Prevalence and differences between type 1 and type 2 diabetes mellitus regarding female sexual dysfunction: a cross-sectional Egyptian study

Objective: To evaluate the female sexual dysfunction in both type 1 and type 2 diabetes mellitus (DM).

Methods: This cross-sectional study was carried out at Suez Canal University Hospitals from the start of February 2015 to the end of May 2016 among 189 married premenopausal women attending endocrinology and diabetology outpatient clinic for regular follow-up; 25 of whom refused to participate and 18 more were excluded due to incomplete data sets resulting in a final sample of 146 diabetic females. Ninety healthy women were recruited from the administrative staff at the hospital as a control group. Sexual dysfunction was assessed using female sexual function index (FSFI), a validated 19-item, self-administered, screening questionnaire comprising the six major sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Responses to each question were reported and scored on 0–5 scale with 0 representing no sexual activity and 5 suggestive of normal sexual activity.

Results: Prevalence of sexual dysfunction was significantly higher in both type 1 and 2?DM groups (44 and 25%, respectively) than in the control group (9%). FSFI mean total score was significantly lower in type 1?DM (21.1?±?3.9) than type 2?DM (26.4?±?4.2) and both were significantly lower than the control group (31.5?±?5.8). With regard to FSFI domains, mean values for desire, arousal, lubrication, orgasm, satisfaction and pain were significantly lower in both type 1 and type 2?DM groups when compared with the controls.

Conclusion: FSD is a significant health problem among premenopausal diabetic Egyptian women. Type 1?DM women were more affected than type 2?DM that in turn was more affected than healthy control females.     

Investigation of mtDNA control region sequences in an Egyptian population sample

The sequences of mitochondrial DNA (mtDNA) control region were investigated in 101 unrelated individuals living in the northern region of Nile delta (Gharbia, N = 55 and Kafrelsheikh, N = 46). DNA was extracted from blood stained filter papers or buccal swabs. HV1, HV2 and HV3 were PCR amplified and sequenced; the resulted sequences were aligned and compared with revised Cambridge sequence (rCRS). The results revealed presence of total 93 different haplotypes, 86 of them are unique and 7 are shared haplotypes, the most common haplotype, was observed with a frequency, 2.97% of population sample. High mtDNA diversity was observed with genetic diversity and power of discrimination, 0.9982 and 0.9883, respectively. In this dataset the west Eurasian haplogroups predominated over the African haplogroups. The results would be useful for forensic examinations and human genetic studies.     

Methotrexate versus cyclosporine in the treatment of severe atopic dermatitis in children: a multicenter experience from Egypt

Topical therapy is usually of limited benefit in the treatment of severe atopic dermatitis (AD), and the need for a safe and effective systemic treatment may be required in certain cases especially in children. We evaluated the efficacy and safety of methotrexate and cyclosporine in the treatment of 40 children with severe AD. Patients were divided into two groups (each consisting of 20 patients); group A was treated with methotrexate (7.5 mg/week) while group B was treated with cyclosporine (2.5 mg/kg/day). The severity scoring for atopic dermatitis (SCORAD) was used to indicate efficacy of treatment. In group A, the mean SCORAD score at the beginning of the study was 57.90?±?3.21 that was reduced at the end of the treatment period to reach 29.35?±?6.32 with a mean absolute reduction of 26.25?±?7.03. In group B, the mean SCORAD score was 56.54?±?4.82 at the start of treatment and was 31.35?±?8.89 at the end of 12 weeks of treatment. The mean absolute reduction was 25.02?±?8.21. There was no statistically significant difference in the reduction of SCORAD score between both groups (P?±?0.93). Mild and temporary adverse effects were reported in some patients in both groups. Conclusion: Methotrexate or cyclosporine in low doses can be considered as effective, relatively safe, and well-tolerated treatments for severe AD in children.     

Role of cyclins A and E in endometrial carcinogenesis in breast cancer patients under tamoxifen treatment

PurposeThe objective of our study was to determine the relevance of cyclins A and E overexpression in endometrial carcinogenesis in hormone receptor-positive breast cancer patients under tamoxifen therapy.Experimental designWe assessed expression of cyclins A and E in Endometrial cytology samples collected from 36 ER and PR positive breast cancer patients; under tamoxifen treatment by using the Tao-brush non-invasive brushing cytology technique. Cyclins were detected in the collected samples by means of immuno-cytochemistry.The patients included in this study are a cohort of 36 breast cancer patients who were operated upon at the National Cancer Institute – Cairo University in the period from February 2006 to May 2008 and received tamoxifen (TAM) as part of their adjuvant treatment.ResultsCyclins A and E were expressed in 17 and 15 of the 36 collected endometrial cytology samples (47.2% and 41.6% respectively).Expression of cyclins A and E was highly correlated to Tamoxifen exposure duration (32 and 43 months respectively) p < 0.001. Tamoxifen median exposure duration was shortened to 21 months in cases showing positivity for either markers, while in cases showing positivity for both cyclins, the median exposure duration was longer (44.5 months) (p < 0.001). Neither cyclin A nor E was detected before median tamoxifen exposure duration of 11 months. Endometrial carcinoma cases had the longest Tamoxifen exposure duration (60 months).ConclusionCyclins A and E expression is involved in the carcinogenesis of endometrium in women with breast cancer and under tamoxifen-treatment. Follow up of the patients using these 2 markers is highly recommended starting from the 12th month.     

