This was a controlled prospective study on the use of an immunomodulator drug, levamisole, in the treatment of frequently relapsing, steroid-dependent (FR/SD) idiopathic nephrotic syndrome. The study was started on 1 January 2001 and completed on 31 December 2003. There were two groups: a treatment group who received levamisole (2.5 mg/kg) on alternate days for 1 year and a control group who received low-dose prednisolone only (<0.5 mg/kg) on alternate days for 1 year. There were a total of 56 patients (32 in the treatment group and 24 in the control group). The male to female ratio was 1.66:1 in both groups. The mean age upon initial diagnosis was 3.3 years in the levamisole group versus 4.3 years in the control group. The mean duration from diagnosis to the start of the second line treatment was 3.2 years in the levamisole group versus 2.8 years in the control group. The relapse rate and the total cumulative dose of prednisolone during the year prior to second line therapy was compared to that during the year following the institution of second line therapy in 56 patients. The mean relapse rate was reduced more significantly in the levamisole group. It was reduced by 0.29 versus 0.11 relapses/patient/month in the control group (P =0.0001). The mean cumulative dose of steroids was also reduced more significantly in the levamisole group. It was reduced by 293 versus 102 mg/m(2)/month in the control group (P <0.0001). Therapy failure was seen in 3/32 (9.4%) in the levamisole group versus 12/24 (50%) in the control group. Of the patients, 20/32 (62.5%) using levamisole were relapse-free in the follow-up year post therapy, while no patient was relapse-free in the control group over the same period. No major adverse effects of levamisole were seen. The cost of levamisole therapy was estimated to be US$ 25 per year for a 20-kg body weight child. Thus, we concluded that levamisole is a highly efficacious, safe and easily affordable initial therapy for FR/SD idiopathic nephrotic syndrome.

Orientation to paraphenylenediamine (PPD) acute systemic intoxication in Egypt has been increased over the last decade. The aim of this study was to provide more insight into the clinical profile of acute PPD intoxication with reviewing the possible underlying mechanisms. Our study was retrospective. It was conducted over 7 years (2001-2008) on 25 cases with acute PPD intoxication admitted to the Poison Control Center Ain Shams University Hospitals, Cairo, Egypt. The mean age of the cases was 35.34 +/- 10.5 years; the male to female ratio was 18:7. Cervicofacial and laryngeal edema was the dominating presenting manifestation in 72% of the cases, 100% of the cases developed rhabdomyolysis, 80% had impaired renal functions, elevated liver transaminases were detected in 76% of cases, 75% showed hyperkalemia and 16% died due to ventricular arrhythmia. In conclusion, PPD causes serious multisystem toxicity and its selling to the public should be officially restricted.

Objectives: Toxin-related ALI (Acute lung injury) and/or ARDS (Acute respiratory distress syndrome) is challenging to critical care physicians. This study aimed at evaluation of clinical scores, pentraxin-3 (PTX3) and C-reactive protein (CRP) as predictors of severity and outcome in toxinrelated ALI/ARDS in 50 acutely intoxicated patients. Material and Method: Laboratory variables were assessed on day1, day 2, day3 and endpoint. Clinical data were employed in the calculation of APACHE II score, Lung Injury score (LIS), Sequential Organ Failure Assessment (SOFA) score. Results: Several variables were associated with poor outcome in the poisoned ARDS patients like prolonged ICU stay, prolonged duration of mechanical ventilation, low PO2/FiO2 and SO2/FiO2 ratios, high APACHE II, SOFA and lung injury scores on the 1 st day, elevated plasma PTX3 levels on the 1 st day, and elevated serum CRP levels after 24 hours of admission. APACHE II score surpassed other scores as an excellent predictor of outcome within the 1 st 24 hours of admission. PTX3 represented an early marker of severity, and its levels correlated with parameters of lung injury, systemic organ failure and outcome. Conclusion: Early combination of plasma PTX3 and predictive scores could help in identifying patients at risk of severe fatal toxinrelated ARDS.

Background type 2 diabetes mellitus (T2DM) is a known risk factor of coronary artery disease (CAD). Cardiovascular disease is the leading cause of death in T2DM patients. Antecedent to and associated with epicardial coronary artery stenosis, T2DM patients develop abnormal microvascular function in systemic circulatory beds. Glycosylated hemoglobin (HgbA1c) has been established as a risk factor for T2DM patients developing microvascular atherosclerosis. Aim of the Work the Effect of Glycosylated Hemoglobin Control on Post-Operative Coronary Artery Bypass Graft Surgery Outcomes this is widely across studies and patient populations, and this heterogeneity must be controlled when using the literature to indicate safety. Patients and Methods this study was performed on 60 patients, who underwent CABG at Cardiothoracic Academy from January 2018 to August 2018. Retrospective Descriptive Observational Study. Cardiothoracic Academy, Ain Shams University Hospitals. Study Period: 6 Months. This study included all patients operated upon for CABG in our hospital and who fulfilled our inclusion and exclusion criteria. Results preoperative HbA1c is not the only predictor of surgical site infection after cardiac surgery in diabetic patients and in patients with previously undiagnosed diabetes. Baseline HbA1c 8.6 was associated with the higher risk of chest wound infection. Interestingly, in this series. Conclusion this study shows that the incidence of chest and leg wound infections are significantly related to the value of the glycosylated hemoglobin and rate of infection increases with poor control of diabetes and from this study we recommend measurement of glycosylated hemoglobin value for all patient undergoing cardiac surgery.