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1.
Saudi J Kidney Dis Transpl ; 29(6): 1267-1273, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30588956

RESUMO

Immunosuppression management in clinical transplantation aims to balance delivery of efficacy against adverse reactions using therapeutic drug monitoring. Adherence to posttransplant immunosuppressive medications and minimizing variability in drug exposure are important considerations in preventing rejection and maximizing overall transplant outcomes. The availability of once-daily tacrolimus may add a potential benefit by simplifying immunosuppressive regimens, though improving compliance among transplant recipients. The aim of our study is to investigate the safety and efficacy of the once-daily formulation of tacrolimus (Advagraf) against the usually used twice daily tablets (Prograf). A prospective randomized trial 1:2 was designed for 99 consecutive live-related renal transplant recipients who received their grafts at a single center (study group, Advagraf, 33 recipients and control group, Prograf, 66 recipients). The demographic data were homogeneous among both groups regarding donors and patients' characteristics. Posttransplant hypertension, infection, malignancy, and diabetes mellitus were comparable among both groups. Renal function and rejection episodes showed no statistical significance among recipients of both groups. Despite slight higher Advagraf unit doses, there was no statistical difference regarding the tacrolimus trough levels, between the two groups. Our singlecenter experience revealed that the availability of once-daily tacrolimus formulation could give potential benefit of improved medication compliance and better allograft outcomes by decreasing pill burden and thereby simplifying dosing schedule, Advagraf was non-inferior to twice-daily tacrolimus regarding safety and efficacy. Although being nonsignificant, a trend for better kidney function was noted in this short-term study in the Advagraf group, so long-term follow-up is needed to verify this.


Assuntos
Inibidores de Calcineurina/administração & dosagem , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunossupressores/administração & dosagem , Transplante de Rim , Tacrolimo/administração & dosagem , Administração Oral , Adolescente , Adulto , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/sangue , Preparações de Ação Retardada , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Feminino , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/sangue , Transplante de Rim/efeitos adversos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Prospectivos , Comprimidos , Tacrolimo/efeitos adversos , Tacrolimo/sangue , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
J Child Psychol Psychiatry ; 59(1): 20-29, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27868194

RESUMO

BACKGROUND: Autism spectrum disorder (ASD) is a frequent developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and nonverbal communication, and stereotyped patterns of interests and activities. It has been previously reported that there is vitamin D deficiency in autistic children; however, there is a lack of randomized controlled trials of vitamin D supplementation in ASD children. METHODS: This study is a double-blinded, randomized clinical trial (RCT) that was conducted on 109 children with ASD (85 boys and 24 girls; aged 3-10 years). The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children. ASD patients were randomized to receive vitamin D3 or placebo for 4 months. The serum levels of 25-hydroxycholecalciferol (25 (OH)D) were measured at the beginning and at the end of the study. The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and the Autism Treatment Evaluation Checklist (ATEC). TRIAL REGISTRATION NUMBER: UMIN-CTR Study Design: trial number: UMIN000020281. RESULTS: Supplementation of vitamin D was well tolerated by the ASD children. The daily doses used in the therapy group was 300 IU vitamin D3/kg/day, not to exceed 5,000 IU/day. The autism symptoms of the children improved significantly, following 4-month vitamin D3 supplementation, but not in the placebo group. This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD. CONCLUSIONS: This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients. Depending on the parameters measured in the study, oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD. At this stage, this study is a single RCT with a small number of patients, and a great deal of additional wide-scale studies are needed to critically validate the efficacy of vitamin D in ASD.


Assuntos
Transtorno do Espectro Autista/sangue , Transtorno do Espectro Autista/tratamento farmacológico , Suplementos Nutricionais , Vitamina D/sangue , Vitamina D/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino
3.
Urology ; 110: 98-103, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28893633

RESUMO

OBJECTIVE: To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations. PATIENTS AND METHODS: A phase III randomized trial was conducted between January 2013 and June 2015; eligible left-side donors were randomized to laparoscopic or open donor nephrectomy in a 1:1 ratio with recovery optimized within a standardized ERP. The primary outcome was patient-reported measure of physical fatigue, as measured by the physical fatigue domain of the translated Multidimensional Fatigue Inventory 20. Secondary outcomes included other donor recovery outcomes, postoperative pain scores, hospital stay, perioperative complications, and graft outcomes. RESULTS: A total of 224 donors (laparoscopy, n = 113; open surgery, n = 111) were randomly allocated. Six weeks postoperatively, physical fatigue domain scores in Multidimensional Fatigue Inventory 20 were significantly lower in the LDN group (mean: laparoscopy, 8.2 ± 3.2 vs open surgery, 13.05 ± 2.9) (P = .007). Median total hospital stay was also significantly shorter in the LDN group (median: laparoscopy, 2; interquartile range, 1-5 vs open surgery, 4; interquartile range, 2-9 days) (P = .002). LDN was associated with less pain scores and less non-opioid analgesic requirements. Warm ischemia times were not significantly different in both groups (mean: laparoscopy, 2.5 ± 0.8 vs open surgery, 2.2 ± 0.6) (P = .431). CONCLUSION: Even when optimized within an ERP, LDN was associated with less general and physical fatigue and better physical function at 6 weeks postoperatively when compared with open surgery for left kidney donations.


