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Purpose: Diabetic retinopathy (DR) is still a leading cause of blindness. The role of miRNAs in diabetic retinopathy still needs more research. We aimed at validating the role of circulating miRNAs: 21,181C and 1179 in early detection, dynamic monitoring, and management of DR. Methods: Whole blood samples were collected from 180 diabetic patients and 60 normal individuals as control. The diabetic patients were subdivided into 60 subjects without retinopathy, 60 with non-proliferative diabetic retinopathy (NPDR), and 60 with proliferative diabetic retinopathy (PDR). Gene expression of miR-21, miR-181c, and miR-1179 were estimated in each sample using two-step reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Results: MicroRNA 181c and miRNA 1179 were significantly higher among PDR group compared to NPDR,W DM and control groups, while no significant difference was detected regarding miRNA 21. The areas under the receiver operating characteristic (ROC) curves of the validated two-serum miRNAs were 0.983 and 0.927 respectively. Combination of miRNA 1179 and miRNA 21 improved the accuracy rate to 90%. Combination of miR-181c and miR-1179 possessed high ability to discriminate between PDR and NPDR with an accuracy rate of 100%. Conclusion: MicroRNAs play a role in pathogenesis of diabetic retinopathy. In our study, miR-181c and miR-1179 were significantly high in PDR patients compared to NPDR and controls hence can be used to anticipate and follow up the progression. MicroRNA antagonists or mimics can be tried as new medications to modify DR by reducing the rate of progression, and subsequent blindness. [ABSTRACT FROM AUTHOR]

Background and aims: Oral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients. Methods: A cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis). Results: The prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL. Conclusion: The inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate health related quality of life (HRQOL) in Egyptian children with systemic lupus erythematosus (SLE) using 3 different tools. Methods: In this questionnaire-based study, 100 children with SLE were included. HRQOL was assessed using the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL™ 4.0 GCS), PedsQL™ 3.0 Rheumatology Module (PedsQL3-RM) and the Simple Measure of the Impact of Lupus Erythematosus in Youngsters (SMILEY). SLE disease activity index (SLEDAI) was used to evaluate activity and SLE International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI) was used to evaluate chronic damage. Results: All mean scores of PedsQLTM4.0 GCS domains in SLE patients were lower than published normative data and previously published results of Egyptian healthy controls (p < 0.001). All mean scores of PedsQL-3RM domains were significantly lower than published normative data except for the treatment and pain and hurt domains (p = 0.1, 0.2 respectively). SMILEY scores were low and the lowest domain scores was "Burden of SLE". Longer duration of illness, higher cumulative steroid doses, higher SLEDAI and SDI scores and presence of obesity were associated with lower scores for all 3 tools (p < 0.001). Conclusion for Practice: The Arabic copies of PedsQL™ 4.0 GCS, PedsQL3-RM and SMILEY are easily used for Arabic speaking subjects and easily interpreted by physician and can be implemented for frequent monitoring of SLE HRQOL. Controlling the disease activity and using lowest doses of steroids and other immunosuppressive drugs are the corner stone strategies for improving HRQOL in SLE children. Significance: This is the first study to evaluate HRQOL scores in Egyptian children with SLE which were found to be lower than published data with long disease duration, high cumulative disease activity, use of steroids and presence of obesity are the main influential factors related to low QoL scores. Generic and disease specific questionnaires are easily used for Arabic speaking subjects and easily interpreted by physician and can be implemented for frequent monitoring of SLE HRQOL. Controlling the disease activity and using lowest doses of steroids and other immunosuppressive drugs are the corner stone strategies for improving HRQOL in SLE children. [ABSTRACT FROM AUTHOR]

