Correlation between Thyroid Radiation Dose and Thyroid Function after Adjuvant Hypofractionated Locoregional Radiotherapy in Breast Cancer Patients

PURPOSE/OBJECTIVE(S)

Radiotherapy (RT) is used quite often among breast cancer patients, and because these patients now live longer than they used to, long-term treatment-related adverse effects, such as hypothyroidism, are becoming increasingly relevant. Radiation-induced hypothyroidism is a late side effect of radiation to the thyroid gland, which could develop months to years after radiotherapy. However, there is no sufficient data on hypothyroidism in patients with breast cancer who receive locoregional RT, which usually affects a portion of the thyroid gland. In this prospective study, we tried to correlate between the radiation dose received by the thyroid gland and the incidence of thyroid dysfunction in breast cancer patients treated with hypofractionated locoregional radiotherapy, as well as establishing potential planning objectives that could help in sparing the thyroid gland.

MATERIALS/METHODS

Our study included 109 women who received 3-D conformal loco-regional breast radiotherapy, these patients had normal thyroid function prior to start of radiotherapy. Patients had follow-up thyroid function tests 6 months after finishing radiotherapy. Based on dose volume histograms (DVH), the percentages of the thyroid volume, and ipsilateral thyroid lobe, receiving 5, 10, 15, 20, 25, 30, 35, and 40 Gy (V5, V10, V15, V20, V25, V30, V35, and V40 respectively), in addition to the mean and maximum thyroid doses, were estimated.

RESULTS

Follow-up assessment of thyroid function and statistical analysis unveiled incidence of radiotherapy induced hypothyroidism to be 8.3%. Possible risk factors included high maximum radiation dose and V40 to the thyroid gland and the ipsilateral thyroid lobe, as well as high mean dose and smaller volume of the ipsilateral thyroid lobe.

CONCLUSION

The likelihood of hypothyroidism was significantly increased with V40 of >5% of the thyroid gland, and V40 of >11% of the ipsilateral thyroid lobe. Further study is recommended for larger populations and longer follow-up periods.

Behçet uveitis: Current practice and future perspectives

Described as early as Hippocrates in his “Third Book of Endemic Diseases,” Behçet's Disease (BD), also known as “The Silk Road Disease” following its initial demographics, consists of a triad of recurrent oro-genital ulcers and associated uveitis. Current demographics and rising percentages of patients seen far beyond the Silk Road in Ocular Inflammatory Disease and Uveitis Clinics list BD uveitis as one of the frontliners of non-infectious autoinflammatory eye diseases. Clinical features of BD and juvenile-onset BD are detailed alongside various approaches in classification and suggested algorithms for diagnosis that are outlined in this review. With the ongoing Human Microbiome Project and studies such as the MAMBA study, the role of the human microbiome in BD is highlighted in the pathophysiology of BD to include the current research and literature perspective. Furthermore, with the advancement of recent diagnostic and investigative techniques, especially in the field of Optical Coherence Tomography (OCT), disease-related characteristics are updated to encompass SD, EDI and OCT-angiography characteristics of BD. Having entered the era of biologic therapy, the role of various specific cytokine-blocking biologic drugs, such as TNF-α inhibitors (e.g., adalimumab, infliximab), interferon α-2a inhibitors, IL-6 and IL-1 inhibitors are presented and contrasted alongside the conventional immunosuppressant drugs and the classic old gold standard: corticosteroids (systemic or local). Finally, with the ongoing SARS-CoV-2 pandemic, it was not possible to conclude the review without reviewing the latest evidence-based literature reporting BD morbidity in this era, the observed pattern and treatment recommendations as well as those related to reported post-vaccine complications and emergence of BD.

Development and Implementation of the AIDA International Registry for Patients with Non-Infectious Scleritis

Introduction

This article points out the design, methods, development and deployment of the international registry promoted by the AutoInflammatory Disease Alliance (AIDA) Network with the aim to define and assess paediatric and adult patients with immune-mediated scleritis.

Methods

This registry collects both retrospective and prospective real-world data from patients with non-infectious scleritis through the Research Electronic Data Capture (REDCap) tool and aims to promote knowledge and real-life evidence from patients enrolled worldwide; the registry also allows the collection of standardised data, ensuring the highest levels of security and anonymity of patients’ data and flexibility to change according to scientific acquisitions over time. The communication with other similar registries has been also ensured in order to pursue the sustainability of the project with respect to the adaptation of collected data to the most diverse research projects.

