Diabetes mellitus in Egypt: risk factors and prevalence

Major sociodemographic changes have occurred in Egypt to promote the development of noncommunicable diseases. We have performed a cross-sectional, population-based survey of persons > or = 20 years of age in Cairo and surrounding rural villages to describe the prevalence of diabetes risk factors, diagnosed diabetes, previously undiagnosed diabetes, and impaired glucose tolerance by age, sex, rural and urban residence, and socioeconomic status (SES). In the survey, we identified 6052 eligible households: 76% of household respondents completed a household examination and 72% of selected household respondents subsequently completed a medical examination. Exercise was assessed by questionnaire; adiposity by measurement of height, weight, and girths; and diabetes by history and 2-h 75 g oral glucose tolerance test. In rural areas, 52% of persons > or = 20 years of age were sedentary, 16% were obese, and 4.9% had diabetes. In lower SES urban areas, 73% were sedentary, 37% were obese, and 13.5% had diabetes. In higher SES urban areas, 89% were sedentary, 49% were obese, and 20% had diabetes. The combined prevalence of diagnosed and undiagnosed diabetes in the Egyptian population > or = 20 years of age was estimated to be 9.3%. Approximately half the diabetes was diagnosed and the other half was previously undiagnosed. The prevalence of diabetes in Egypt is high, and the gradient in risk factors and disease from rural to urban areas and in urban areas from lower to higher SES suggest that diabetes is a major, emerging clinical and public health problem in Egypt.

Cytogenetic characterization of sarcomas of bone and soft tissues

Specific chromosome rearrangements in different types of solid tumors have been described recently in a number of studies. However, the frequency and diagnostic importance of these chromosome rearrangements are currently under intensive investigation. The objective of this study is to provide a preliminary report on the types of clonal chromosome abnormalities observed in sarcomas of bone and soft tissues. Included in this report are osteosarcoma (five), synovial sarcoma (three), Ewing sarcoma (two), leiomyosarcoma (one), and spindle cell sarcoma (one). Cytogenetic analysis revealed clonal chromosome rearrangements in all of the tumors studied. Our findings correlated well with previously reported cytogenetic data on various types of solid tumors.

Chromophobe cell carcinoma of the kidney. A clinicopathologic study of 21 cases

The clinicopathologic features in a series of 21 chromophobe cell carcinomas are reviewed. Patients' ages ranged from 30 to 83 years (mean, 53 years), and the number of men and women was roughly equal. Major presenting complaints included hematuria, flank pain, and flank mass. All but two tumors were staged as tumor node metastasis (TNM) T2N0M0. Histologically, the carcinomas were composed of large cells with variably reticulated, translucent cytoplasm. The tumor cells could be divided into three types according to the extent and distribution of reticulated cytoplasm. Ultrastructurally, these reticulated areas were characterized by the presence of large numbers of microvesicles, which appeared to be unique to chromophobe cell carcinomas because ultrastructural examination of 20 clear cell carcinomas and six granular cell carcinomas failed to reveal similar structures. The origin of the vesicles appeared to be from saccular outpouchings from the outer mitochondrial membrane. Immunohistochemical studies revealed that all the tumors were variably positive for cytokeratins 8, 18, and 19, and epithelial membrane antigen but negative for vimentin. Flow cytometric DNA analysis of eight carcinomas revealed slightly hypodiploid cell populations in seven tumors. Of these, four also contained hyperdiploid cell populations. Follow-up (6-108 months) of 16 patients revealed all these patients to be alive and well. These findings further confirm the concept that chromophobe cell carcinoma is a special subtype of renal cell carcinoma in which the presence of microvesicles is a characteristic morphologic feature. Furthermore, loss of chromosomal DNA may also be a frequent, perhaps unique, feature of chromophobe cell carcinoma.

Aspiration cytology of chromophobe cell carcinoma of the kidney

Fine-needle aspiration biopsy findings in three cases of chromophobe cell carcinoma are described and correlated with histologic and ultrastructural observations. In addition, comparisons are made with three cases each of oncocytoma and granular cell carcinoma. The cells in aspiration smears from chromophobe cell carcinoma closely correlated with histologic pattern of three cell types which were not present in oncocytomas and granular cell carcinomas. These cells had prominent cell borders, and their cytoplasm was either opaque and granular (type I) or variably translucent and reticular (type II and III). Ultrastructurally, the translucent areas within the cytoplasm contained large numbers of microvesicles which were unique to chromophobe cell carcinoma and were not seen in other neoplasms. Fine-needle aspiration may be used to diagnose chromophobe cell carcinoma and distinguish it from other related renal neoplasms.

