A retrospective study aimed to analyze our experience in 46 patients with blunt traumatic diaphragmatic rupture (BTDR) admitted to our tertiary hospital from 1995 to 2007. Charts, chest roentgenograms (CXR), and computed tomography (CT) scans were carefully reviewed. The mean age was 36.5+/-10.1 years, 36 (78.3%) were males. The etiology was a traffic accident in 36 (78.3%) patients. BTDR was left-sided in 34 (73.9%) and right-sided in 12 (26.1%) patients. CXR was diagnostic in 26 (56.5%) and CT in 12 (26.1%) patients. Associated injuries included lung 12 (26.1%), liver 10 (21.7%), spleen 24 (52.2%) and bowel 2 (4.2%) patients. BTDR was approached through thoracotomy 26 (56.5%), laparotomy 16 (34.8%), and combined approach 4 (8.7%) patients. The repair was primarily with interrupted non-absorbable sutures in 42 (91.3%) and by prosthetic mesh in four patients. Complications developed in 20 patients. Mortality was observed in 2 (4.3%) patients. We concluded that BTDR is a common lesion in young adult males on the left side caused by a traffic accident. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Associated injuries represent the main prognostic factor affecting morbidity and mortality. Thoracotomy and primary repair is adequate surgical treatment.

A comparison is made of the characteristics of female breast cancer patients, their diseases, and treatment practices in medical centers in Israel and the West Bank of the Jordan River. This experience is further compared with tumor registry data from a major medical center in the United States. Differences are found in the age distributions of patients, marital status, parity, stage of disease at diagnosis, delay between onset of symptoms and diagnosis as well as between diagnosis and treatment. Some of these observations reflect differences in population characteristics, sociocultural practices and local attitudes toward disease, its diagnosis and management.

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This paper describes the demographic experience on 373 young cancer patients (less than 20 years of age) at two oncology centers initiated in Israel by one medical team in 1975-1977. These units are the Assaf Harofeh Medical Center (AHMC), which predominantly serves a Jewish population (103 cases); and the West Bank Cancer Unit (WBCU), which provides similar care services to the Arab population of the West Bank (270 cases). The two centers have the unique feature of serving two populations residing in close relationship but still differing in many cultural and socioeconomic characteristics. The Arab patients at WBCU tended to be younger than the Jewish children at AHMC. The five most common diagnostic sites for both AHMC and WBCU included hematopoietic system, bones and joints, soft tissue, urinary tract, and brain and nervous system, although not in the same order of occurrence. These tumor sites accounted for approximately 80% of the cases at each center. The experience with WBCU patients was also compared with data for all Jews in Israel. This comparison identified for both sexes combined statistically significant differences in relative frequency of tumors of soft tissue, eye and orbit, brain and nervous system, and thyroid gland. If confirmed by additional data, reasons for the suggested excess risks should be pursued through more definitive epidemiological studies.

Background and Aims Renal biopsy is the “gold standard” for diagnosis of lupus nephritis (LN). It is necessary for classification and is the basis for treatment strategy decisions. This study was carried out in order to analyse the results of renal biopsy in LN patients, its effect on treatment and predictors for remission in an Egyptian cohort. Method The results of renal biopsies of LN patients undergoing regular follow up in the outpatient clinic of Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Egypt in the period between October 2017 and September 2019 were reviewed. The histopathological data were analyzed and correlated to the clinical data of the study group. Results A total of 100 LN patients with documented renal biopsy were enrolled in this study. The median age of the patients was 29 years. Most of the patients were females (n=89). Serum creatinine at presentation ranged from 0.57 to 13.5 mg/dl (median 1.3 mg/dl). Class IV (diffuse proliferative) LN was the most frequently encountered class, followed by Classes III, V, II and VI respectively, while class I was detected in only one patient. In proliferative classes (III and IV), the total score of activity indices, ranged from 0 to 16 (minimum–maximum). Mesangial hypercellularity was the most frequent encountered active lesions. Total score of chronicity indices ranged from 0 to 10 (minimum-maximum). Interstitial fibrosis was the most frequent chronicity index. Remission was achieved in 73 patients. Patients who achieved remission had lower serum creatinine and lower pathological chronicity score. In a multivariate logistic regression analysis, serum creatinine at presentation was the strongest predictor for renal remission in this cohort and chronicity index was the strongest predictor in proliferative classes (III and IV). Receiver operating characteristic curve (ROC curve) was done to identify the cutoff point of serum creatinine which can indicate the probability of renal recovery in proliferative and non-proliferative classes (n=100) and in proliferative classes only (n=73). A serum creatinine value of 1.65 mg/dl or less identifies the probability of renal recovery with 76% sensitivity and 71% specificity in proliferative and non-proliferative classes . A chronicity index value of 6 or less identifies the probability of renal recovery with 93% sensitivity and 58% specificity. Conclusion Renal biopsy is a must in LN to guide treatment and prognosis. In this Egyptian cohort, serum creatinine at presentation and pathological chronicity index score are the strongest predictors of renal response in LN patients.

Background and Aims Lupus nephritis (LN) is a common complication of systemic lupus erythematosus (SLE) that is associated with poor prognosis. The current available urinary biomarkers are neither sensitive nor specific for diagnosing LN. This study was undertaken to investigate whether urinary hepcidin represents a marker of nephritis in SLE patients. Method A cross-sectional study was conducted with 3 study groups compromising 30 patients with biopsy proven LN, 30 patients with non-nephritis SLE and 20 healthy control. Spot urinary samples were collected from all participants and the levels of hepcidin in urine were measured by ELISA, 24 h urinary proteins, urinary and serum creatinine were measured. Results Urinary hepcidin was significantly higher in LN patients than in non-nephritis SLE and control (470, 258, 43.0 ng/mg creatinine respectively) (P < 0.001) as shown in figure 1. Urinary hepcidin was significantly correlated with serum creatinine (P 0.017) and 24 hours urinary proteins (P 0.003). ROC curve cut-off values of urinary hepcidin were 4.3000, Area under curve (AUC) of hepcidin was 0.553, with sensitivity (SN) of 63.3%, specificity (SP) of 60%, Positive predictive value (PPV) 70.4, negative predictive value (NPV) 52.2 in SLE patients as shown in table 1 and figure 2. Conclusion Although urinary hepcidin level was significantly higher in LN patients than in non-nephritis SLE and control, it failed to discriminate patients with LN from those without. Further studies are still needed before considering urinary hepcidin as a non-invasive diagnostic marker of LN.