Dengue fever (DF) is one of the common mosquito-borne viral diseases. It is transmitted by Aedes aegypti and Aedes albopictus.The aim to study the clinical and laboratory manifestations of serologically confirmed cases of DF in outpatient clinics.This cross-sectional study was carried out in outpatient setting. According to WHO criteria all patients above 14 years old who were suspected to have DF were tested by IgM dengue antibody test. Additionally all patients underwent history, clinical examination and investigation including complete blood count, liver function test and abdominal ultrasound. Data was analyzed using SPSS version 20.Out of 126 patients presented with acute febrile illness, 71 (56.3%) had seroreactivity for dengue IgM antibodies. Fever, headache and muscloskeletal pain were the most common clinical presentation (100%). Decreased appetite (92.9%) , retro-orbital pain (78.8%) and dizziness(64.7%) were the next common symptoms. 29(40.8%) had hepatomegally, 11 (15.4%) had splenomegally.Elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were observed in 58(81.6%) and 53(74.6%) respectively. Lastly; Fever associated with headache, retro-orbital pain, along with thrombocytopenia and elevated liver transaminases should prompt a clinician on the possibility of DF. Increased community awareness and vector control measures need to be strengthened to reduce the burden of dengue cases.

?AIM:To compare the efficacy and safety of penetrating keratoplasty ( PK) and deep anterior lamellar keratoplasty ( DALK) in the treatment of stromal corneal dystrophy.?METHODS:A systematic review and Meta-analysis was conducted for studies comparing visual acuity [ best-corrected visual acuity ( BCVA ) ( LogMAR ) ] and corneal endothelial cell count ( ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference ( WMD ) and risk ratios ( RRs ) , respectively, along with their respective 95％confidence intervals ( CIs) .? RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71％ males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively ( WMD=401.62 cell/mm2 , 95％CI:285.39-517.85, P< 0.001 ) , and graft and endothelial rejection rates were significantly lower ( RR=0.30, 95％ CI: 0.14-0.64, P=0.002;RR=0.09, 95％ CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet' s membrane perforations and postoperative double anterior chamber ( All P<0.001) .?CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

AIM: To compare the efficacy and safety of penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in the treatment of stromal corneal dystrophy.

METHODS: A systematic review and Meta-analysis was conducted for studies comparing visual acuity \〖best-corrected visual acuity(BCVA)(LogMAR)\〗 and corneal endothelial cell count(ECC)as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference(WMD)and risk ratios(RRs), respectively, along with their respective 95% confidence intervals(CIs).

RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy(59.71% males)were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively(WMD=401.62 cell/mm2, 95% CI: 285.39-517.85, P<0.001), and graft and endothelial rejection rates were significantly lower(RR=0.30, 95% CI: 0.14-0.64, P=0.002; RR=0.09, 95% CI: 0.02-0.46, P=0.004, respectively)when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet's membrane perforations and postoperative double anterior chamber(All P<0.001).

CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

Objective: To assess diffusion tensor imaging (DTI) parameters of the hepatic parenchyma for the differentiation of biliary atresia (BA) from Alagille syndrome (ALGS). Materials and Methods: This study included 32 infants with BA and 12 infants with ALGS groups who had undergone DTI.Fractional anisotropy (FA) and mean diffusivity (MD) of the liver were calculated twice by two separate readers and hepatic tissue was biopsied. Statistical analyses were performed to determine the mean values of the two groups. The optimum cut-off values for DTI differentiation of BA and ALGS were calculated by receiver operating characteristic (ROC) analysis. Results: The mean hepatic MD of BA (1.56 ± 0.20 and 1.63 ± 0.2 x 10-3 mm2 /s) was significantly lower than that of ALGS (1.84 ± 0.04 and 1.79 ± 0.03 x 1010-3mm2 /s) for both readers (r = 0.8, p = 0.001). Hepatic MD values of 1.77 and 1.79 x 1010-3 mm2 /s as a threshold for differentiating BA from ALGS showed accuracies of 82 and 79% and area under the curves (AUCs) of 0.90 and 0.91 for both readers, respectively. The mean hepatic FA of BA (0.34 ± 0.04 and 0.36 ± 0.04) was significantly higher (p = 0.01, 0.02) than that of ALGS (0.30 ± 0.06 and 0.31 ± 0.05) for both readers (r = 0.80, p = 0.001). FA values of 0.30 and 0.28 as a threshold for differentiating BA from ALGS showed accuracies of 75% and 82% and AUCs of 0.69 and 0.68 for both readers, respectively. Conclusion Hepatic DTI parameters are promising quantitative imaging parameters for the detection of hepatic parenchymal changes in BA and ALGS and may be an additional noninvasive imaging tool for the differentiation of BA from ALGS.

