64) during IVM of heat-shocked COCs on embryonic development. After IVM at 38.5 °C for 22 h (control group) or at 38.5 °C for 5 h followed by 41 °C for 17 h (heat shock group) either with or without 1 µM E-64, activities and protein expression of cathepsin B and caspase 3 were evaluated as well as TUNEL staining. After IVF, developmental rate, total cell number, and the percentage of apoptotic cells in blastocysts were evaluated on day 8 (day 0, IVF day). Heat-shocked IVM COCs showed significantly high activities and expressions of both cathepsin B, and caspase 3 accompanied by a significant increase in number of TUNEL-positive cells. Addition of E-64 significantly decreased the activities of cathepsin B and caspase 3, and TUNEL-positive cells in heat-shocked IVM COCs. Moreover, addition of 1 µM E-64 during IVM under heat shock conditions significantly improved both developmental competence and quality of the produced embryos. These results indicate that heat shock induction of cathepsin B is associated with apoptosis of COCs, and inhibition of cathepsin B activity can improve the developmental competence of heat-shocked COCs during IVM.

Congenital maxillomandibular fusion: a report of three cases.

Congenital fusion of the mandible to the maxilla (syngnathia) is a rare disorder. The first case was reported in 1936 and only a few cases have been reported in the literature since then. This paper reports three new cases of syngnathia. Clinical and radiographic features are presented, as well as surgical management and complications.

Intracellular cathepsin B activity is inversely correlated with the quality and developmental competence of bovine preimplantation embryos.

Recently, the activity of cathepsins B was found to be correlated inversely with the developmental competence of bovine oocytes. In this study, we investigated (1) the role of intracellular cathepsin B expression and developmental competence as well as the quality of bovine preimplantation embryos, and (2) the effect of cathepsin B inhibitor (E-64) during in vitro culture (IVC) on the development and quality of bovine embryos. After in vitro fertilization (IVF) followed by IVC for 7 days, good and poor quality embryos classified by morphology and developmental rate on days 2, 4, and 7 were assessed for cathepsin B expression and activity. To investigate the effect of cathepsin B inhibition on embryonic development, putative zygotes were cultured with or without E-64, followed by evaluation of cleavage and blastocyst rates on days 2 and 7, respectively. Embryonic quality was evaluated by both TUNEL staining and total cell number in day-7 blastocysts. In each developmental stage, cathepsin B expression and activity were significantly higher in poor quality embryos than good quality ones. Moreover, addition of E-64 during IVC significantly increased both the blastocyst rate and the total cell number. TUNEL staining revealed that inhibition of cathepsin B significantly decreased the number of apoptotic nuclei in day-7 blastocysts. These results indicate that cathepsin B activity can be useful as a marker for inferior quality embryos. Moreover, inhibition of cathepsin B greatly improves the developmental competence of preimplantation embryos and increases the number of good quality embryos.

Cathepsin B activity is related to the quality of bovine cumulus oocyte complexes and its inhibition can improve their developmental competence.

Recently, the quantity of cathepsin transcripts in cumulus cells was found to be associated with low-developmental competence of bovine oocytes. In the present study, we investigated (1) the relation between cathepsin B activity and the quality of in vitro-matured cumulus-oocyte complexes (IVM COCs) and denuded oocytes and (2) the effect of a cathepsin B inhibitor (E-64) on embryo development and quality. The activity of cathepsin B was evaluated in IVM COCs and denuded oocytes. After maturation of COCs with or without E-64, followed by in vitro fertilization, zygotes were cultured for 8 days. Cleavage and blastocyst rates were evaluated on days 2 and 8, respectively. Quality of embryos was evaluated by differential staining of day 8 blastocysts. TUNEL staining was conducted on IVM COCs and blastocysts. Cathepsin B activity was clearly detected in the low-quality oocytes, and in the cumulus cells of both high- and low-quality oocytes. This latter activity was diminished by addition of E-64. The presence of E-64 during IVM also significantly increased both the blastocyst rate and the total cell number, and improved blastocyst quality associated with a significant increase of trophoectoderm cells. TUNEL staining revealed that inhibition of cathepsin B significantly decreased the number of apoptotic nuclei in both the cumulus cell layer of matured oocytes and blastocysts. These results indicate that cathepsin B activity can be a useful marker of oocyte quality. Furthermore, inhibition of cathepsin B greatly improves the developmental competence of bovine oocytes and increases the number of high-quality embryos.

Laryngolith.

OBJECTIVE: To report an extremely rare and interesting case of a woman who developed a laryngeal stone. CASE REPORT: A 44-year-old woman was referred to our ENT clinic complaining of dyspnoea and stridor. She had been treated for chest problems for approximately 30 years. On examination, she had a large, spiky, subglottic lesion compromising the airway. A laryngeal computed tomography scan and histopathological and biochemical examination showed the lesion to be a calcium phosphate stone. Review of the literature from the past 50 years, using several search engines, revealed no similar cases. CONCLUSION: To the author's knowledge, this is a unique case of a stone that developed in the subglottis. This rare entity was the cause of long-standing chest problems unresponsive to medical treatment. The patient recovered completely from all her symptoms after removal of the laryngolith.

Association analysis of tissue inhibitor of metalloproteinase2 gene polymorphisms with COPD in Egyptians.