A study of 875 cases of thyroid cancer observed over a fifteen-year period (1975-1989) at the King Faisal Specialist Hospital and Research Centre

Thyroid cancer (TC) is a common malignancy encountered at King Faisal Specialist Hospital and Research Centre (KFSH&RC). Of 19,885 different malignant tumors seen during the period fro 1975 to 1989, there were 875 cases (4.4%) of TC. Of 1374 tumors of endocrine glands seen during the same period, 67% were thyroid neoplasms. TC represented 7.5% (618 cases) of all neoplasms in the females, second only to breast cancer. All types of TC were seen, with papillary thyroid carcinoma (PC) being the most common (79%). Anaplastic, medullary, follicular (FC), malignant lymphoma and Hürthle cell cancer accounted for 5.4%, 5.3%, 4.3%, 3.6% and 0.9% respectively. The frequency of PC was very similar (16%) in each of the third, fourth and fifth decades. The relative frequency (RF) of different types of TC was highest for PC with a ration of 18:1 between PC and FC, which could be the highest ever reported. There was a clearly progressive increase in the number of thyroid tumors referred between 1975 and 1989. Although this increase was evident for both sexes, it was more apparent for females. There was also a distinct increase (P<0.01) in the RF of PC from 76% (1975 to 1980) to 85% (1986 to 1989) with a decrease in FC from 9% to 2.5% over the same periods.

An unusual cause of small bowel obstruction. A case report

A patient presented with recurrent episodes of colicky abdominal pain, nausea and vomiting, precise cause of which could not be established on evaluation. Exploratory laparotomy revealed internal herniation of proximal small bowel loops into the mesentericoparietal fossa of Waldeyer. There was a successful surgical outcome.

Phosphorylase b kinase deficiency glycogenosis with cirrhosis of the liver

We describe an Arab girl with complete absence of phosphorylase b kinase activity in the liver, symptomatic hypoglycemia, and persistently elevated serum aminotransferase values whose symptoms did not lessen with age; sequential liver biopsies showed progression to cirrhosis. Cirrhosis could not be ascribed to any other known cause. We conclude that type IX glycogenosis is not always associated with a benign outcome.

Antipyrine clearance and metabolite excretion in Saudi patients with non-alcoholic chronic liver disease

In this report, we examined the hepatic microsomal enzyme activity in 34 Saudi patients with chronic liver disease (CLD) and in 21 healthy Saudi subjects by measuring antipyrine clearance (APCI) and the fraction (%) of antipyrine (AP) dose excreted in urine unchanged (fAP) and in the form of its main metabolites: 3-hydroxymethylantipyrine (fHMAP), norantipyrine(fNORAP), and 4-hydroxyantipyrine (f4OHAP). While APCI, fHMAP, fNORAP, f4OHAP were significantly reduced in patients with CLD, fAP was significantly higher in these patients. Correlation was observed between serum albumin and APCI, fHMAP, fNORAP, or f4OHAP and between each two of the last three variables. We conclude that Saudis with CLD have uniform rather than selective reduction of hepatic microsomal enzyme activity and that serum albumin is a sensitive indicator of this activity.

Preoperative administration of antibodies against tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1) and their impact on peritoneal adhesion formation

This study investigates the effects of preoperative intravenous administration of antibodies against TNF-alpha and IL-1 on peritoneal adhesion formation. Fifty-six Sprague-Dawley rats (350-400 gm) were used in this study. Eight rats were used to empirically determine the amount of anti TNF-alpha and anti IL-1 needed for complete in vivo neutralization. This amount was used for preoperative treatment of selected groups. Forty-eight rats were divided into four equal groups (n = 12). All rats underwent a midline laparotomy. Ten cm square of cecal serosa was abraded, the peritoneal cavity was irrigated with normal saline, and the incision was closed in layers. Cultures were obtained intraoperatively and rats with positive cultures were excluded. Rats in Group 1 were not treated (control), while rats in Groups 2, 3, and 4 were treated with anti TNF-alpha, anti IL-1, and a combination of anti TNF-alpha and IL-1 respectively. All rats were killed at 3 weeks, and peritoneal adhesions were graded using a scale of 0 (none) to 3 (extensive, dense). Rats treated with anti IL-1 (Group 3) and those treated with a combination of anti TNF-alpha and anti IL-1 (Group 4) had significantly fewer adhesions when compared with Group 1 (control) (P < 0.01 and < 0.005, respectively). Least adhesion formation was associated with Group 4 rats. In conclusion, selective immunosuppression, at a molecular level, appears to have a significant impact on rates of postoperative peritoneal adhesion formation.