Assuntos
Transplante de Rim , Laparoscopia , Nefrectomia , Coleta de Tecidos e Órgãos/métodos , Humanos , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica
4.
J Autism Dev Disord ; 47(9): 2671-2678, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28589497

RESUMO

The aim of our study was to evaluate the frequencies of myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) in children with ASD. Subjects were 32 children with ASD and 30 healthy children as controls. The numbers of mDCs and pDCs and the expression of CD86 and CD80 on the entire DCs were detected by flow cytometry. ASD children had significantly higher percentages of mDCs and pDCs when compared to controls. We found significant inverse relationships between serum 25-hydroxyvitamin D levels and the frequencies of mDCs and pDCs in autistic children. Our data suggested that DCs could play a role in the clinical course of ASD. The relationship of DCs to immune disorders in ASD remains to be determined.


Assuntos
Transtorno do Espectro Autista/sangue , Células Dendríticas/metabolismo , Antígeno B7-1/genética , Antígeno B7-1/metabolismo , Antígeno B7-2/genética , Antígeno B7-2/metabolismo , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Vitamina D/análogos & derivados , Vitamina D/sangue
5.
Clin Respir J ; 11(4): 529-531, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26260444

RESUMO

INTRODUCTION: We report a case in our center of unilateral urinothorax that occurred post percutaneous nephrolithotomy as a rare cause of pleural effusion and acute dyspnea. METHODS: Report of a case. RESULTS: Initial chest CT showed massive left sided pleural effusion from which biochemical investigations revealed exudative effusion and urinothorax. The effusion was drained by central venous pressure catheter and urologic problem was resolved. CONCLUSIONS: urinothorax should be suspected as a cause of pleural effusion in obstructive uropathy and post renal and ureteric maneuvers.


Assuntos
Cateteres Venosos Centrais/estatística & dados numéricos , Nefrolitotomia Percutânea/efeitos adversos , Derrame Pleural/etiologia , Cálculos Urinários/complicações , Pressão Venosa Central , Diagnóstico Diferencial , Exsudatos e Transudatos/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Tomógrafos Computadorizados , Resultado do Tratamento , Cálculos Urinários/cirurgia
7.
Nutr Neurosci ; 19(8): 346-351, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25876214

RESUMO

OBJECTIVES: Autism spectrum disorder (ASD) is a developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and non-verbal communication, and stereotyped patterns of interests and activities. Vitamin-D deficiency was previously reported in autistic children. However, the data on the relationship between vitamin D deficiency and the severity of autism are limited. METHODS: We performed a case-controlled cross-sectional analysis conducted on 122 ASD children, to assess their vitamin D status compared to controls and the relationship between vitamin D deficiency and the severity of autism. We also conducted an open trial of vitamin D supplementation in ASD children. RESULTS: Fifty-seven percent of the patients in the present study had vitamin D deficiency, and 30% had vitamin D insufficiency. The mean 25-OHD levels in patients with severe autism were significantly lower than those in patients with mild/moderate autism. Serum 25-OHD levels had significant negative correlations with Childhood Autism Rating Scale (CARS) scores. Of the ASD group, 106 patients with low-serum 25-OHD levels (<30 ng/ml) participated in the open label trial. They received vitamin D3 (300 IU/kg/day not to exceed 5000 IU/day) for 3 months. Eighty-three subjects completed 3 months of daily vitamin D treatment. Collectively, 80.72% (67/83) of subjects who received vitamin D3 treatment had significantly improved outcome, which was mainly in the sections of the CARS and aberrant behavior checklist subscales that measure behavior, stereotypy, eye contact, and attention span. CONCLUSION: Vitamin D is inexpensive, readily available and safe. It may have beneficial effects in ASD subjects, especially when the final serum level is more than 40 ng/ml. TRIAL REGISTRATION NUMBER: UMIN-CTR Study Design: trial Number: R000016846.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Fenômenos Fisiológicos da Nutrição Infantil , Colecalciferol/uso terapêutico , Suplementos Nutricionais , Estado Nutricional , Deficiência de Vitamina D/dietoterapia , Atenção , Transtorno do Espectro Autista/sangue , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/fisiopatologia , Calcifediol/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Colecalciferol/metabolismo , Estudos Transversais , Egito/epidemiologia , Movimentos Oculares , Humanos , Hipercinese/etiologia , Hipercinese/prevenção & controle , Masculino , Cooperação do Paciente , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Comportamento Social , Transtorno de Movimento Estereotipado/etiologia , Transtorno de Movimento Estereotipado/prevenção & controle , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia
8.
J Nutr Metab ; 2016: 2978741, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28050280

