Effect of endorectal pullthrough on external anal sphincter integrity (in cases of Hirchsprung’s disease) using EMG

Objective The transanal mucosectomy of the aganglionic segment is a critical step in the transanal endorectal pullthrough procedure for the treatment of Hirchsprung’s disease. It exerts considerable traction on the anorectal tissue during dissection. Anal sphincter electromyography (EMG) is an indispensable parameter for the diagnosis of patients with any anorectal dysfunction. The aim of our study was to assess the integrity of the anorectal sphincter after transanal endorectal pullthrough using anal EMG.Methods This prospective study was carried out on 25 infants and children with Hirchsprung’s disease who underwent the endorectal pullthrough (soave) procedure. Needle EMG was used to assess the sphincter preoperatively and postoperatively.Results Preoperative EMG showed positive neuropathic changes in 28% of the patients. Postoperative EMG showed neuropathic changes in 60% of the patients, of whom 28% showed preoperative changes and 32% showed absolute postoperative findings, mostly related to difficult operative dissection.Conclusion The functional results of the endorectal pullthrough procedure were acceptable overall. Significance The reduced sphincter function encountered postoperatively was because of a combination of preoperative and intraoperative influences.Keywords: anal electromyography, Hirschsprung’s disease, transanal endorectal pullthroug

Evaluation of visfatin in patients with systemic lupus erythematosus: Correlation with disease activity and lupus nephritis

AbstractIntroductionRenal involvement affects about 50% of SLE patients accounting for significant morbidity and mortality in these patients. The adipokine “visfatin” acting as a growth factor for B-lymphocyte-precursors, exerts several proinflammatory functions. It was demonstrated as a marker of endothelial dysfunction (ED) in chronic kidney disease (CKD) thus could be a factor linking inflammation in SLE and kidney disease.Aim of the workTo assess serum visfatin level in SLE patients and its correlation to disease activity and lupus nephritis (LN) in these patients.Patients and methodsSerum level of visfatin using enzyme-linked immunosorbent assay (ELISA), chemical and immunological markers of SLE and LN were measured in 40 SLE patients and 40 age and sex matched healthy controls. Disease activity and renal involvement were assessed using SLE Disease Activity Index (SLEDAI) and Renal SLEDAI respectively further dividing patients into active versus inactive and LN versus non-LN respectively. Renal biopsies were taken from LN subgroup and were classified according to the modified WHO classification.ResultsA significantly higher serum visfatin level was found on comparing SLE patients (mean 109±180ng/ml, median18) with controls (mean 9.4±11ng/ml, median2.5) with statistically highly significant difference (z=5.2, P<0.001). Also there was a statistically significant difference as regards serum visfatin level between active SLE patients (mean 173±111ng/ml, median 14) and inactive patients (mean 139±88ng/ml, median 5) (z=2.1, P<0.05) as well as between patients with LN (mean 226±180ng/ml, median18) and patients with no LN (mean 101±140ng/ml, median 8(2-229)) (z=2.1, P<0.05). Visfatin had a highly significant positive correlation with disease duration (r=0.48, P<0.001), SLEDAI (r=0.62, P<0.001) as well as ESR, CRP and, renal score (r=0.45, 0.35, and 0.65, respectively) while inverse correlation with estimated GFR (r=−0.614) and C3 and C4 titre (r=−0.26, r=−0.35, respectively) was recorded. Visfatin showed high sensitivity in detecting active SLE and LN 83% and 85%, respectively.ConclusionSerum visfatin is strongly associated with LN in SLE patients and is a promising biomarker for prediction of renal involvement in these patients. It reflects SLE activity specially LN activity namely renal score and GFR decline. Further prospective studies are required to confirm visfatin as a destructive mediator of predictive and prognostic value in active lupus nephritis

Evaluation of endothelial protein C receptor in patients with systemic lupus erythematosus: correlation with disease activity and lupus nephritis