Objective: To assess diffusion tensor imaging (DTI) parameters of the hepatic parenchyma for the differentiation of biliary atresia (BA) from Alagille syndrome (ALGS). Materials and Methods: This study included 32 infants with BA and 12 infants with ALGS groups who had undergone DTI.Fractional anisotropy (FA) and mean diffusivity (MD) of the liver were calculated twice by two separate readers and hepatic tissue was biopsied. Statistical analyses were performed to determine the mean values of the two groups. The optimum cut-off values for DTI differentiation of BA and ALGS were calculated by receiver operating characteristic (ROC) analysis. Results: The mean hepatic MD of BA (1.56 ± 0.20 and 1.63 ± 0.2 x 10-3 mm2 /s) was significantly lower than that of ALGS (1.84 ± 0.04 and 1.79 ± 0.03 x 1010-3mm2 /s) for both readers (r = 0.8, p = 0.001). Hepatic MD values of 1.77 and 1.79 x 1010-3 mm2 /s as a threshold for differentiating BA from ALGS showed accuracies of 82 and 79% and area under the curves (AUCs) of 0.90 and 0.91 for both readers, respectively. The mean hepatic FA of BA (0.34 ± 0.04 and 0.36 ± 0.04) was significantly higher (p = 0.01, 0.02) than that of ALGS (0.30 ± 0.06 and 0.31 ± 0.05) for both readers (r = 0.80, p = 0.001). FA values of 0.30 and 0.28 as a threshold for differentiating BA from ALGS showed accuracies of 75% and 82% and AUCs of 0.69 and 0.68 for both readers, respectively. Conclusion Hepatic DTI parameters are promising quantitative imaging parameters for the detection of hepatic parenchymal changes in BA and ALGS and may be an additional noninvasive imaging tool for the differentiation of BA from ALGS.

Tumor necrosis factor-alpha (TNF-α) is an important cytokine in generating an immune response against infection with hepatitis C virus (HCV). The functions of TNF-α may be altered by single-nucleotide polymorphisms (SNPs) in its gene structure. We hypothesized that SNPs in TNF-α may be important in determining the outcome of an HCV infection. To test this hypothesis, we investigated the role of the polymorphism -308G/A, which is located in the promoter region of the TNF-α gene, in the progression of HCV infection in Egyptian patients using a quantitative real-time polymerase chain reaction (qRT-PCR). The distribution of this polymorphism and its impact on the serum level of TNF-α was compared between 90 HCV-infected patients [45 with HCV-induced cirrhosis and 45 with HCV-related hepatocellular carcinoma (HCC)] and 45 healthy Egyptian volunteers without any history of liver disease. Our results showed that at the TNF-α -308 position, the G/G allele was most common (78.5%) in the study population, with the G/A and A/A alleles occurring less frequently (13.3% and 8.1%, respectively). Frequencies of G/G, G/A, and A/A genotypes were 87%, 7%, and 6% in patients with liver cirrhosis and were 94%, 4%, and 2% in patients with HCC, respectively. Serum levels of TNF-α were significantly higher in HCV-infected patients than in healthy controls, indicating that the TNF-α -308 polymorphism does not influence the production of TNF-α. The serum level of TNF-α was positively correlated with HCV infection. Taken together, these findings suggest that the TNF-α -308 polymorphism may not be a host genetic factor associated with the severity of HCV infection, but may be an independent risk factor for HCC.
Adult ; Aged ; Alleles ; Carcinoma, Hepatocellular ; blood ; genetics ; virology ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Hepatitis C, Chronic ; blood ; genetics ; Humans ; Liver Cirrhosis ; blood ; genetics ; Liver Neoplasms ; blood ; genetics ; virology ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Real-Time Polymerase Chain Reaction ; Risk Factors ; Tumor Necrosis Factor-alpha ; blood ; genetics