Results

Since the launch of the registry, 99 centres have been involved from 20 countries and four continents. Forty-eight of the centres have already obtained a formal approval from their local ethics committees. At present, the platform counts 259 users (95 principal investigators, 160 site investigators, 2 lead investigators, and 2 data managers); the platform collects baseline and follow-up data using 3683 fields organised into 13 instruments, including patient’s demographics, history, symptoms, trigger or risk factors, therapies and healthcare utilization.

Conclusions

The development of the AIDA International Registry for patients with non-infectious scleritis will allow solid research on this rare condition. Real-world evidence resulting from standardised real-life data will lead to the optimisation of routine clinical and therapeutic management, which are currently limited by the rarity of this ocular inflammatory condition.

MONTHLY INTRAVITREAL INFLIXIMAB IN BEHÇET'S DISEASE ACTIVE POSTERIOR UVEITIS: A Long-Term Safety Study

PURPOSE

To study the safety of extended monthly intravitreal infliximab injections in patients with active posterior uveitis in Behcet's disease.

METHODS

This is a prospective, interventional, noncomparative, open-label, pilot study of 9 monthly intravitreal infliximab injections (1 mg/0.05 mL) for 22 eyes of 16 patients with active posterior uveitis in Behcet's disease. Control of inflammation and visual outcomes were assessed, and ocular complications were monitored during the study period.

RESULTS

Successful treatment was achieved in 7 eyes (35%), and failure was encountered in 13 eyes (65%). Only seven eyes of six patients (35%) had completed the study and achieved complete resolution of inflammation with improved best-corrected visual acuity and no complications. Failure was either because of inability to control the inflammation in nine eyes (45%) or development of exacerbation of inflammation in four eyes (20%). Four eyes developed severe immunological reaction from the drug after first (n = 1), second (n = 2), and third (n = 1) injections and had to discontinue the injections. Kaplan-Meier survival analysis showed that the mean estimated time to failure was 3.3 ± 0.2 months, and all failed eyes required revision of their systemic immunotherapy to control the ocular inflammation.

CONCLUSION

Intravitreal infliximab for active posterior uveitis in Behcet's disease was associated with a high complication rate and failure to control inflammation in most eyes. It should not be considered a substitute to systemic therapy.

Association of ficolin-2 gene polymorphisms and susceptibility to systemic lupus erythematosus in Egyptian children and adolescents: a multicenter study

BACKGROUND

Pediatric-onset SLE (pSLE) is a multisystem autoimmune disease. Recently, the ficolin-2 (FCN2) gene has emerged as a potential candidate gene for susceptibility to SLE.

OBJECTIVES

The objective of this study was to evaluate the association of the FCN2 gene polymorphisms at positions -986 (G/A), -602 (G/A), -4 (A/G) and SNP C/T (rs3124954) located in intron 1, with susceptibility to pSLE in Egyptian children and adolescents.

METHODS

This was a multicenter study of 280 patients diagnosed with pSLE, and 280 well-matched healthy controls. The FCN2 promoter polymorphisms at -986 G/A (rs3124952), -602 G/A (rs3124953), -4 A/G (rs17514136) and SNP C/T (rs3124954) located in intron 1 were genotyped by polymerase chain reaction, while serum ficolin-2 levels were assessed using enzyme-linked immunosorbent assay.

RESULTS

The frequencies of the FCN2 GG genotype and G allele at -986 and -602 positions were significantly more represented in patients with pSLE than in controls (p < 0.001). Conversely, the FCN2 AA genotype and A allele at position -4 were more common in patients than in controls (p < 0.001). Moreover, patients carrying the FCN2 GG genotype in -986 position were more likely to develop lupus nephritis (odds ratio: 2.6 (95% confidence interval: 1.4-4.78); p = 0.006). The FCN2 AA genotype at position -4 was also identified as a possible risk factor for lupus nephritis (odds ratio: 3.12 (95% confidence interval: 1.25-7.84); p = 0.024).

CONCLUSION

The FCN2 promoter polymorphisms may contribute to susceptibility to pSLE in Egyptian children and adolescents. Moreover, the FCN2 GG genotype at position -986 and AA genotype at position -4 were associated with low serum ficolin-2 levels and may constitute risk factors for lupus nephritis in pSLE.