Purpose: To study optic disc in idiopathic intracranial hypertension (IIH) with diffusion tensor imaging.Methods: Prospective study was carried out on 31 consecutive patients with IIH and 17 age and sex-matched controls that underwent diffusion tensor imaging of optic nerve. Fractional anisotropy (FA) and mean diffusivity (MD) of optic disc were measured by two readers. Grades of papilledema and visual field defects were evaluated by ophthalmologist.Results: FA of optic disc was significantly lower in IIH than controls (p = 0.001) with excellent inter-observer agreement (K = 0.93) of both readers. The cutoff FA used to differentiating IIH from controls were 0.28 and 0.29 with area under curve (AUC) of 0.921 and 0.914, accuracy 92% and 91%, and sensitivity 97% and 96%. MD of optic disc were significantly higher in IIH than in controls (p = 0.001) with excellent inter-observer agreement (K = 0.91) of both readers. The cutoff MD used to differentiating IIH from controls was 1.51 and 1.22 × 10−3 mm2/s with AUC 0.943 and 0.922, and accuracy 94% and 92% respectively. FA of optic disc was significantly lower in early than advanced papilledema and visual field defects (p = 0.001, 0.001) respectively. The MD of optic disc was significantly higher in early than advanced papilledema and visual field defects (p = 0.001, 0.001) respectively.Conclusion: Diffusion tensor imaging parameters of optic disc are non-invasive reliable imaging parameters that can be used for diagnosis of IIH and well correlated with papilledema and visual field defects. [ABSTRACT FROM AUTHOR]

Background: The burden of post-coronavirus disease (COVID)-19 symptoms has been increasing and is of great concern in patients with pre-existing chronic medical conditions.This study aimed to delineate the post-COVID-19 neuropsychiatric symptoms among migraine patients compared to the non-migraine control group. Methods: Two groups, each of 204 COVID-19 survivors, were enrolled in the study after 3 months of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, one group fulfilling the episodic migraine criteria and the other serving as a matching control group. Subjects were evaluated through an in-person interview for post-COVID-19 neuropsychiatric symptoms, including detailed headache patterns and severity, using the visual analogue scale. Results: The Frequency of headache during the acute phase of COVID-19 was more frequent in migraine patients (OR = 1.60, 95%CI = 1.04–2.45, P-value = 0.031). The reported significant post-COVID-19 neuropsychiatric symptoms in migraine patients compared to controls were fatigue (OR = 1.662, 95%CI = 1.064–2.596, P-value = 0.025), anosmia/hyposmia (OR = 2.06, 95%CI = 1.164- 3.645, P-value = 0.012), cacosmia (OR = 2.663, 95%CI = 1.145–6.195, P-value = 0.019), depression (OR = 2.259, 95%CI = 1.284- 3.975, P-value = 0.004), anxiety (OR = 3.267, 95%CI = 1.747- 6.108, P-value ≤ 0.001), insomnia (OR = 2.203, 95%CI = 1.298- 3.739, P-value = 0.003), and headache (OR = 3.148, 95%CI = 1.616–6.136, P-value = ≤ 0.001).While there was no statistically significant difference between migraine patients and controls regarding the post-COVID-19 functional status score (P-value = 0.102). The pattern of post-COVID-19 headache was reported as chronic headache transformation in 17.6% of the migraine group, with the median intensity rate being 5.5 and IQR (3–7). In the control group, 14% experienced chronic headache attributed to systemic viral infection with a median intensity rate of 2 and IQR (2–5), while 12% experienced a new daily persistent headache with a median intensity of 5 and IQR (1–6). Conclusion: The study highlighted the importance of follow-up migraine patients upon recovery from COVID-19 infection, being more vulnerable to post-COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