RESUMO

Objective. The purpose of this study is to investigate the role and efficiency of the locally injected vitamin C in the treatment of persistent gingival inflammation. Design. Twenty adult patients with persistent chronic gingival inflammation were included in this study. The same dose of sterile vitamin C was injected in gingival tissues after the completion of phase I therapy. Gingival biopsies were taken after total resolution of inflammation. The specimens were examined histologically, using H&E stain. Results. Clinical evaluation revealed great improvement of the injected sites with recall visits. Histopathological results revealed marked decrease in inflammatory cells and epithelial thickness and a higher number of newly formed subbasal capillaries. Conclusions. Vitamin C is an effective adjunctive treatment in reducing various degrees of chronic gingival inflammation.

9.
Acta Neurol Belg ; 115(4): 657-63, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25576444

RESUMO

The aim of this study is to evaluate the neuropsychological status in a cohort of children with early and continuously treated phenylketonuria in Assiut, Upper Egypt. The study was implemented in seventy-eight phenylketonuria (PKU) children. Only 34 patients met the inclusion criteria. Investigated patients were evaluated according to detailed history, neurological examination, Childhood Autism Rating Scale, full scale Intelligence Quotient, attention deficit hyperactivity disorder, electroencephalography and magnetic resonance imaging (MRI). This study concluded that the prognosis for early diagnosed children with PKU treated from the first weeks of life is generally good. However, they are at increased risk for neurological complications and behavioral problems. So, neonatal screening for PKU is highly recommended in Egypt, for early detection and management. In addition, neuropsychological and MRI assessments in PKU children should be done.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno Autístico/epidemiologia , Fenilcetonúrias/epidemiologia , Encéfalo/patologia , Criança , Pré-Escolar , Egito/epidemiologia , Eletroencefalografia , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Fenilcetonúrias/diagnóstico , Fenilcetonúrias/dietoterapia
10.
Ann Hematol ; 93(12): 2045-50, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25062719

RESUMO

Hydroxycarbamide (hydroxyurea or HU) has been shown to increase fetal hemoglobin (HbF) in patients with ß-thalassemia intermedia (TI). The reported effects of HU in increasing the total hemoglobin (Hb) have been inconsistent. Studies of long-term therapy with HU in pediatric TI are rather uncommon. A retrospective observational study was carried out to evaluate the clinical responses to HU in Egyptian patients with ß-TI. One hundred patients; children (n = 82, mean age 9.9 ± 4.1 years) and adults (n = 18) were studied for the mean Hb, HbF%, median serum ferritin, transfusion history, and splenic size before and after HU therapy (mean dose 20.0 ± 4.2 mg/kg/day, range 10-29 mg/kg/day) over a follow-up period 4 to 96 months (mean 35.4 ± 19.2 months). Molecular studies were also done for group of patients (n = 42). The overall response rate to HU was 79 %; 46 % were minor responders (with a reduction in transfusion rate by 50 % or more and/or an increase in their total hemoglobin level by 1-2 g/dl) and 33 % major responders (becoming transfusion-free and/or having an increase in total hemoglobin level by >2 g/dl). Mean hemoglobin increased among responders from 6.9 ± 0.9 g/dl to 8.3 ± 1.4 g/dl (p < 0.001). A significant rise in mean HbF (27.0 vs. 42.5 %; p < 0.011) and a decrease in median serum ferritin (800 vs. 644 ng/ml; p < 0.001) were also observed among responders (n = 45). Transfusions stopped in 44 % of pretreatment frequently transfused responders (n = 11/25). Splenic size decreased in 37 % of patients (n = 30/81). The predominant ß-thalassemia mutation was 1-6 (T > C) in 32/42 (76 %) of studied patients; 28/32 were responders. Bivariate analysis showed no predictors of response as regards sex, pediatric and adult age, splenic status, or genotype. Hydroxycarbamide is a good therapeutic modality in the management of pediatric as in adult TI patients. It can minimize the need for blood transfusion, concomitant iron overload, and blood-born viral transmission especially in developing countries like Egypt.