Multicenter randomized controlled trial assessing the impact of a cervical traction maneuver (Amr's maneuver) on the incidence of postpartum hemorrhage

OBJECTIVE

To assess the impact of a cervical traction maneuver (Amr's maneuver) used in conjunction with active management of the third stage of labor (AMTSL) on the incidence of postpartum hemorrhage (PPH).

METHOD

The present multicenter randomized controlled trial was conducted in Cairo between March 1, 2016, and June 30, 2017. Women aged at least 18 years who had singleton pregnancies and were candidates for vaginal delivery were enrolled. After block randomization, AMTSL was performed for all participants. Following placental delivery, Amr's maneuver using cervical traction for 90 seconds was carried out in the study group. The primary outcome, incidence of PPH (>500 mL blood loss) within 6 hours of delivery, was compared between the study and control groups in an intention-to-treat analysis.

RESULTS

There were 852 patients randomized to the study (n=426) and control (n=426) groups. The incidence of PPH was significantly lower in the study group compared with the control group (6 [1.4%] vs 19 [4.5%]; P=0.015). Absolute risk reduction of 3.1% (95% CI 0.8-5.6), relative risk reduction of 0.32 (95% CI 0.13-0.78), and number needed to treat of 33 (95% CI 129-18) were observed in the study group.

CONCLUSION

Amr's maneuver was effective in decreasing the incidence of PPH. ClinicalTrials.gov Identifier: NCT02660567.

Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study

Background

Biologic therapies have revolutionized the treatment of moderate‐to‐severe psoriasis. However, for reasons largely unknown, many patients do not respond or lose response to these drugs.

Objectives

To evaluate demographic, social and clinical factors that could be used to predict effectiveness and stratify response to biologic therapies in psoriasis.

Methods

Using a multicentre, observational, prospective pharmacovigilance study (BADBIR), we identified biologic‐naive patients starting biologics with outcome data at 6 (n = 3079) and 12 (n = 3110) months. Associations between 31 putative predictors and outcomes were investigated in univariate and multivariable regression analyses. Potential stratifiers of treatment response were investigated with statistical interactions.

Results

Eight factors associated with reduced odds of achieving ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) at 6 months were identified (described as odds ratio and 95% confidence interval): demographic (female sex, 0·78, 0·66–0·93); social (unemployment, 0·67, 0·45–0·99); unemployment due to ill health (0·62, 0·48–0·82); ex‐ and current smoking (0·81, 0·66–0·99 and 0·79, 0·63–0·99, respectively); clinical factors (high weight, 0·99, 0·99–0·99); psoriasis of the palms and/or soles (0·75, 0·61–0·91); and presence of small plaques only compared with small and large plaques (0·78, 0·62–0·96). White ethnicity (1·48, 1·12–1·97) and higher baseline PASI (1·04, 1·03–1·04) were associated with increased odds of achieving PASI 90. The findings were largely consistent at 12 months. There was little evidence for predictors of differential treatment response.

Conclusions

Psoriasis phenotype and potentially modifiable factors are associated with poor outcomes with biologics, underscoring the need for lifestyle management. Effect sizes suggest that these factors alone cannot inform treatment selection.

What's already known about this topic?

Biologic therapy used in the treatment of moderate‐to‐severe psoriasis differs in its effectiveness across patients.

Previous research has indicated that patients with a higher body mass index, who smoke or who have smoked, and with a lower baseline Psoriasis Area and Severity Index (PASI) are less likely to have a good outcome with biologic therapy for the treatment of moderate‐to‐severe psoriasis.

What does this study add?

This large‐scale study in a real‐world setting confirms that weight, smoking status and baseline PASI are associated with effectiveness of biologic therapy.

There is evidence that non‐white ethnicity, female sex, unemployment, psoriasis of the palms and soles and the presence of small chronic plaques are associated with poor outcomes with biologics.

There is some evidence that men have a comparatively worse response to etanercept, relative to adalimumab, than women. Otherwise, most factors do not appear to be predictors of differential treatment response.