Epidemiology and aetiology of malocclusion among Syrian paediatric patients.

AIM: The knowledge of the distribution and causes of malocclusion in early childhood can prevent such malocclusions and their consequences and possibly to reduce complex orthodontic treatment. METHODS: All children (n = 234; 116 male, 118 female, age 2-16) who presented with occlusal or functional problems at the Department of Paediatric Dentistry at Damascus University (1995-1999) were classified according to the type and causes of malocclusion and the subsequent orthodontic treatment. RESULTS: 57.3% of the malocclusions affected the anterior-posterior plane, 12.4% the vertical, and 35.9% the transverse. Most of the malocclusions had causes which could be modified by preventive or interceptive efforts: thumb sucking (5.12%), infantile swallowing (3.84%), mouth breathing (0.85%), tongue thrusting (1.7%), delayed exfoliation of a primary tooth (3.41%), premature loss of a primary tooth (9.82%), delayed eruption of a permanent tooth (2.13%), or an impacted tooth (6.41%). The subsequent early orthodontic treatment consisted of space maintainers (26%), removable (40.9%), functional (11.9%), or fixed appliances (21.2%). CONCLUSION: These data stress the importance of early orthodontic diagnosis in paediatric practice. Malocclusion in this Syrian sample could be treated to a great extent with preventive or interceptive orthodontics, which required only simple appliances and techniques.     

Radionuclide ventriculography detects early anthracycline cardiotoxicity in children with Hodgkin lymphoma

Serial echocardiography to detect doxorubicin dose-related cardiotoxicity correlates poorly with endomyocardial biopsy-proven cardiotoxicity. To compare radionuclide ventriculography (RVG) and echocardiography for the assessment of left ventricular (LV) function in children with Hodgkin disease (HD) receiving doxorubicin, we studied 39 children with HD before radiotherapy, both early (≤ 2 adriamycin, bleomycin, vinblastine, and dacarbazine cycles) (group A; n=10) and late (≥ 6 adriamycin, bleomycin, vinblastine, and dacarbazine cycles) (group B; n=36) during treatment. Seven children were assessed twice. The patients underwent full clinical assessment, echocardiography, and RVG. In group A, LV ejection fraction (LVEF) was significantly lower when measured by RVG compared with echocardiography (P<0.05). Group B had lower LVEF compared with group A by echocardiography (P=0.09), and by RVG (P=0.000). Paired analysis of children studied early and late showed a significant drop in LVEF by echocardiography (58.7 ± 7.3 vs. 52 ± 52.44%; P=0.04) and RVG (51.4 ± 2.6% vs. 47.2 ± 3.1%; P=0.004). The cumulative dose of doxorubicin inversely correlated with RVG-measured LVEF (r=-0.531; P=0.001). No correlation was found between LVEF measured by RVG and echocardiography (r=0.217; P=0.25). Cardiotoxicity occurred early and at low cumulative doses of doxorubicin in children with HD. RVG was more sensitive than echocardiography in detecting early impairment of LV function. We recommend baseline and serial assessment of LV function by RVG in children with HD receiving doxorubicin.     

Accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance: Experience from the National Cancer Institute,Cairo University,Egypt

Aim

To evaluate the accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance.

Patients and methods

85 cases of FNAC of bone lesions were included. Sixty two procedures were performed by the radiologist and 23 procedures by the histopathologists. The aspirates were immediately fixed in 95% ethanol alcohol for Papanicolaou staining. If there was sufficient material, cell block was prepared. Diagnosis was established in 81 cases (95.3%), classified into 3 categories: (1) positive for malignant cells (57.6%); (2) suspicious for malignant cells (10.6%); and (3) benign, borderline or inflammatory lesions (27.1%). Cytology findings were compared with subsequent available histology.