Assuntos
Hemoglobina Fetal/análise , Hidroxiureia/uso terapêutico , Talassemia beta/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Terapia Combinada , Avaliação de Medicamentos , Egito , Ferritinas/sangue , Humanos , Hidroxiureia/efeitos adversos , Sobrecarga de Ferro/etiologia , Sobrecarga de Ferro/prevenção & controle , Neutropenia/induzido quimicamente , Estudos Retrospectivos , Esplenectomia , Esplenomegalia/etiologia , Esplenomegalia/cirurgia , Reação Transfusional , Resultado do Tratamento , Adulto Jovem , Talassemia beta/sangue , Talassemia beta/complicações , Talassemia beta/terapia
11.
Mol Diagn Ther ; 18(4): 427-34, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24711060

RESUMO

BACKGROUND: Asthma is a multifactorial respiratory disease determined by interactions of multiple disease susceptibility genes and environmental factors. Interleukin (IL)-18 is an important cytokine for initiating and perpetuating the catabolic and inflammatory response in allergic asthma. A number of single nucleotide polymorphisms that influence IL-18 production are found in the gene promoter region. OBJECTIVES: The aim of this study was to investigate the association of IL-18 -607C/A promoter polymorphism with asthma and whether this polymorphism influenced the severity of asthma in affected children. The influence of this promoter gene polymorphism on total serum IgE level in studied subjects was also investigated. SUBJECTS AND METHODS: This study was carried out at the Allergy Clinic of Abu El Reesh Children's Hospital at Cairo University, Egypt. This study included 40 asthmatic children, subdivided into four groups according to different degrees of asthma severity, and 20 apparently healthy subjects as the control group. All cases were subjected to history taking, clinical examination, and the following laboratory investigations: complete blood count, total serum IgE level assay by ELISA and genomic DNA extraction, and analysis for IL-18 -607C/A promoter gene polymorphism using the PCR-RFLP (restriction fragment length polymorphism) technique. RESULTS: In the present study the IL-18 -607AA genotype frequency was higher in cases (22.5 %) than in the control group (15 %); however, the difference was not statistically significant (p = 0.773). No statistically significant difference between the degree of asthma severity and IL-18 -607C/A polymorphism was found (p = 0.489). No significant association could be detected upon comparing the frequencies of C and A alleles among the two studied groups (p = 0.366). Also, no significant differences were demonstrated for the allele frequencies when the intermittent with mild [odds ratio (OR) = 2.72, 95 % CI 1.03-2.33, p = 0.067], intermittent with moderate, and severe (OR = 2.8, 95 % CI 1.01-8.5, p = 0.066) asthma groups were compared. The median value of the total serum IgE level in asthmatic cases with the mutant genotype (AA) was significantly higher [360 IU/L (96.6-1,340 IU/L)] than in the control group [119 IU/L (70.6-158.9 IU/L)] (p = 0.033). CONCLUSION: No significant statistical difference was encountered regarding the distribution of IL-18 -607C/A genotypes and allele frequencies in asthma patients and healthy controls. Also, there were no significant associations between asthma severity and different genotypes or alleles. The median value of the total serum IgE level in asthmatic cases with the mutant genotype (AA) was significantly higher than in the control group. Thus, IL-18 -607AA genotype frequency might be related to higher total serum IgE.


Assuntos
Asma/genética , Interleucina-18/genética , Polimorfismo Genético/genética , Criança , Pré-Escolar , Feminino , Frequência do Gene , Predisposição Genética para Doença/genética , Humanos , Masculino , Polimorfismo de Nucleotídeo Único/genética , Regiões Promotoras Genéticas/genética
12.
J Pak Med Assoc ; 64(1): 5-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24605703

RESUMO

OBJECTIVES: To assess the effectiveness of intensive phototherapy in reducing the need for exchange transfusion and the duration of phototherapy. METHODS: The prospective study with historical controls was conducted at Cairo University Paediatric Hospital, from February to July 2012, and comprised 360 newborns with indirect hyperbilirubinaemia. The 183 subjects were treated with Bilisphere 360 (Bilisphere group) compared with 177 who had been treated with conventional phototherapy (control group). Both groups were subjected to complete clinical evaluation and laboratory investigations. RESULTS: Bilisphere 360 decreased the need for exchange transfusion in 19 (10.4%) neonates of the Bilisphere group versus 130 (73.4%) of the control group (p<0.001); decreased the level of serum bilirubin as exchange transfusion (6.7 mg/dl [24.9%] in the subjects vs. 6.9 mg/dl [22.7%] in the controls); shortened the duration of phototherapy (2.7 days in the subjects, vs. 4.2 days in the controls; p<0.001). CONCLUSION: The use of Bilisphere 360 in the treatment of indirect pathological hyperbilirubinaemia is as effective as exchange transfusion in lowering Total Serum Bilirubin when its level is within 2-3 mg/dl (34-51umol/l) of the exchange level. Bilisphere 360 is effective in reducing needs for exchange transfusion and duration of phototherapy.


Assuntos
Transfusão Total , Icterícia Neonatal/terapia , Fototerapia , Bilirrubina/sangue , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Resultado do Tratamento
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