"Splenic abscess in a HIV patient"

We report a case of surgically treated splenic abscess in a HIV patient. The patient presented with fever and splenomegaly. The diagnosis was based on ultrasonography and computed tomography. Surgical experience with clinically overt splenic abscess remains limited more so in a HIV patient.

Regulation of melatonin secretion by light in the isolated pineal organ of the white sucker (Catostomus commersoni)

The effects of different lighting conditions and physical parameters of light were investigated in the isolated pineal organ of the white sucker kept under static or superfusion culture. The secretion of pineal melatonin is directly controlled by the photoperiod and completely suppressed under constant illumination. When pineal organs are exposed to unexpected light at night, the secretion of melatonin is significantly reduced within 15 min and reaches basal value after 30-35 min of light treatment. The inhibition of melatonin secretion by unexpected light at night depends on the irradiance, duration, timing of the treatment and the lighting history of the pineal organ.

Impact of hepatitis C virus infection on kidney transplant outcome

One hundred and forty kidney transplant recipients were evaluated to study the impact of hepatitis C virus (HCV) infection on patient and graft outcome. There .were 98 males arid 42 females with a mean age of 32.1 +/- 13 years. The duration of follow-up ranged from 6-60 months with a mean period of 27.8 +/- 18.2 months. Seventy-four (53%) patients had received cadaveric kidneys while 66 (47%) received living donor grafts. Anti-HCV reactivity was tested using second generation enzyme-linked immunosorbent assay and positivity was confirmed by recombinant immunoblot assay. HCV infection was diagnosed in 29 cases (20.7%) while HBsAg was found in nine (6.4%) and concomitant anti-HCV and HBsAg positivity was observed in two patients (1.4%). Seventeen of 29 (58.6%) patients with anti-HCV reactivity showed elevated ALT levels as against 17 of 111 (17.3%) anti-HCV non-reactive patients (P< 0.001). There was no association between the sex of the patient, source of the graft, and anti-HCV reactivity. Serum creatinine values were higher in the anti-HCV positive group, but this did not rank to statistical significance. We observed a significantly higher graft loss among the anti-HCV reactive group (27.6% versus 1.8%, P< 0.003). Thirteen anti-HCV reactive patients were subjected to 18 liver biopsies; the commonest lesion observed was chronic active hepatitis, which was progressive in two patients subjected to re-biopsy. We conclude that HCV infection is a serious health problem among kidney transplant recipients and it significantly affects the graft outcome.

Hepatitis C Virus Infection in a Hemodialysis and Kidney Transplant Patient: An Eight Year Follow-up Report

We report our experience in the management of a hemodialysis (HD) patient who acquired hepatitis C virus (HCV) infection while on dialysis, and subsequently received a kidney transplant. The potential role of alpha-interferon in the management of HCV infection is discussed, as well as the potential for azathioprine to perpetuate HCV induced liver disease following kidney transplantation. The management of this patient summarizes our standard practice for the management of HCV infection during HD and following kidney transplantation.

Screening for diabetes mellitus in adults. The utility of random capillary blood glucose measurements

OBJECTIVE

Because half of the people with non-insulin-dependent diabetes mellitus (NIDDM) are undiagnosed and because near-normal glycemic control can prevent diabetic complications, we evaluated the use of field-based random capillary blood glucose measurement as a screening test for NIDDM.

RESEARCH DESIGN AND METHODS

A cross-sectional sample of 828 Egyptians > or = 20 years of age underwent both a random capillary blood glucose measurement performed with a portable reflectance meter in the field and an oral glucose tolerance test in the laboratory. The sensitivity and specificity of random capillary blood glucose measurements in predicting the presence of NIDDM were evaluated.

RESULTS

Multivariate analyses showed that the screening test performed better when subjects had eaten shortly before the test (area under receiver operating characteristic curve, 0.87 for a 1-h postprandial period compared with 0.69 for an 8-h postprandial period) and that the optimal capillary blood glucose cutoff points to define a positive test increased with age. For a postprandial period of 1 h, cutoff points of 115 mg/dl for individuals 30 years of age and 140 mg/dl for those 75 years of age yielded similar performance characteristics (sensitivity 82% and specificity 78% for those 30 years old; sensitivity 81% and specificity 80% for those 75 years old).

CONCLUSIONS

Adjusting random capillary blood glucose measurements for the postprandial period and using age-specific cutoff point values can improve performance of the screening test.