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Protective effects of sea cucumber (Holothuria atra) extract on testicular dysfunction induced by immune suppressant drugs in Wistar rats

The current study was aimed to evaluate the protective effect of Holothurian atra (HA) extract; naturally occurring marine resource, against methotrexate (MTX) induced testicular dysfunction. Mature rats received either MTX (20 mg/kg, intraperitoneally) or saline on the 7th day of experiment al design. Seven days prior and after MTX-injection, rats received HA at dose of 300 mg/kg intragastrically (HA + MTX group; HA group alone). Serum was extracted and testicular tissues were examined for the changes in serum biochemistry (liver & kidney biomarkers, testicular hormones and antioxidants), molecular and histopthological alterations using RT-PCR and immunohistochemistry. MTX-injected rats induced alteration in all testicular parameters. Prior administration of HA ameliorated the MTX-induced oxidative stress. HA administration normalised MTX-induced decrease in serum levels of interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ), reproductive hormones (FSH, LH and testosterone) and antioxidants GST, SOD and catalase. MTX-injected rats down-regulated mRNA expression of GST, SOD, steroidogenesis associated genes, IFN-γ, Bcl2 and NFKB. MTX up-regulated BAX expression and caspase 9 immunoreactivity that were ameliorated in HA + MTX group. Collectively, HA ameliorated and restored all altered genes. In conclusion, HA is a promising supplement that is helpful in protection against testicular cytotoxicity and dysfunction induced by methotrexate.

Species-specific control of hepatocyte growth factor expression and production in adipocytes in a differentiation-dependent manner

Hepatocyte growth factor (HGF) is a mesenchymal cell-derived factor that regulates cell growth, cell motility, and morphogenesis. Since there are conflicting reports on HGF-producing cells, we herein examined HGF activity in conditioned medium (CM) of bovine and mouse preadipocytes before and after adipogenic differentiation. CM of bovine adipocytes and mouse preadipocytes induced the morphogenesis of mammary epithelial cells that was inhibited by an NK4 HGF antagonist, whereas CM of bovine preadipocytes and mouse adipocytes did not. HGF mRNA expression was increased by a treatment with dexamethasone and isobutylmethylxanthine in bovine as well as human cells, whereas it was decreased in rodent cells. It was unfortunate that HGF gene promoter activity failed to reflect HGF mRNA expression in these cells. After actinomycin D treatment, expression of HGF mRNA remained stable in pre- and differentiated bovine adipocytes and mouse preadipocytes, whereas rapidly decreased in mouse-differentiated adipocytes. These results indicate that expression and production of HGF are regulated in a species-specific adipogenic differentiation-dependent manner and suggest that the decrease in HGF mRNA in mouse differentiated adipocytes is, at least in part, mediated by differentiation-dependent loss of its stability.

Effect of different fixative solutions on eyes with experimental proliferative vitreoretinopathy

The aim of this study was to evaluate the use of different fixatives on the reliability of histopathological changes in a rabbit model of proliferative vitreoretinopathy (PVR). Twenty eyes from 10 rabbits were divided into four groups. The right eyes were used in two experimental groups (each n = 5), and the left, in two control groups (each n = 5). Using a newly developed scleral incision marker, an oblique scleral incision was standardized in the experimental groups, followed by intravitreal injection of 0.4 ml autologous blood and the left for wound repair for four weeks. Eyes were enucleated at four weeks. The groups differed in the type of used fixative solution (formaldehyde 4% vs. 1% buffered formaldehyde and 1.25% glutaraldehyde). The eyes were evaluated for the development of fibrosis, retinal detachment (RD), and processed for histopathology. Fibrous ingrowth of a variable degree was present in the experimental groups originating from the trauma site. Experimental eyes fixed with formaldehyde 4% had RD extension that was greater than that fixed in formaldehyde/glutaraldehyde mixture; however, the difference did not reach statistical significance (P = 0.15). This difference was not fully explained by the fibrosis which developed. In addition, in control groups, formaldehyde 4% induced a fixative-dependent retinal separation that was absent in eyes fixed with formaldehyde/glutaraldehyde mixture (P = 0.03). In conclusion, a mixture of buffered formaldehyde 1% and glutaraldehyde 1.25% combined with standardized scleral incision resulted in consistent pathological changes. A reliable PVR model is a condition sine qua non to evaluate antifibrotic treatment strategies.

Epidemiology of diabetic retinopathy in Egypt: a hospital-based study

PURPOSE

To determine the prevalence and determinants of diabetic retinopathy (DR) in patients ≥18 years at the Cairo University and Sixth of October University hospitals.