Bilio-enteric anastomosis is the main line of treatment of bile duct injury (BDI). This study aims at exploring factors related to poor outcome after surgical reconstruction especially operative factors. Special emphasis on Hepp-Couinaud technique, theoretically, ensuring larger stoma and better blood supply. Between January 1992 and July 2015, 321 cases of postcholecystectomy BDI underwent hepaticojejunostomy. Retrospective analysis of demographics, perioperative data and management, and outcome according to Terblanche et al. Development of anastomotic strictures (AS) was evaluated. The mean follow-up time was 84.7 ± 61.9 months. Women represented 76% of all cases with a mean age of 40.1 ± 12.8. ERCP was performed in 105 (32.7%) patients. E2 and E3 strictures accounted for 76% of cases. One hundred thirty-seven (42.7%) patients underwent an end-to-side HJ. Abdominal collection or biloma was the commonest complication. Anastomotic stricture occurred in 16 (5.2%) patients after a mean time of 45 ± 31.3 months. Excellent or good outcome was detected in 281 (91.8%) patients, while fair or poor outcome was proved in 25 (8.2%) patients. On multivariate analysis, the only significant factors that predict a poor outcome were post-ERCP pancreatitis (p = 0.008), the design of HJ as end to side (p = 0.033), and postoperative biloma or abdominal collection (p = 0.021). On multivariate analysis, the only factor that was found to significantly affect the development of AS was postoperative development of collection or biloma (p = 0.032). HJ has very good results in specialized centers. Careful operative technique with sound wide stoma improves the outcome. ERCP should be used selectively and with caution for diagnosis of biliary strictures. [ABSTRACT FROM AUTHOR]

Background: Given the burden and poor outcome of end-stage renal disease in sickle cell disease (SCD), early markers of sickle cell nephropathy (SN) are desirable. Disordered angiogenesis underlies many complications of SCD. We aimed to determine the relationship between serum FMS-like tyrosine kinase-1 (sFLT-1) and other biomarkers of renal damage for the early diagnosis of SN. Methods: Forty-seven SCD patients and 49 healthy controls were enrolled. Microalbuminuria was determined in patient urine samples. Blood samples were tested for sFLT-1, serum creatinine, and various hemolysis and inflammation markers. Peripheral blood monocyte expression of sFLT-1 was measured using real-time polymerase chain reaction (PCR). Results: The serum level of sFLT-1 (pg/ml) in SCD patients was higher than controls (median/range/IQR = 142/ 60-1300/61 pg/ml vs. 125/ 110-187/52 pg/ml, respectively) ( p = 0.006). Median (range) of sFLT-1 level was higher in SCD patients with microalbuminuria compared to SCD patients with normoalbuminuria, 185 (140-1300) vs. 125 (60-189) mg/g, respectively) ( p = 0.004). There was a significant positive correlation between serum sFLT-1 and microalbuminuria, lactate dehydrogenase (LDH), and indirect bilirubin ( r = 0.59, 0.39, 0.30, and p = <0.001, 0.007, 0.041, respectively). sFLT-1 sensitivity in early detection of renal affection in SCD was 93.6 %, while specificity was 68.6 %. Finally, peripheral blood monocytes (PBM) sFLT-1 expression was significantly higher in SCD patients compared to controls ( p = 0.05). Conclusions: sFLT-1 may contribute to pathogenesis of albuminuria in SCD patients and constitute a novel renal biomarker of SN. [ABSTRACT FROM AUTHOR]

Background: Localized scleroderma (morphea) is characterized by hardening and thickening of the dermis due to excessive collagen deposition. A decreased number of CD34+ cells and an increased number of Factor XIIIa+ cells are seen in the affected skin. The flashlamp pulsed dye laser (FLPDL) has been used in the treatment of localized morphea with promising results. Objective: The purpose of this study was to evaluate the therapeutic effectiveness of the pulsed dye laser in localized scleroderma and to assess its effect on CD34+ cells, Factor XIIIa+ cells, and blood vessels. Study Design: Thirty patients with plaque morphea were treated with a FLPDL (585 nm wavelength, 450 μs pulse duration). Fluence ranged from 7.5 to 8.5 J/cm. Sessions were performed biweekly for a maximum of 6 months. Clinical, histopathologic, and immunohistochemical assessments were performed. Results: Patients showed varying degrees of improvement of indurated skin. There was no worsening or further improvement at the treated sites during the follow-up assessments at 3, 6, and 12 months. An increased number of CD34+ cells were found in both the upper and the lower dermis, and a decreased number of Factor XIIIa+ cells were found in the lower dermis. Conclusion: The FLPDL is effective in the treatment of morphea, as confirmed by the changes in the pathologic tissue and levels of CD34+ and Factor XIIIa+ cells. [ABSTRACT FROM AUTHOR]