Proteinase/antiproteinase imbalance is recognized to play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). A relative increase in the activities of matrix metalloproteinases might be caused by mutations of tissue inhibitor of metalloproteinase2 (TIMP2). Recently, two polymorphisms of the TIMP2 gene, +853 G/A and -418 G/C (+551 and -720 from the translation initiation site), have been shown to be associated with the development of COPD in the Japanese population. In this study, a case-control association analysis for these polymorphisms was conducted in the Egyptian population using 106 COPD patients and 72 healthy controls. The genotype frequency of +853 G/A was significantly different between the patient and the control groups (P = 0.029), although no significant difference was detected in the allele frequency between the two groups. These results suggest that the +853 G/A polymorphism of the TIMP2 gene might be associated with COPD across ethnicities. In contrast, neither the distributions of genotype nor allele frequencies of -418 G/C were significantly different between the two groups, raising the possibility that a combination of different genetic factors contributes to the development of COPD in different ethnic groups.

A new biomechanical model for the functional assessment of knee osteoarthritis.

The severity of symptoms in osteoarthritis (OA) of the knee can be difficult to assess. A new method for assessing medial compartment OA of the knee is proposed. The purpose of this study was to determine if a relationship exists between the severity of OA and single limb stance knee adduction moment (SSKAM). Fourteen patients with medial compartment OA of the knee were tested and compared with 14 age-matched volunteers. WOMAC OA index scores were documented. Biomechanical data were collected from a single Kistler force platform and a six-camera ProReflex motion analysis system, and the knee adduction moments were calculated. A significant difference in the maximum, minimum and mean adduction moments was found between the two groups, and a correlation of r=0.66 for WOMAC physical function subscale, r=0.63 for the WOMAC pain subscale and r=0.63 for the sum of the subscales and mean SSKAM was found. Single limb stance adduction moments provide additional, objective information in the assessment of medial compartment OA of the knee. It may be useful in the selection of patients for surgery and for evaluating various treatment modalities for medial compartment OA of the knee.

Bleeding esophageal varices. How to treat this dreaded complication of portal hypertension.

Bleeding esophageal varices, one of the most feared complications of portal hypertension, contribute to the estimated 32,000 deaths annually attributed to cirrhosis. Successful control requires knowledge of the pertinent anatomy, underlying pathophysiology of portal hypertension, and natural history of gastro-esophageal varices. Drs Hegab and Luketic review these topics and discuss the various prophylactic and therapeutic approaches to management, including pharmacologic agents, endoscopic sclerotherapy, and trans-jugular intrahepatic portosystemic shunt (TIPS).

Elevation of nitrotyrosine and nitrate concentrations in cystic fibrosis sputum.

Nitric oxide (NO) is increased in the exhaled air of some patients with inflammatory lung disorders, but not in others. NO may combine with superoxide to form peroxynitrite, which lowers NO gas concentrations, increases formation of nitrate, and increases nitration of tyrosine residues on proteins. We hypothesized that superoxide released from neutrophils in the lower respiratory tract of cystic fibrosis (CF) results in increased nitrate and nitrotyrosine levels in sputum. In order to test this hypothesis, exhaled NO was collected from 5 stable adult CF subjects and from 5 nonsmoking normal controls. Consistent with previous reports, exhaled NO concentrations were not increased in CF exhaled air (22.6 +/- 1.5 ppb vs. 28.6 +/- 1.5 ppb in normals, P > 0.05). Sputum was collected from 9 adult CF subjects and the same 5 normal controls and evaluated for nitrite, nitrate, and nitrotyrosine. Nitrate and nitrotyrosine levels, but not nitrite, were significantly elevated in CF. Recently, myeloperoxidase has also been implicated as a mechanism of nitrotyrosine formation. Therefore, myeloperoxidase was measured and found to be elevated in the CF sputum (64.2 +/- 35.9 vs. 0.73 +/- 0.16 U/mL, P < 0.001), and was found to correlate with concentrations of nitrotyrosine (r = 0.87, P < 0.05). However, in vitro studies with myeloperoxidase and murine lung epithelial cells did not demonstrate a reduction of NO gas with nitrotyrosine or an increase in nitrate formation. These data demonstrate that nitrate and nitrotyrosine are elevated in the sputa of CF subjects and suggest increased production of NO in the lower respiratory tract of CF patients, despite the relatively low exhaled NO levels. Pediatr Pulmonol. 2000; 30:79-85. Published 2000 Wiley-Liss, Inc.

Neglected rupture of the patellar tendon.

Neglected rupture of the patellar tendon is a rare but well recognised complication of knee trauma. We present the case of a 43-year-old man who sustained a complete rupture of the patellar tendon of his left knee following a fall. Clinical diagnosis was delayed by 2 months and was confirmed by magnetic resonance imaging. Treatment began with skeletal patellar traction and was followed by late reconstruction of the patellar tendon and transfer of the gracilis and semitendonosus tendons supplemented by figure-of-eight tension band wiring.

Case report. Recurrent laryngeal nerve palsy after laryngeal mask airway insertion.

A 39-year-old man developed a unilateral recurrent laryngeal nerve palsy following laryngeal mask airway insertion for a day case procedure.