PATIENTS AND METHODS

This is a cross-sectional survey among known diabetic patients attending diabetic clinics. Patients were randomly selected to complete an interviewer-administered questionnaire and a medical assessment. All patients had a dilated fundus examination for evidence of DR using slit-lamp biomicroscopy.

RESULTS

A sample of 1,325 patients was selected with a mean age of 49 years (SD ±12.9). DR was found in 20.5% of patients. Most patients (82%) were not aware of the hazards of diabetes mellitus for the eyes. The prevalence of DR was statistically significantly higher in females (22 vs.17%, p < 0.05), with longer diabetes disease duration (p < 0.001), hypertension (p < 0.001) and absence of hypertension control (p < 0.001), especially proliferative DR. Increasing age and poor glycemic control were associated with a nonsignificant increase in the rate of DR (p = 0.340 and p = 0.444, respectively).

CONCLUSION

The prevalence of DR in our study population is 20.5%. Regular screening is highly recommended for early detection of DR where timely laser photocoagulation is known to reduce the risk of visual loss in these patients.

Pattern of ocular trauma in Egypt

PURPOSE

To review the epidemiology of serious ocular trauma presenting to Kasr El Aini Hospital, Cairo University.

METHODS

This is a prospective epidemiological and clinical study of ocular trauma patients admitted to Kasr El Aini hospital during a 6-month period; January-June 2000. Cases were analyzed with respect to: (1) demographics, (2) time, place and nature of trauma, (3) type of injury, (4) time to receive care, and (5) management and visual outcomes following primary repair.

RESULTS

One hundred and fifty three eyes of 147 patients (six bilateral injuries) sustaining serious ocular injury requiring hospitalization were included during the study period. Eighty percent of ocular trauma occurred in men (P < 0.001 chi-square test) with an average age of 22 years (ranging from 2 months to 76 years). There were 123 (80.4%) open globe injuries and 30 (19.6%) closed globe injuries. Of the open globe injuries, 48 eyes (31.4% of all eyes) were ruptured globes and 75 eyes (49% of all eyes) were lacerated globes (37 intraocular foreign bodies, 35 penetrating injuries and three perforating injuries, that is 24%, 23%, and 2% respectively of all injured eyes). Of the closed globe injuries, 5.9% had hyphema (33% of all patients), 4% lamellar lacerations, and 2.5% vitreous hemorrhage with retinal detachment. Most of the injuries occurred (39.5%) and presented (36.7%) between 12:00-5:59 PM: . Eighteen patients (12%) presented after 24 hours, and nine patients (6%) 1 week after the time of trauma. Presenting visual acuity in 123 patients (123 eyes) was as follows: 98 (80%), ten (8%) and 15 (12%) patients had poor, moderate and good visual acuity respectively. Ten eyes developed posttraumatic endophthalmitis (8% of open globe injuries). On leaving the hospital, 77.1% eyes had a visual acuity of less then 1/60 (poor), 3.9% were between 1/60 and 6/60 (moderate), and 19% were 6/36 and/or better (good). Fifty-two (35%) patients were lost in follow-up: at 1 month, 60%, 7% and 33% of the rest had poor, moderate and good visual acuity respectively.

CONCLUSION

The majority of ocular trauma in our population was due to assaultive injuries occurring mainly in males. Open globe injuries were more common than closed globe injuries, and globe lacerations were more common than ruptured globes. Open globe injuries, especially ruptured globes, had the worst visual outcomes. The initial visual acuity correlated well with the final visual acuity. Immediate and comprehensive medical care is mandatory for ocular trauma patients. Educating the public is essential if we wish to prevent eye injuries.

Diurnal variations of serum leptin in dogs: effects of fasting and re-feeding

Leptin is a protein synthesized and secreted primarily by adipocytes, and plays a key role in the regulation of energy balance. We have reported that serum leptin is elevated in obese dogs. In the present study, we examined diurnal variations of serum leptin in the dog, with special references to feeding and fasting cycles. Four male beagles were accustomed to feed once a day at 10:00 h, and blood samples were taken every 3 h for 24-36 h. Serum leptin concentration showed clear diurnal variations, being lowest before food intake (2.3+/-0.5 ng/mL) at 09:00 h, and highest (10.5+/-2.4 ng/mL) at 18:00 h. Such diurnal variations disappeared when the dogs were fasted. Serum insulin also showed diurnal variation with higher levels at 12:00-15:00 h. When insulin or glucose was injected in the fasted dogs to mimic the post-prandial insulin rise, serum leptin concentration was significantly increased in 4-8 h, but in both cases to a lesser extents than those after food intake. The results indicate that serum leptin concentrations change diurnally in association with feeding-fasting cycles in the dog, partially due to changes in insulin secretion.