Results

The overall accuracy was 91%. The 49 cases diagnosed as malignant by cytology were all correct. FNAC could differentiate various giant cell rich lesions and round cell malignancies as Ewing’s sarcoma, myeloma and NHL. Uncommon bone lesions as chordoma and MFH were also correctly diagnosed. Cytological diagnosis of benign and borderline lesions was made in 23 patients. The authors encountered difficulties diagnosing a case of MFH that was reported as osteosarcoma and a case of metastasis that was reported as chondrosarcoma.

Conclusion

FNAC of bone lesions is a simple, safe and accurate diagnostic technique for diagnosis of bone lesions especially when other diagnostic modalities are unavailable.     

Antiandrogen therapy in metastatic male breast cancer: results from an updated analysis in an expanded case series

Male breast cancer is a rare disease treated as hormone receptor-positive female breast cancer. The characterization of breast cancer at the molecular level has lately revealed gender-related differences. As the androgen receptor is emerging as a potential oncogenic driver in male breast cancer, we analyzed efficacy data from metastatic patients treated with antiandrogens. We evaluated the activity of cyproterone acetate, either as a monotherapy or combined with a GnRH analog, in 36 metastatic male breast cancer patients. Fourteen patients were treated with cyproterone acetate as monotherapy and 22 patients with complete androgen blockade. We recorded 4 complete responses and 15 partial responses, for an overall response rate of 52.8 % (95 % CI, 36.5–69.4). Stable disease was reported in 11 patients. Median PFS was 8.9 months (95 % CI, 6.1–11.7), and median OS was 24.3 months (95 % CI, 22.5–26.1). Data on androgen receptor expression were available for 7 patients. All the 4 patients with androgen receptor-expressing tumors had a clinical benefit, including a patient with an estrogen receptor-negative disease. Conversely, none of the 3 patients with androgen receptor-negative tumors had a tumor response. Antiandrogen-based therapy showed efficacy in metastatic male breast cancer patients. Our results encourage considering antiandrogens in the therapeutic continuum, especially if supported by androgen receptor expression.     

The clinical utility of miR-21 as a diagnostic and prognostic marker for renal cell carcinoma

Renal cell carcinoma (RCC) is the most common neoplasm of the kidney. Increasing evidence suggests that microRNAs are dysregulated in RCC and are important factors in RCC pathogenesis. miR-21 is a known oncogene with tumor-promoting effects in many types of cancer. In this study, we analyzed miR-21 in 121 cases of healthy kidney and different RCC subtypes, including clear cell (ccRCC), papillary (pRCC), chromophobe (chRCC), and oncocytoma. Total RNA was extracted, and the expression of miR-21 was measured with real-time quantitative RT-PCR using miR-21-specific probes. The expression of miR-21 was significantly up-regulated in RCC compared with healthy kidney. There was a significant difference in the expression levels between RCC subtypes, with the highest levels of expression in ccRCC and pRCC subtypes. miR-21 expression distinguished ccRCC and pRCC from chRCC and oncocytoma with 90% specificity (95% CI, 63.9% to 98.1%) and 83% sensitivity (95% CI, 53.5% to 97.6%). Significantly higher miR-21 levels were associated with higher stage and grade. Patients who were miR-21 positive had statistically significant shorter disease-free and overall survival rates. Thus, miR-21 is up-regulated in RCC, and its expression levels can be used as a diagnostic marker to distinguish ccRCC and pRCC from chRCC and oncocytoma. Moreover, it has potential as a prognostic marker in RCC, although it is not independent of tumor stage and grade.     

Treatment of localized non-segmental vitiligo with intradermal 5-flurouracil injection combined with narrow-band ultraviolet B: A preliminary study

Abstract Background: Several treatment modalities had been used for the treatment of vitiligo but the optimal treatment has not yet been identified. Aim: To evaluate the efficacy and safety of intradermal injection of 5-flurouracil (5-FU) combined with narrow-band ultraviolet B (NB-UVB) as a treatment option for vitiligo. Patients and methods: The study included 60 vitiligo patients with overall symmetrical lesions affecting less than 30% of body surface area. For each patient, one side of the body was treated with NB-UVB alone (control side) while the other side was treated with NB-UVB therapy in addition to intradermal injection of 5-FU (50 mg/ml), 0.01-0.02 ml per injection with 1 cm apart in skin of vitiligo, every 2 weeks for 4 months. Results: The overall repigmentation was significantly higher in the 5-FU side compared with control side in all body parts (p < 0.001) except for the acral lesions where the difference was not significant (p = 0.561). No systemic side effects of 5-FU were detected, and the majority of the patients reported pain during injections. Conclusions: Intradermal 5-FU injection in combination with NB-UVB could be considered as a simple, safe, tolerable and cheap technique for treatment of vitiligo. It shortens the duration of NB-UVB therapy and improves the outcome, repigmentation. Longer follow-up is needed.