Central serous chorioretinopathy shows reduced retinal flow circulation in retinal function imaging (RFI)

Purpose: To assess retinal blood flow in patients with central serous chorioretinopathy (CSR). Methods: The hospital‐based observational comparative study included a study group with 12 patients (age: 45 ± 13 years) with an acute onset of CSR and a control group of 12 subjects matched for age and gender with the study group. The diagnosis was substantiated by fluorescein angiography and optical coherence tomography. All study participants underwent measurement of retinal blood perfusion using the retinal function imager (RFI). Results: The retinal blood flow velocity in the retinal veins was significantly lower in the study group than in the control group (2.76 ± 0.53 mm/s versus 3.33 ± 0.76 mm/s; p = 0.03).The difference between the study group and control group was more marked for the larger retinal veins (2.87 ± 0.51 mm/s versus 3.47 ± 0.48 mm/s; p = 0.001) than for the smaller veins (2.69 ± 0.53 mm/s versus 3.42 ± 1.05 mm/s; p = 0.04). Both groups did not differ significantly in the data of the retinal arterial flow velocities. Conclusions: The data suggest an abnormal retinal venous blood flow regulation in patients with active CSR.     

Increased serum asymmetric dimethylarginine levels in hyperemesis gravidarum

Purpose  

We sought to investigate the serum levels of asymmetric dimethylarginine in pregnant women with hyperemesis gravidarum.     

Botulinum toxin: could it be an effective treatment for chronic tension-type headache?

Several clinical trials suggest that botulinum toxin type-A (BTX-A) may be an effective treatment option for patients with chronic tension-type headache (CTTH); however, controversy remains as to how the botulinum toxin optimally should be used for treating headache and which patient's profile fits this treatment. The objective of this study was to evaluate the efficacy and tolerability of BTX-A for the prophylactic treatment of CCTH in Egyptian patients. This was a randomized, single-blind, placebo-controlled study of BTX-A for the treatment of patients aged 25–50 years old with CCTH. Following a 30-day screening, headache parameters and severity assessed by the standard visual analogue scale (VAS), and the 25-item Henry Ford Hospital Headache Disability Inventory (HDI) were recorded as a baseline. Then, injection was done with either BTX-A or with saline by a combination of two methods for detecting injection sites (the fixed-site approach and follow-the-pain approach). Our study showed significant improvement after 1 month of BTX-A injection regarding headache days/month, severity measured by VAS and HDI in headache severity. There was significant reduction of prophylactic medications, and there were minor complications, but these reversed spontaneously without further treatment. BTX-A was an effective and well-tolerated prophylactic treatment in Egyptian patients with CCTH.     

Effect of TNF-alpha on CD3-zeta and MHC-I in postnatal rat hippocampus

The zeta subunit of the CD3 T-cell receptor complex and the major histocompatibility complex class 1 (MHC-I) are important not only for the immune response to antigens, they also function as signal molecules in the brain, where they play a role in the postnatal maturation process. The expression of these molecules can be regulated by cytokines. In situations associated with increased cytokine production, such as neonatal hypoxia, the hippocampus is particularly susceptible to permanent damage. This has prompted us to examine the MHC-I and CD3-zeta expression in hippocampus from early postnatal, weanling and adolescent rats and to record the effects of TNF-alpha and IL-1beta, cytokines commonly increased in neonatal hypoxia, on MHC-I and CD3-zeta expression in the hippocampus. We show that there is a robust postnatal up-regulation of CD3-zeta and MHC-I protein as well as of MHC-I mRNA and that TNF-alpha down-regulates the expression of CD3-zeta protein and MHC-I mRNA in early postnatal but not in weanling nor in adolescent rats. These results may offer a molecular explanation to the adverse effects of increased circulating levels of cytokines on brain in neonatal hypoxia.     