Comparative clinical trial of topical anesthetic agents in cataract surgery

PURPOSE

To assess the efficacy of lidocaine gel, bupivacaine drops, and benoxinate drops as topical anesthetic agents in cataract surgery.

SETTING

Kasr El-Aini Hospital, Cairo University, Cairo, Egypt.

METHODS

This prospective randomized study comprised 90 patients scheduled for routine cataract extraction. Patients were randomized into 3 groups of 30 each based on which anesthetic agent they received: lidocaine 2% gel, bupivacaine 0.5% drops, or benoxinate 0.4% drops. Subjective pain at application of the agent and intraoperatively was quantified by the patients using a verbal pain score (VPS) scale from 0 to 10. The duration of discomfort at application, duration of surgery, rate of supplemental sub-Tenon's anesthesia, and complications were recorded.

RESULTS

The mean VPS at application was 2.97, 1.53, and 1.03 in the lidocaine, bupivacaine, and benoxinate groups, respectively; the VPS in the lidocaine group was statistically significantly higher than in the other 2 groups (P<.001). The mean duration of pain at application was 25 seconds, 14 seconds, and 6 seconds in the lidocaine, bupivacaine, and benoxinate groups, respectively, and was statistically significantly higher in the lidocaine group (P<.001). The mean VPS during surgery was 1.6, 4.1, and 7.1 in the lidocaine, bupivacaine, and benoxinate groups; the lidocaine group had a statistically significantly lower mean VPS than the other 2 groups (P<.001). The incidence of supplemental sub-Tenon's injection was 3.3%, 10.0%, and 73.3%, respectively, and was statistically significantly lower in the lidocaine and bupivacaine groups than in the benoxinate group (P<.001). The patients' overall satisfaction was statistically significantly higher in the lidocaine and bupivacaine groups than in the benoxinate group (93.3%, 83.3%, and 33.3%, respectively) (P<.001). Three patients in the lidocaine group had corneal haze at the time of surgery, which was not statistically significant (P>.1).

CONCLUSIONS

Lidocaine gel was a better topical anesthetic agent than bupivacaine and benoxinate drops. Bupivacaine drops were effective in providing deep topical anesthesia.

Opacification of two hydrophilic acrylic intraocular lenses 3 months after implantation

BACKGROUND AND OBJECTIVE

To report clinical, pathologic, histochemical, ultrastructural, and spectrographic analyses of explanted hydrophilic acrylic intraocular lenses (IOLs) obtained from two patients who had early visual disturbances caused by postoperative opacification of the lens optic.

MATERIALS AND METHODS

Two hydrophilic IOLs were explanted from patients with decreased visual acuity. The patients became symptomatic 3 months after uneventful phacoemulsification and lens implantation. IOL optic opacification was associated with a fine granularity within the substance of the lens optic. The IOLs were examined by gross and light microscopy. Full-thickness cut sections of the optics were stained with 1% alizarin red (a special stain for calcium). Some sections were submitted for scanning electron microscopy and energy dispersive x-ray spectroscopy.

RESULTS

Microscopic analyses revealed the presence of multiple fine, granular deposits of variable sizes within the optics of the lenses distributed in a line parallel to the anterior and posterior curvatures of the optic, with a clear zone just beneath the optics' surface. Extension of the opacification into the haptics of the IOLs could also be observed. The deposits stained positive with alizarin red. Energy dispersive x-ray spectroscopy of the internal substance of the IOLs also demonstrated the presence of calcium within the deposits.

CONCLUSIONS

This is the first clinicopathologic report of optic and haptic opacification occurring with this hydrophilic acrylic IOL model only 3 months postoperatively. Further studies on other similar cases with this lens should be done to determine the incidence and possible mechanisms of this phenomenon.

Carticaine versus lidocaine for peribulbar anesthesia in cataract surgery

PURPOSE

To compare carticaine 4% and lidocaine 2% for peribulbar anesthesia in cataract surgery.

SETTING

Ain Shams and Cairo University Hospitals, Cairo, Egypt.