The 140-kDa RR1 protein from both HSV-1 and HSV-2 contains an intrinsic protein kinase activity capable of autophosphorylation but it is transphosphorylation defective

The 140-kDa RR1 protein from both herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) functions as the large subunit of viral ribonucleotide reductase (RR) and contains an intrinsic serine/threonine protein kinase (PK) activity at the unique NH2-terminal domain. This PK activity is capable of autophosphorylation and reported to transphosphorylate histone and calmodulin by some groups but not by others. It has been suggested that the lack of consensus in the finding of transphosphorylation activity with RR1 protein may be due to HSV strain variations used in different laboratories. In the present study, we have attempted to resolve this issue by immunospecifically isolating the 140-kDa RR1 protein from four different strains of HSV-1 including F, KOS, HF, and MP and three different strains of HSV-2 including G, 333, and MS and subjecting them to immunocomplex kinase assays. In PK assays autophosphorylation of 140-kDa RR1 was readily observed in protein immunopurified from all HSV-1 and HSV-2 strains used in this study. However, using the same assay no transphosphorylation activity was observed with either the 38-kDa RR2 protein present in immunocomplex along with the RR1, or with histone, when added as an exogenous PK substrate. This conclusion is further supported by the evidence that a commercial preparation of PK (protein kinase catalytic subunit from bovine heart) readily phosphorylated histone under the conditions used for RR1 immunocomplex kinase assay. These results show that the 140-kDa RR1 protein contains an autokinase activity but it is incapable of transphosphorylating heterologous substrates such as histone. In addition, we show that the RR enzyme complex (140 and 38-kDa proteins) is associated with purified HSV-2 virions.

Intraradicular disc herniation: a case report and review of the literature

Intradural disc herniation accounts for < 0.3% of all disc herniations. Intraradicular disc herniation accounts for 4.1% of all such cases. Preoperative diagnosis is difficult, and a high index of suspicion during surgery is required for the diagnosis. We present a patient with intraradicular disc herniation in the lumbar region whose symptoms were severe enough to recommend surgery. The myelogram showed a block at the involved nerve root. Diagnosis of intraradicular herniation was made during surgery. The symptoms were immediately relieved by surgery. The literature on intradural and intraradicular disc herniation is reviewed.

Isolation of multiple serotypes of bluetongue virus from sentinel livestock in Malaysia

Sixteen isolations of bluetongue virus (BTV) were made from the heparinised bloods of 4 groups of cattle and sheep in Peninsular Malaysia. These viruses were typed as BTV serotypes 1, 2, 3, 9, 16 and 23. Multiple serotypes of BTV are apparently endemic in Malaysia and in other countries in the region.

Effect of temperature on the lipid and fatty acid composition of Yersinia pseudotuberculosis

In Yersinia pseudotuberculosis, the total lipid content is increased by decreasing the temperature of the growth medium. Thin layer chromatography of phospholipids revealed the presence of phosphatidy glycerols (PG) and phosphatidylethanolamine (PE) in the bacterium when grown at 26 degrees and 37 degrees C. Cardiolipin (CL) is present only in the bacterium grown at 37 degrees C, while lysophosphatidylglycerol (LPG) is present only in the bacterium grown at 26 degrees C. Unidentified phospholipids designated X1 was present in the bacterium at the two temperatures and X2 was only detected at 26 degrees C. Fatty acid unsaturation increased with decreasing temperature. Hexadecenoic acid (C16:1) content increased as the temperature was reduced to 26 degrees C. At lower temperature, stearic, oleic, linoleic, eicosanoic and linolenic acids were decreased. These observations support the view that regulation of membrane adaptation and the mechanism behind the responses might be more complex than is generally believed.

Antipyrine clearance and metabolite excretion in patients with chronic hepatitis C

BACKGROUND/AIMS

Our aim was to study whether chronic hepatitis C affects the three metabolic pathways of the model drug antipyrine differently.

METHODS

We measured antipyrine clearance from saliva as well as urinary excretion of its main metabolites 4-hydroxy-antipyrine, 3-hydroxy-methyl-antipyrine, and nor-antipyrine in 24 patients with chronic hepatitis C and in 21 healthy control subjects. Due to incomplete urine collection, 12 liver patients and three controls were excluded.

RESULTS

Antipyrine clearance (mean +/- SD) was significantly lower in patients with chronic hepatitis C, 1.2 +/- 0.7 l.h-1 (n = 12), than in controls (n = 18), 2.2 +/- 1.0 l.h-1 (p = 0.006). The urinary excretion of each of the metabolites was depressed to an equal extent in liver patients. The severity of the liver disease, as assessed by Child Pugh score, serum albumin and bilirubin, correlated significantly with antipyrine clearance and urinary excretion of the metabolite 3-hydroxy-methyl-antipyrine. The hepatitis activity index (Knodell) correlated with 3-hydroxy-methyl-antipyrine and 4-hydroxy-antipyrine, only.

