The supracerebellar infratentorial approach in pineal region tumors: Technique and outcome in an underprivileged setting

Background: Pineal region tumors represent 1.5–8.5% of the pediatric brain tumors. Management includes endoscopic third ventriculostomy and biopsy in cases presenting with hydrocephalus. In addition, surgical resection provides survival advantage in selected cases. The supracerebellar infratentorial approach is a widely preferred approach for such region.Methods: After approval of the local ethics committee of Alexandria University and acquisition of the appropriate formal consents according to the committee’s standards, we have reviewed the records of fifteen cases presenting with pineal region tumors in Alexandria main university hospital from 2013 to 2016. The mean age at the diagnosis was 14 years (2–54 years). All cases had supracerebellar infratentorial approach for surgical resection. Follow up period was from 12 to 59 months.Results: All 15 cases presented with hydrocephalus and increased intracranial pressure manifestations. Out of the 15 cases, 3 cases were germ-cell tumors, 2 cases were pineoblastomas, one parenchymal tumor with intermediate differentiation (PPID), one pineocytoma, 2 cases were anaplastic ependymomas and 6 cases were astrocytomas. Gross total resection (GTR) was achieved in 4 cases, subtotal resection was achieved in 7 cases and partial resection in 4 cases. Major surgical complications included severe postoperative cerebellar edema in 2 cases that required further decompression and hemorrhage in one case that has been managed conservatively.Conclusion: In Alexandria university, the supracerebellar infratentorial approach is considered a safe approach with minimal morbidity and no surgery related mortality.Keywords: Pineal region tumors, Tectal tumors, Supracerebellar infratentorial approac

Evaluation of interleukin-9 expression as a potential therapeutic target in chronic lymphocytic leukemia in a cohort of Egyptian patients

Background: Chronic lymphocytic leukemia (CLL) is a common lymphoid malignancy that has a highly variable clinical course. Genomic features as zeta-chain-associated protein kinase 70 (ZAP70) expression and CD38 expression provide further differentiation of disease prognosis. Extensive studies have confirmed the oncogenic activities of IL-9 in lymphoma. The aim of the current study was to investigate the contribution of IL-9 expression to the pathogenesis of CLL and its correlation to other prognostic parameters.Methods: This study was conducted on 80 patients at diagnosis with CLL and 80 healthy controls. Using real time polymerase chain reaction and enzyme linked immunosorbant assay, IL-9 mRNA expression and its serum level were compared between patients and controls. They were both correlated with other prognostic factors.Results: There was an overexpression of IL-9 in CLL patients that correlated with modified Rai staging, ZAP70, CD38 and all hallmarks of an active and aggressive disease. The correlation between IL-9 upregulation and patient characteristics provided a direct clinical evidence for its contribution to the pathogenesis of CLL.Conclusions: Significantly higher expression of IL -9 measured at both the mRNA and the protein levels in patients with CLL that correlates with more complex course of the disease and worse prognosis may allow one to speculate its importance in the pathogenesis of the disease and its possible role as a potential therapeutic target

Complication of Type 1 Diabetes in Craniofacial and Dental Hard Tissue

Diabetes mellitus (DM) is a chronic systemic disease arisen under the conditions when the body cannot produce enough insulin or cannot use it effectively. Type 1 diabetes is caused by an autoimmune reaction, where the body’s defense system attacks the insulin-producing β-cells in the pancreas. Type 1 diabetes incidence has been rising all over the world, especially under the age of 15 years. There are strong premonitions of geographic difference; however, the overall annual increase in a number of affected population is estimated to be approximately 3%

Ultrastructure of the anterior adhesive apparatus of the gill parasite Macrogyrodactylus clarii and skin parasite M. congolensis (Monogenea; Gyrodactylidae) from the catfish Clarias gariepinus

Transmission electron microscopy (TEM) was used for the first time to study the anterior adhesive apparatus of the monogeneans Macrogyrodactylus clarii Gussev, 1961 and M. congolensis (Prudhoe, 1957) Yamaguti, 1963 inhabiting gills and skin respectively of the same catfish Clarias gariepinus. Despite the different microhabitats occupied by these parasites, the present study revealed that they have a similar anterior adhesive system. In both parasites, the anterior adhesive apparatus consists of three types of gland cells: G1 cells that produce rod-shaped bodies (S1), G2 cells manufacture irregularly shaped bodies (S2) and G3 cells form mucoid-like secretions (S3). In the cytoplasm of G1 cells, a single layer of microtubules encloses each developing rod-shaped body. A unique feature of S1 secretory bodies is that some fully developed S1 bodies are attached to each other, forming large condensed globules in the cytoplasm of G1 gland cells and terminal portion of the G1 ducts, but none were detected in the adhesive sacs outside the ducts. In the adhesive sacs, G1 ducts open with multiple apertures whereas each of the G2 and G3 ducts have a single opening. The adhesive sacs are lined with two types of tegument (st1 and st2). A third tegument type (st3) connects the st2 tegument with the general body tegument. Only st1 has microvilli. Each adhesive sac is provided with a spike-like sensillum and single uniciliated sense organ. The possible functions of microvilli in increasing the surface area and assistance in spreading and mixing of the adhesive secretion, and the role of sense organs associated with the adhesive sacs are discussed

Management of the Rectal Stump after Subtotal Colectomy Operations for Inflammatory Bowel Disease in the Era of Immunologic Therapy : A Two-Centre Cohort Study

Funding Sources The authors received no financial support for the research, authorship, and/or publication of this article.Non peer reviewedPublisher PD

BONE MINERAL DENSITY AND VITAMIN D RECEPTOR GENETIC VARIANTS IN EGYPTIAN CHILDREN WITH BETA THALASSEMIA ON VITAMIN D SUPPLEMENTATION

Background: Low bone mineral density (BMD) is a characteristic feature of Beta thalassemia major (βTM) patients. Vitamin D is important for bone mineralization. Vitamin D receptors (VDR) genetic variants may be related to vitamin D status and BMD. Objectives:  To evaluate the effect of VDR genetic variants on vitamin D levels and BMD in βTM Egyptian patients supplemented with vitamin D. Methods: This study was conducted on forty children with βTM and forty unrelated healthy sex and age-matched controls. Serum calcium, phosphorus, ALP, ferritin and vitamin D were measured. VDR genetic variants (BsmI, TaqI, and FokI) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). BMD was measured by dual-energy X-ray densitometry (DEXA) of the lumbar spine. Results: In βTM patients, 22.5% had deficient, 50% had insufficient and only 27.5% had sufficient levels of vitamin D. BMD Z score was significantly lower in βTM patients compared to controls (p<0.001). Osteopenia and osteoporosis of lumbar spines were observed in 70% and 22.5% of βTM patients respectively. BsmI bb and FokI Ff and ff genotypic variants were significantly associated with lower vitamin D and BMD Z score. No association was observed with TaqI genotypic variants. Conclusions: We reported a high prevalence of low BMD in βTM despite vitamin D supplementation. The BsmI bb, FokI Ff and ff genotypic variants of VDR can be considered as risk factors for the occurrence of osteoporosis in these children. Vitamin D doses should be adjusted individually according to the genetic makeup of each patient