METHODS

This prospective double-blind randomized study comprised 200 cataract patients assigned to 1 of 2 groups of 100 each based on type of anesthesia: carticaine 4% or lidocaine 2%. The efficacy, safety, and duration of the motor and the analgesic block produced by carticaine 4% adrenaline hyaluronidase mixture and lidocaine 2% adrenaline hyaluronidase mixture used as peribulbar anesthesia were compared. The mean time for satisfactory block, need for supplementary injections, incidence of intraoperative and postoperative pain, and postoperative complications were evaluated. The data were analyzed using the Student t test and Mann-Whitney U test for intergroup differences. The chi-square or Fisher exact test was used to assess eye movement scores, the need for supplementary injections, the onset of postoperative pain, and the incidence of postoperative complications.

RESULTS

The mean time for satisfactory anesthesia was 7.5 minutes +/- 1.68 (SD) for lidocaine 2% and 2.5 +/- 1.53 minutes for carticaine 4% (P <.001). The need for supplementary injections was 28% in the lidocaine group and 4% in the carticaine group (P <.001). The mean onset of postoperative pain was 2.00 +/- 0.86 hours in the lidocaine group and 5.52 +/- 1.80 hours in the carticaine group (P <.05). There were no cases of postoperative neurotoxicity or extraocular muscle dysfunction in either group.

CONCLUSIONS

Carticaine 4% adrenaline hyaluronidase mixture was an effective and safe agent for peribulbar anesthesia. It was more efficient than lidocaine 2% adrenaline hyaluronidase mixture in the onset and quality of anesthesia as well as postoperative analgesia.

Comparison of serum antibody responses to Giardia lamblia of symptomatic and asymptomatic patients

The circulating anti-parasite antibody response against Giardia lamblia in symptomatic and asymptomatic Egyptian children with confirmed giardiasis was examined. Symptomatic patients were identified using the following criteria: presence of only G. lamblia cysts in the feces, and one or more of the following symptoms, diarrhea, abdominal pain, loss of weight, vomiting and/or nausea, and abdominal distention. The anti-parasite humoral response was measured using indirect immunofluorescence (IFA), ELISA, and immunoblotting. There was a significant difference in the anti-parasite antibody response measured by IFA of asymptomatic and symptomatic patients, in which more than 34% of the asymptomatic patients had a titer equal to or less than 1:500, and more that 29% of the symptomatic patients had a titer of 1:8,000 or higher. The circulating anti-parasite total IgM and IgA but not IgG, measured by ELISA, was significantly higher in symptomatic than in asymptomatic patients, and were related to higher cyst output observed in symptomatic individuals. Although total anti-parasite IgG response was similar in symptomatic and asymptomatic patients, the analysis of the IgG isotype responses revealed that both IgG1 and IgG3 were significantly higher in symptomatic patients. The antigen recognition by anti-parasite IgM, IgA, IgG1, and IgG3 of symptomatic and asymptomatic individuals, determined by immunoblotting, was heterogeneous and revealed only minor differences in the response of the two groups.

Selenium and cadmium induced pulmonary functional impairment and cytotoxicity

Ovalbumin-sensitized (50 mg/kg, i.p.) male Hartley-guinea-pigs (550-610 g; n = 6) were treated 14 days later intratracheally with saline, cadmium (Cd 0.3 mg), selenium (Se 0.3 mg or 0.06 mg) or Se (0.06 mg) with Cd (0.3 mg). After 24 h, baseline dynamic-lung-compliance (Cdynl) and pulmonary-resistance (Rp), and percent change after ovalbumin-aerosol-challenge (10 mg/ml, 60 s) were assessed. Cadmium or Se (0.3 mg), Se (0.06 mg) and/or Cd (0.3 mg) decreased Cdynl (P < 0.05). Selenium (0.3 mg) increased Rp (P < 0.05). Ovalbumin-challenge decreased Cdynl and increased Rp in all groups. Analysis of bronchoalveolar-lavage-fluid (BALF) displayed increased activities of lactate-dehydrogenase (LDH), beta-glucuronidase (beta-G), alkaline-phosphatase (AP), and protein due to 0.3 mg Se, 0.3 mg Cd alone or with 0.06 mg Se (P < 0.05). Findings indicated that, 0.3 mg Se is more detrimental than 0.3 mg Cd to lung-dynamics despite a modest protection by 0.06 mg Se against Cd illustrated by an ameliorated Cdynl and lower protein in BALF.