Background and Objectives: Sarco/endoplasmic reticulum Ca2＋-ATPase (SERCA) inhibition was proved in streptozotocin (STZ)-diabetic rats. The present study aimed at investigating and comparing the therapeutic effect of bone marrow mesenchymal stem cells (BMMSCs), BMMSCs combined with ascorbic acid (AA) and SERCA1a gene transfected BMMSCs in induced type I diabetic myopathy of male albino rat. Methods: and Results: 54 rats were divided into donor group of 6 rats for isolation, propagation and characterization of BMMSCs and SERCA1a transfected BMMSCs, groups I∼V 48 rats. Group I of 8 control rats, group II (Diabetic) of 10 rats given STZ 50 mg/kg intraperitoneal, group III (BMMSCs) of 10 rats given STZ and BMMSCs intravenous (IV), group IV (BMMSCs and AA) of 10 rats given STZ, BMMSCs IV and AA 500 mg/kg and group V (SERCA 1a transfected BMMSCs) of 10 rats given STZ and SERCA1a transfected BMMSCs IV. The rats were sacrificed after 8 weeks. Gastrocnemius specimens were subjected to biochemical, histological, morphometric and statistical studies. Diabetic rats revealed inflammatory and degenerative muscle changes, a significant increase in blood glucose level, mean DNA fragmentation and mean MDA values and a significant decrease in mean GSH and catalase values, area of pale nuclei, area% of CD105 and CD34 ＋ve cells, SERCA1a protein and gene values. The morphological changes regressed by therapy. In group III significant decrease in DNA fragmentation and MDA, significant increase in GSH and catalase, significant increase in the mean area of pale nuclei, area % of CD105 and CD34 ＋ve cells versus diabetic group. In group IV, same findings as group III versus diabetic and BMMSCs groups. In group V, same findings as group IV versus diabetic and treated groups. Western blot and PCR proved a mean value of SERCA1a protein and gene comparable to the control group. Mean calcium concentration values revealed a significant increase in the diabetic group, in BMMSCs and AA group versus control and SERCA1a group. Conclusions SERCA1a transfected BMMSCs proved a definite therapeutic effect, more remarkable than BMMSCs combined with AA. This effect was evidenced histologically and confirmed by significant changes in the biochemical tests indicating oxidative stress, muscle calcium concentration, morphometric parameters and PCR values of SERCA1a.

BACKGROUND AND OBJECTIVES: Insulin secretion entirely depends on Ca²⁺ influx and sequestration into endoplasmic reticulum (ER) of β-cells, performed by Sarco-ER Ca²⁺-ATPase 2b (SERCA2b). In diabetes, SERCA2b is decreased in the β-cells leading to impaired intracellular Ca²⁺ homeostasis and insulin secretion. Adipose mesenchymal stem cells (AMSCs) play a potential role in transplantation in animal models. The present study aimed at investigating and comparing the therapeutic effect of non-transfected AMSCs and SERCA2b gene transfected AMSCs on the pancreas of induced diabetes type 1 in rat. METHODS AND RESULTS: 58 adult male albino rats were divided into: Donor group: 22 rats, 2 for isolation, propagation and characterization of AMSCs and SERCA2b transfected AMSCs, in addition 20 for isolated islet calcium level assessment. Group I (Control Group): 6 rats, Group II (Diabetic Group): 10 rats, 50 mg streptozotocin (STZ) were injected intraperitoneal (IP), Group III (AMSCs Group): 10 rats, 1×10⁶ AMSCs were injected intravenous and Group IV (SERCA2b transfected AMSCs Group): 10 rats, 1×10⁶SERCA2b transfected AMSCs were injected as in group III. Groups I, II, III and IV were sacrified 3 weeks following confirmation of diabetes. Serological, histological, morphometric studies and quantitative polymerase chain reaction (qPCR) were performed. Nuclear, cytoplasmic degenerative and extensive fibrotic changes were detected in the islets of group II that regressed in groups III and IV. Isolated islet calcium, blood glucose, plasma insulin and qPCR were confirmative. CONCLUSIONS: AMSCs and SERCA2b gene transfected AMSCs therapy proved definite therapeutic effect, more obvious in response to SERCA2b gene transfected AMSCs.
Adult ; Animals ; Blood Glucose ; Calcium ; Cytoplasm ; Endoplasmic Reticulum ; Homeostasis ; Humans ; Insulin ; Male ; Mesenchymal Stromal Cells ; Models, Animal ; Pancreas ; Plasma ; Polymerase Chain Reaction ; Rats ; Stem Cells ; Streptozocin ; Tissue Donors

Background: and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. Methods: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). Results: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). Conclusions Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.
Anorexia ; Child ; Child Care ; Deglutition Disorders ; Diagnostic and Statistical Manual of Mental Disorders ; Diet ; Disulfiram ; Feeding and Eating Disorders ; Eating* ; Hope ; Humans ; Meals ; Pediatrics