Introduction Systemic lupus erythematous (SLE) is a systemic, multifaceted inflammatory disease with clinical manifestations is protean and follows a relapsing and remitting course. Lupus Nephritis (LN) is one of the most frequent and serious manifestation. Endothelial protein C receptor (EPCR) is a transmembrane receptor that is shed into soluble form (sEPCR) in inflammatory status. It is demonstrated as a part of the pathobiology of the SLE disease. Aim of the work To assess correlation of sEPCR level in SLE patients to the disease activity in these patients and to relate sEPCR to LN. Patients and methods Serum level of sEPCR using enzyme-linked immunosorbent assay (ELISA), chemical and immunological markers of SLE were measured in 30 SLE patients and 30 age and sex matched apparently healthy controls. SLE patients were subgrouped into 20 patients without LN and 10 with LN. Disease activity was assessed using SLE Disease Activity Index (SLEDAI). Results A significantly higher sEPCR level was found on comparing SLE patients to controls with statistically highly significant difference (z = 4.8, P < 0.001). Moreover, there was a significantly higher sEPCR level on comparing SLE patients with LN to those without LN with statistically highly significant difference (z = 3.9, P < 0.001). Serum sEPCR had a highly significant positive correlation with SLEDAI in SLE patients (r = 0.66, P < 0.01). Conclusion sEPCR has a possible role in the pathogenesis of SLE and particularly LN diseases, reflecting disease activity in SLE patients

Localization of composite prosthetic feet: manufacturing processes and production guidelines

Abstract Amputation levels in Egypt and the surrounding neighborhood require a state intervention to localize the manufacturing of prosthetic feet. Amputations are mainly due to chronic diseases, accidents, and hostilities’ casualties. The prosthetic foot type is traditionally classified according to the number of axial rotational movements, and is recently classified according to the energy activeness of the foot. The localization of this industry needs a preliminary survey of the domestic technological levels with respect to the foot type. Upon the results of this survey, the energy storage response foot has appealing metrics to proceed with its manufacturing. A prototype manufacturing chain is designed and a set of these feet with a certain commercial size of 27 is manufactured. Resin impregnation technology for carbon fiber composites is followed in this work. The feet are tested according to ISO 22,675. Based on the dimensional and mechanical results, a manufacturing value chain is proposed with the prospective resin transfer molding technology. This value chain will guarantee the required localization as well as the natural growth of this value chain with all related activities like accreditation of practices as well as manpower certification

Soluble and membranous endothelial protein C receptor in systemic lupus erythematosus patients: Relation to nephritis

Aim of the work: To investigate the role of endothelial protein C receptor (EPCR) (membrane and soluble forms) as a biomarker of lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients and to study its relation to the prognosis and response to treatment. Patients and methods: The study included 30 SLE patients and 30 matched healthy volunteers as well as 10 renal biopsies from surgical nephrectomy as a control for membranous (mEPCR) examination. SLE disease activity index-2000 and damage index were assessed. Serum sEPCR was measured. Renal expression of mEPCR was analyzed. All patients were reassessed after 3 months. Results: Patients were 26 females and 4 males with a mean age of 29.6 ± 10.04 years and disease duration of 4.4 ± 3.5 years. Their mean SLEDAI was 13.9 ± 9.9 and damage index 1 ± 1.5. Serum levels of sEPCR were significantly higher in patients with LN (19.9 ± 5.7 ng/ml) than those without (8.95 ± 4.2 ng/ml) and controls (5.3 ± 2.6 ng/ml)(p < 0.001). SLE patients with cutaneous vasculitis (n = 9) had significantly higher sEPCR levels than those without (18.1 ± 7.8 vs 10.2 ± 5.2 ng/ml)(p = 0.02). There was a significant correlation between sEPCR percentage of change and of SLEDAI-2k with and without LN (p < 0.01 and p < 0.05). A significant difference was observed in sEPCR according to the prognosis and treatment response after 3 months. mEPCR stained positively in glomeruli and tubules of LN patients with no relation to histopathological grading. Conclusion: sEPCR plays a role in the pathogenesis, is related to a bad prognosis and poor response to treatment in LN. mEPCR was not related to LN grading. Keywords: Lupus nephritis, Systemic lupus erythematosus, Soluble and membranous EPCR, ELIS, AImmunohistochemistr