CONCLUSIONS

Moderate-severe chronic hepatitis C does not seem to depress the three main metabolic pathways of antipyrine differently.

The role of smooth-ended ameloblasts in enamel protein degradation in the rat incisor pigmentation

Rats were perfused with glutaraldehyde. The lower incisors were dissected free. Mid-sagittal slice was cut through the entire incisor, demineralized. The pigmentation zone was isolated and further sliced into cross sections. These sections were incubated for CMPase. CMPase reaction product were associated with the lateral cell membrane of subclass II and Subclass III. This localization confirm the role of extracellular space of SAs as a route of enamel proteins during maturation.

A comparative study of picomolar affinity 2-[(125)I]iodomelatonin binding sites in the hearts of three salmonid species

The hearts of three cultured salmonid species, collected at either mid-light or mid-dark were studied for their binding to 2-[(125)I]iodomelatonin, a specific melatonin agonist. The binding was saturable, reversible, and highly specific. The equilibrium dissociation constant (Kd) ranged from 30.1 ± 3.0 pmole 1(-1) in Arctic charr (Salvelinus alpinus) to 40.5 ± 2.3 pmole 1(-1) in rainbow trout (Oncorhynchus mykiss) indicating a high binding affinity. The maximum density of binding (Bmax) was at the low femtomolar level of 0.57 to 0.87 fmole mg(-1) protein. Higher Bmax appeared to be demonstrated in the mid-light samples when compared to the mid-dark samples but the difference was not significant (p > 0.05). Competition study with various indoles showed the following order of potency: 2-iodomelatonin > melatonin > 6-chloromelatonin ≫ N-acetylserotonin ⋙ serotonin. Guanosine 5'-O-(3-thiotriphosphate) (GTPγS) strongly inhibited the binding (IC50 = 0.66 μmole 1(-1)) in the rainbow trout heart, suggesting that these binding sites belong to the superfamily of G-protein linked receptors. Our results suggest the presence of melatonin receptors in the fish heart. In addition, there was no marked intraspecies differences in Kd, Bmax and specificity that could be correlated with the phylogeny or life history of the salmonid species.

Melatonin activity rhythms in eyes and cerebral ganglia of Aplysia californica

In this study, we used a sensitive and specific radioimmunoassay to detect a substance which appears to be melatonin, an acetylation and methylation product of serotonin, in the eyes and central nervous system of the opisthobranch mollusc Aplysia californica. This identification was confirmed in the eyes by HPLC with fluorimetric detection. Melatonin activity was high in the eyes during the day and in the cerebral ganglia during the night. Only small amounts of melatonin were present at midday or midnight in the pedal ganglia. A single 1-hr exposure to light in the middle of the dark phase resulted in a sharp increase of melatonin in the eyes, whereas no such activity was detectable in cerebral and pedal ganglia. Eyes maintained in culture exhibited a diurnal rhythm of released melatonin activity over a 3-day period. These results suggest that melatonin is produced in A. californica in a rhythmic pattern different from that associated with pineal melatonin production in vertebrates.

Rhythmic secretion of melatonin by the superfused pike pineal organ: thermo- and photoperiod interaction

In the pineal organ of the pike (Esox lucius, teleost), the rhythmic production of melatonin by the photoreceptor cells is governed by a population of endogenous circadian oscillators, synchronized and entrained by the light/dark (L/D) cycle. Production of melatonin is inhibited by light and highly increased in the dark. In the present study, isolated and superfused pike pineals were exposed to a 24-hour temperature cycle of high (10 degrees C) or low (4 degrees C) amplitude, either under L/D, or under constant darkness. Under L/D, photoperiod is the dominant entraining stimulus for the melatonin secretion rhythm. It was high during the dark phase and low during the light phase, either under cold light/warm dark or under warm light/cold dark conditions. Under a warm light/cold dark cycle, the amplitude of the melatonin rhythm was reduced. In pineals cultured at 10 degrees C, a 20 degrees C temperature pulse potentiated or reduced the night-induced rise in melatonin production when applied, during the dark or during the preceding light phase, respectively. Under constant darkness, high- or low-amplitude temperature cycles could synchronize the rhythmic production of melatonin, which peaked with the high temperature. However, the shape of the oscillation could appear modified under warm subjective-L/cold subjective-D, depending on the experimental conditions. Finally, the rhythmic release of melatonin synchronized by a temperature cycle under constant darkness was no longer observed after removal of the external zeitgeber. The present study provides direct evidence that the pineal acts as a photothermotransducer.