Oral manifestations and histochemical studies of the gingiva in Down syndrome

Down syndrome is the most frequent of the aneuploids observed in newborn infants whose major manifestations are mental and growth retardation. The purpose of this work was to study the oral manifestations, histological and histochemical changes in gingiva of Egyptian Down syndrome children and to correlate the noted histochemical changes with the intelligence quotient and the karyotype. The study comprised 29 cases (19 males and 10 females) with a mean age of (4.673 + 2.406) and 30 control children (19 males and 11 females) with a mean age of (4.632 + 2.568). 27 cases had pure trisomy 21 and 2 cases was mosaics. General clinical and orodental examination confirmed the developmental variability of Down syndrome patients. The orodental examination showed: 1--A high susceptibility to periodontal disease. 2--Bad oral hygiene. 3--High arched palate, macroglossia, hypocalcification, fissured tongue, underdeveloped maxilla delayed eruption of the primary teeth. The histological and histochemical changes were: 1--Increased inflammatory signs in the epithelium and connective tissue of the gingiva. 2--Amorphous amyloid deposits in lamina propria of Down syndrome children, while it was absent in that of control children. It was more in low I.Q. children with fair gingival index than those with better I.Q. 3--Neutral glycoprotein was stronger in Down syndrome than that in controls. 4--Reduction in the highly acidic MPS. 5--Total protein content was increased in Down syndrome children that of their controls. 6--Acid phosphatase activity was stronger in Down syndrome than of their controls. 7--Alkaline phosphatase activity was less in Down syndrome than of their controls. These changes point to a correlation which needs further investigation in a larger number of cases.

Matrix solid phase dispersion (MSPD) extraction and gas chromatographic screening of nine chlorinated pesticides in beef fat

A multiresidue technique is presented for the extraction and quantitative gas chromatographic screening of 9 insecticides (lindane, heptachlor, aldrin, heptachlor epoxide, p,p'-DDE, dieldrin, endrin, p,p'-TDE, and p,p'-DDT) as residues in beef fat. Beef fat was fortified by adding the 9 insecticides, plus dibutyl chlorendate as internal standard, to 0.5 g portions of beef fat and blending with 2 g C18 (octadecylsilyl)-derivatized silica. The C18/fat matrix blend was fashioned into a column by adding the blend to a 10 mL syringe barrel containing 2 g activated Florisil. The insecticides were then eluted from the column with 8 mL acetonitrile, and a 2 microL portion of the acetonitrile eluate was then directly analyzed by gas chromatography with electron capture detection. Unfortified blank controls were treated similarly. The acetonitrile eluate contained all of the pesticide analytes (31.25-500 ng/g) and was free of interfering co-extractants. Correlation coefficients for the 9 extracted pesticide standard curves (linear regression analysis, n = 5) ranged from 0.9969 (+/- 0.0021) to 0.9999 (+/- 0.0001). Average relative percentage recoveries (85 +/- 3.4% to 102 +/- 5.0%, n = 25 for each insecticide), inter-assay variability (6.0 +/- 1.0% to 14.0 +/- 6.7%, n = 25 for each insecticide), and intra-assay variability (2.5-5.1% n = 5 for each insecticide) indicated that the methodology is acceptable for the extraction, determination, and screening of these residues in beef fat.

Heated fats. Part 3. Biological effect and effect of heating and tempering oils on fatty acid composition of liver, heart and serum lipids of rats

The study deals with the biological effect caused by changes in fats during heating. The study includes feeding experiments and extraction of serum, liver, and heart from the animals tested. The biological study reveals that animals fed heated oil showed retardation of growth, poor efficiencies, rough, greasy mottled coats, and shortened life span.

Renal amyloidosis and schistosomiasis

A retrospective study of 60 renal biopsies obtained from nephrotic subjects with schistosomiasis showed amyloid deposits in 10 cases. Distribution was usually segmental, mainly mesangial and overlapped with the conventional mesangio-proliferative lesions of schistosomiasis. The invariable clinical presentation was proteinuria with generalized oedema of insidious onset and a slowly progressive or intermittent course. Differences from conventional schistosomal nephropathy are described. Response to anti-schistosomal treatment was very poor. Repeat renal biopsies showed no regression of the lesions. The possible links between schistosomiasis and amyloidosis are discussed and causes of amyloid deposition suggested.