Primary peritonitis in children with nephrotic syndrome: results of a 5-year multicenter study

Primary peritonitis is a well-described infectious complication of nephrotic syndrome. Current data on the true incidence of peritonitis and efficacy of preventive pneumococcal vaccination are not clear in this group of children. In this nationwide study, among a total of 268 patients with an initial diagnosis of steroid sensitive nephrotic syndrome, eight episodes of primary peritonitis were detected in seven patients during 5 years. All eight attacks of peritonitis occurred in the relapse period. Seven of these peritonitis episodes occurred in the first 2 years of nephrotic syndrome, three of them during the first attack. One patient had two attacks with a 6-month interval. Only two of the patients were steroid sensitive, while four of them were steroid dependent, and one was steroid resistant at the diagnosis of peritonitis. The causing microorganism was identified in three patients (Streptococcus hemolyticus, Streptococcus pneumoniae, and α-hemolytic Streptococcus). Incidence of peritonitis (2.6%) in our series was not high when compared with previous reports. None of the patients had been immunized against pneumococcus before or after the peritonitis attack. It raises the question if the vaccine is necessary for every child with steroid sensitive nephrotic syndrome. However, we suggest that immunization against pneumococcus is not indicated in children with steroid-responsive nephrotic syndrome (NS) and should be reserved for the small number of children who have steroid-dependent or steroid-resistant NS.     

The role of serum neopterin level in the evaluation of activation and response to treatment in the patients with pulmonary tuberculosis

Neopterin is an important parameter showing cell mediated immunity activation. In this study we aimed to determine whether serum neopterin level could be used as a marker in the evaluation of tuberculosis activation and response to treatment. The study comprised 40 new case smear positive pulmonary tuberculosis patients and 40 healthy control. Serum neopterin levels were measured both before the treatment and 2nd month of the treatment in the patient group. The association between serum neopterin level and clinical, radiological and bacteriological parameters were also investigated. In patients with pulmonary tuberculosis the mean levels of serum neopterin were 35.1+/-13.4 nmol/L before the treatment and 21.2+/-10.4 nmol/L in the 2nd month of the treatment. In the control group, serum neopterin level was 19+/-10.4 nmol/L. The serum neopterin levels of the patients were significantly higher than the control group (p=0.001). Also, there was significant difference between serum neopterin levels before the treatment and the 2nd month of the treatment (p=0.000). Serum neopterin level was higher in the group with extensive disease than the cases with limited disease (p=0.02). In conclusion, we think that serum neopterin level might be used as a reliable immunological marker in the evaluation of tuberculosis activation and response to treatment.     

Nail alterations during pregnancy: a clinical study

During pregnancy, cutaneous and appendageal alterations manifest and may cause concern in the subject. The nails may be affected by pregnancy. This study investigated the frequency and nature of nail changes occurring during pregnancy in 312 healthy, 18–40‐year‐old pregnant women in gestation weeks 16–40. After a routine obstetric examination at the obstetrics and gynecology clinic at the study institution, all subjects submitted to an examination of all fingernails and toenails. Only nail alterations that had developed during pregnancy were recorded. Any nail changes that had occurred before the start of gestation were not considered. Data were presented as percentages. The Shapiro–Wilk and chi‐squared tests were used to make categorical comparisons. A P‐value of < 0.05 was considered to indicate statistical significance. No nail pathologies were detected in 116 (37.2%) of the 312 subjects. The most commonly found nail change was leukonychia (24.4%). Ingrown toenail (9.0%) and onychoschizia (9.0%) represented the second most common nail changes. Rapid nail growth and subungual hyperkeratosis were observed in 6.7% and 4.2%, respectively, of subjects. When the alterations were evaluated according to gestational age, the most common nail pathology was leukonychia at both 14–28 weeks (16.3%) and 29–42 weeks (27.4%) of pregnancy. Leukonychia, onychoschizia, onycholysis, and brittle nail pathologies were frequently observed at 29–42 weeks of pregnancy (P = 0.047). A large proportion of nail changes that occur during pregnancy are benign and do not require treatment. However, these changes may cause significant cosmetic stress in women.